Sleep Apnea

Source: Adapted from Knowing Your Options: The Definitive Guide to Choosing The Medical Treatments, Reader’s

What is sleep apnea?

If you have sleep apnea, you’ll breathe normally during the day. It’s only at night, when you fall asleep, that your breathing stops—sometimes for 10 seconds, sometimes for a minute or more. You may snore loudly or even struggle for air when the level of oxygen in your blood starts to fall. In response, you wake only briefly—so briefly that you don’t remember it the next morning—then immediately fall back to sleep. This cycle can repeat itself many times a night (as frequently as 100 times an hour in some cases), preventing deep sleep and leaving you exhausted the next day.

The consequences go beyond a little fatigue. Those with sleep apnea are two to three times more likely to have car accidents than those who sleep normally. The buildup of carbon dioxide in your blood can put you at risk for high blood pressure and other health threats, including heart attack or stroke.

Who is at risk for sleep apnea?

The most common form of the disease, obstructive sleep apnea (OSA), occurs when tissues in the airway relax and “collapse” during sleep, blocking the flow of air. The seriously overweight are particularly prone to this condition, as are men and those over age 65. If you sleep on your back or are blood-related to someone with sleep apnea, you have an increased chance of developing it. Far fewer people have another form, called central sleep apnea (CSA). It has the same symptoms as OSA, but is thought to occur when the brain fails to send “breathing signals” to respiratory muscles.

Treatment for sleep apnea

Once you’ve answered a few questions, your doctor will have a good idea whether or not you have sleep apnea, but you’ll need a specialized test to determine which kind of apnea it is. The main test for sleep apnea, polysomnography, takes place in a sleep laboratory. For one or two nights, a technician monitors such things as your breathing pattern, oxygen levels, face and leg movements, and brain waves. These readings are studied to determine, scientifically, how well you’re sleeping.

If you’re like the vast majority of people with apnea, you probably have the obstructive form. While you might need surgery to remove air-blocking tissue from your airways, most likely you’ll be advised to make a few lifestyle changes and try a home device called a CPAP machine that makes it easier for air to get into your lungs.

Medications for sleep apnea

Only a few drugs relieve sleep apnea symptoms. Some can have serious side effects. Always use such medications under your doctor’s supervision.

• Protriptyline. This antidepressant (brand names Triptil, Vivactil) can increase tension in throat tissues and help keep them from sagging when you sleep. It also reduces the amount of rapid-eye movement (REM) sleep—the stage when most apnea episodes occur.
• Steroid nasal sprays. These are typically used for sinusitis, but can help reduce inflammation and congestion that may contribute to sleep apnea.
• OTC decongestants. Good for relieving snoring and minor breathing difficulties due to mucus-clogged sinuses, decongestants (Sudafed, Drixoral) should be used for only a few days at a time. Some brands contain antihistamines, which can have sedating properties, making breathing problems worse.

Lifestyle Changes

Nearly everyone with sleep apnea needs to lose weight. Studies show that the frequency of breathing interruptions increases 32% for every 10% you’re over your ideal weight. Looked at another way, losing just 10% of your weight could reduce sleep apnea episodes by 26%. You’ll also want to avoid alcoholic beverages and sedating medications (such as antihistamines or sleeping pills) in the evening. Both can relax your throat muscles and make them more likely to sag into your windpipe.

Another key suggestion for mild sleep apnea is to sleep on your side or stomach, not on your back. The reason is gravity: Sleeping on your back pulls on the upper part of your airway, encouraging the soft palate tissue to droop down and block air flow. One good way to stay on your side is to sew a tennis ball into a small pocket on the back of your pajamas or T-shirt. It will irritate you if you inadvertently roll onto your back.

Perhaps the most effective and widely used home treatment for obstructive apnea is an artificial breathing device called a CPAP machine (the letters stand for “continuous positive airway pressure”). Consisting of a bedside fan, connecting tube, and nasal mask (see illustration opposite), the device blows a steady stream of pressurized air into your nostrils. That helps keep your throat open during sleep. One key drawback is that you’ll have to use the device for life: Your sleep apnea will return as soon you stop. Regular CPAP users, however, report feeling much better, mainly because they’re less tired and in a better mood during the day. Partners are happy, too, because they get some sleep for a change.

Related Procedures for Sleep Apnea

Sometimes the CPAP machine, weight loss, or other lifestyle measures don’t eliminate the problem. You may be diagnosed with severe sleep apnea or have a cardiac condition or frequent respiratory distress. In such cases, your doctor might recommend surgery.

One of the most widely used procedures for treating sleep apnea is uvulopalatopharyngoplasty (UPPP). Despite its name, this is a fairly simple surgery in which tissue is removed from the uvula and other soft palate tissues at the back of your throat, including your tonsils, if you still have them. The goal is to widen your airway and reduce abnormal muscle movements that interfere with your breathing. While the procedure greatly reduces snoring, UPPP eliminates apnea in only about 50% of those who undergo it. A less invasive procedure is radiofrequency ablation, in which a surgeon uses radiowaves instead of a scalpel to destroy tissue at the base of your tongue. A number of treatment sessions are required, each taking about 20 minutes, for this procedure to work. Ablation is used only for mild obstructive apnea, but the success rate is high.

For many years, tracheostomy was the only treatment for sleep apnea. While nearly 100% successful, the procedure is recommended today only when apnea is life-threatening. It involves opening a permanent, quarter-sized hole in your windpipe and inserting a tube. The tube stays closed during waking hours so you can speak normally. You open it before bedtime, so air flows directly into your lungs, bypassing the obstructed airway.

Other types of surgery may be required if you have a deformity of your lower jaw or a nasal obstruction such as polyps or a deviated septum. If you are severely obese, your doctor may recommend gastric banding or bypass surgery to help you lose weight.

Alternative Therapies for Sleep Apnea

Recently more patients (and sometimes their physicians) have turned to herbs and other alternative treatments for relieving dozens of medical conditions—but sleep apnea isn’t one of them. The potential health risks from apnea are so serious, in fact, that doctors advise everyone to use only mainstream treatments.

Questions for Your Doctor

• Does my heavy-duty snoring mean I have sleep apnea?
• Will my apnea get worse if I ignore it?
• Is apnea the reason I can’t stay awake until the end of a movie, or could I have another problem?

Living with Sleep Apnea

• If you’re living with sleep apnea, here are a few quick tips to help you take control:
• Elevate the head of your bed four to six inches using bricks or fat books. Doing so helps prevent heartburn, a common apnea trigger.
• Get hay fever under control, either by avoiding allergens or using nonsedating antihistamines to reduce congestion. Allergy symptoms often cause an increase in apnea and snoring.
• Avoid a heavy meal near bedtime. It can make breathing problems worse.
• Watch out for LAUP. Often recommended to decrease snoring, laser-assisted uvulopalatoplasty (LAUP) uses a laser device to eliminate tissue in the back of your throat. While it does work for snoring, LAUP does not eliminate sleep apnea. Since your snoring is gone after the procedure, you may not realize that you have apnea. This could be life-threatening for some, so ask your doctor whether you need an apnea test.