Sleep Apnea

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Do you often find yourself struggling to get a good night's sleep without pauses in your sleep? A lot of people experience from breathing pauses or shallow breaths multiple times during sleep, called Sleep Apnea - a chronic sleep disorder. Sleep apnea is almost twice as common in men as it is in women.

With Sleep Apnea, you will experience breathing pauses that can last from a few seconds to minutes and may occur more than five times an hour to 100 times per hour. The most common type of sleep apnea is Obstructive Sleep Apnea which is caused by a blockage of the airway, when your throat muscles intermittently relax and block your airway during sleep.

Central Sleep Apnea, is a less common form of apnea which causes an individual to stop breathing during sleep for a period of 10 seconds or more before restarting again. This happens when the brain fails to send signals to the diaphragm to breathe.

One may be unaware of apnea events since they happen while you are asleep. When breathing pauses, we partially wake up from sleep due to which sleep is interrupted, and we may often feel tired and irritable the next day.

According to NIH's National centre on Sleep Disorders Research, sleep apnea may lead to poor sleep quality resulting in serious health issues like increased risk for high blood pressure, heart attacks, heart failure, stroke, obesity, and diabetes.

Common Treatment Options for Sleep Apnea include:

  • Lifestyle Changes
  • Medication
  • Positive Airway Pressure (PAP DEVICES)
  • Oral appliance therapy
  • Surgery

Devices Used For Treating Sleep Apnea

  1. Positive Airway Pressure Devices (PAP Devices)

    Positive airway pressure (PAP) machines are the most widely used treatment for moderate and severe sleep apnea. These are non-invasive form of treatment for sleep apnea that delivers pressurized air, via a mask, to keep the airways free from obstructions as you sleep. These are used with a variety of breathing masks which are worn tightly over the nose, or at times nose and mouth.

    During sleep, these masks supplies pressurized air that flows continuously or intermittently into the throat. The increased air pressure prevents the person's airway from collapsing. The pressurized air is supplied through a flexible tube from one of several types of machines:

  2. CPAP (Continuous Positive Airway Pressure)

    CPAP machines are most common treatment options for obstructive sleep apnea. These devices deliver steady, constant stream of pressurized air into the patient airways to prevent them from collapsing and causing apnea events. CPAP machines can be set only to a single pressure that remains consistent all through the night.

    However, many CPAP machines are also equipped with a ramp feature that begin with a lower pressure setting and steadily builds to the prescribed pressure.

    One disadvantage with CPAP machines is that, some patients find it difficult to exhale against the constant singular pressure. In patients with higher pressure strengths, exhaling against the incoming air can feel difficult, as if they have to force their breathing out.

    BiPAP (Bilevel Positive Airway Pressure): Also referred as Variable Positive Airway Pressure (VPAP). These devices are newer type that lowers the amount of pressure when a person breathes out. The device uses an electronic circuit to monitor the person's breathing.

    Having less pressure when a person is exhaling may make it more comfortable for the person with sleep apnea. This type of machine is often used for people who have other breathing problems or who can't sleep if they have to breathe out against a stream of air.

    Advantage of using BiPAP over the CPAP machines, is the dual pressure setting feature. The BiPAP devices have the option of setting two pressures one for the prescribed pressure for inhalation (ipap), and the other for the lower pressure for exhalation (epap). This dual setting option allows the patient to get more air in and out of their lungs.

    BiPAPs are frequently used if CPAP machines device is ineffective to treat certain patients. These devices are most often prescribed for:

    • Sleep apnea patients with high pressure settings or low oxygen levels,
    • People with lung disorders or certain neuromuscular disorders
    • Patients with cardiopulmonary disorders such as congestive heart failure
  3. Automatic Positive Airway Pressure (APAP):

    APAP devices works on the principle similar to CPAP machines. But, APAP devices are equipped with two settings, a low range setting and a high range setting, that the machine will fluctuate throughout the night. As the device constantly monitors a person's breathing it automatically adjusts itself to suit your particular needs at any given moment throughout your sleep.

    This type of device constantly monitors a person's breathing and makes adjustments. These devices have pressure sensors and a computer to monitor. APAP devices use algorithms to sense slight changes in breathing and adjust itself to the best pressure setting at any time of the night.

    Disadvantages associated with the use of APAP are:

    • The algorithms used in the APAP devices varies from one manufacturer to another which may make prescribing the best machine for you, a little more difficult as APAPs are not as standardized as CPAP machines. However, an experienced sleep technician familiar with the various machines can help you to choose the best possible option.
    • At times the changes in pressure settings can be a little slow to react to the ideal pressure needs, especially during apnea events.
    • APAP machines generally cost more than CPAP machines.

    Studies on the effect of PAP therapy, show that people with sleep apnea who consistently use their machines feel better and, as a result of the reduction of apnea and hypopnea episodes during sleep, they encounter fewer complications of the disease.

    If your doctor recommends a positive airway pressure device, a technician will come to your home with the equipment. He or she will set it up and make adjustments as your doctor orders. Although PAP devices are not used to treat snoring alone, they do eliminate snoring in addition to treating obstructive sleep apnea.

Oral Appliances / Dental Appliances FOR SLEEP APNEA

Oral appliances (OA) are an alternative treatment for OSA. Use of oral appliances continue to increase in popularity as awareness grows amongst the people that oral appliances are an effective first line treatment for many sleep apnea sufferers. More than 100 different oral appliances are approved by FDA for treating snoring and sleep apnea problems.

Oral appliances are worn like a sports mouth guard or an orthodontic appliance during sleep. These appliances hold the lower jaw forward just enough to keep the airway open and prevent the tongue and muscles in the upper airway from collapsing and blocking the airway.

Oral appliance therapy (OAT) is approved as a first line treatment for patients with mild to moderate OSA by the American Academy of Sleep Medicine (AASM). AASM also recommended the use of these appliances for patients with severe OSA, who are unable to tolerate CPAP machines. The combination therapy with CPAP machines is one option for people with severe OSA. This combination strategy helps in reduction of the pressure on CPAP machine making it more comfortable to use.

The Two Most General Types Of Dental Devices Are:

  1. Mandibular (lower jaw) Advancing Devices (MADs): These devices look similar to sports mouthguards or orthodontic retainers. MADs work by pushing the lower jaw and tongue slightly forward, which helps prevent throat muscles from collapsing back into the airways allowing for normal breathing during sleep.
  2. Tongue Retaining Mouthpieces: These are similar in construction to the MAD, but has a small compartment that fits around the tongue using suction to keep it held forward, preventing it from collapsing back into the airway. These devices are mostly used in patients who cannot adequately have their jaw repositioned forward.

Advantages of Oral Appliance Therapy:

  • Comfortable and tolerable to wear as opposed to CPAP masks
  • Dryness, itching associated with PAP devices is not seen in patients using iral appliances.
  • Easy to wear and convenient while travelling.
  • Quiet, portable and easy to care for.

Disadvantages of Oral Appliance Therapy:

  • Jaw pain, soreness, or tension
  • Sore teeth and/or gums
  • Excessive salivation
  • May cause possible damage or permanent change to jaw position.
  • Loosening of dental restorations (crowns, bridges, etc)

Why BSR Hospital?

BSR ENT Hospital is an advanced ENT hospital with latest technologies in place, such as Sleep Laboratory, to study patients' sleeping disorders like Sleep Apnea. We are a team of experienced doctors providing full spectrum treatment services for ear, nose and throat disorders and surgeries that include the head and neck.

We are equipped to treat Sleep Apnea with therapies or surgeries that best address the patient's problems. From the initial fitting of devices to ongoing management of the device's performance, our specialists provide optimal, personalized care.

Have questions or need an appointment for any of your ENT problems ?

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