Are you falling asleep driving or sitting in the movie theater. Are you irritable, lack energy at work, job performance is depleted, and you feel somewhat depressed. You may be suffering from sleep apnea. People with obstructive sleep apnea (OSA) have disrupted sleep and low blood oxygen levels.
When obstructive sleep apnea occurs, the tongue is sucked against the back of the throat. This blocks the upper airway and airflow stops. When the oxygen level in the brain becomes low enough, the sleeper partially awakens, the obstruction in the throat clears, and the flow of air starts again, usually with a loud gasp.
Repeated cycles of decreased oxygenation lead to very serious cardiovascular problems. Additionally, these individuals suffer from excessive daytime sleepiness, depression, and loss of concentration, diabetes, high blood pressure, obesity, and development of an enlarged neck.
Some patients have obstructions that are less severe called Upper Airway Resistance Syndrome (UARS). In either case, the individuals suffer many of the same symptoms.
The first step in treatment resides in recognition of the symptoms and being referred to a physician specializing in sleep disorders to have a consultation and detailed evaluation.
In addition to a detailed history, the doctors will assess the anatomic relationships in the maxillofacial region. With various types of imaging (cephalometric – skull, MRI, CT) and sleep study tests, the doctors can understand the level and structure of obstructions. Sometimes a naso-pharyngeal exam is done with a flexible fiber-optic camera that will show obstructions that influence air flow. To confirm the amount of cardiovascular compromise and decreased oxygenation levels, a sleep study may be recommended to monitor an individual overnight.
There are several treatment options available. An initial treatment may consist of using a nasal CPAP machine that delivers pressurized oxygen through a nasal mask to limit obstruction at night. One of the surgical options is an uvulo-palato-pharyngo-plasty (UPPP), which is performed in the back of the soft palate and throat. A similar procedure is sometimes done with the assistance of a laser and is called a laser assisted uvulo-palato-plasty (LAUPP). In other cases, a radio-frequency probe is utilized to tighten the soft palate. These procedures usually performed under light IV sedation in the physician’s office. There are new technologies being developed currently. Your physician can assist you in deciding with OSA method is best for you.
For some patients who have mild apnea diagnosed by a sleep study, Drs. Mogelof are trained to provide an oral appliance that provides an improved jaw position to address snoring and mild sleep apnea.
In more complex cases, the bones of the upper and lower jaw may be repositioned to increase the size of the airway (orthognathic surgery). This procedure is done under general anesthesia and requires a one to two day overnight stay in the hospital.
OSA is a very serious condition that needs careful attention and treatment. Most major medical plans offer coverage for diagnosis and treatment.
Make it a point to discuss this important medical issue with us when you are in the office.