Sleep Apnea

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Sleep apnea is common in men but often undiagnosed. In fact, according to the World Health Organization, 1 in 4 men have some degree of sleep apnea. However, less than 1 in 4 of these men have been diagnosed. Sleep apnea deprives the brain of oxygen and has serious consequences.

 


 

What Is Sleep Apnea?

As you fall asleep, your breathing slows and your muscles relax, including the muscles in your throat. However, you must continue to inhale and exhale in order to stay alive. Unfortunately, when the muscles in your throat relax, they are no longer able to actively keep the airway open. If you have a narrow airway or excessive tissues in and around your throat (much more common in overweight, out-of-shape individuals), the tissues in your throat may interfere with or completely block air from moving through your airway. If the airway narrows but does not completely block airflow (as shown below), you will start to snore.

Snoring

If the airway becomes completely blocked, air movement ceases leading to a drop in blood oxygen level. Since your body needs oxygen, it wakes itself up to actively open the airway following each apnea episode. People can actually have hundreds of these episodes each night, without knowing it.  Nevertheless, sleep apnea will take a heavy toll on your body.

Sleep Apnea

While snoring by itself does not mean that you have sleep apnea, it is a common indicator of sleep apnea. And, sleep apnea can have serious consequences. Sleep apnea has been linked to decreased testosterone and growth hormone secretion.1-3 Even more importantly, sleep apnea can be life-threatening as the repeated drops in blood oxygen level can lead to high blood pressure, heart disease, and stroke among other problems.4

 

What to Look Out For

The most common predictors of sleep apnea are large body mass and older age. If you’re an overweight or obese man or if you snore loudly, stop breathing, or make choking sounds during sleep, consult a medical professional about screening for apnea.

Since it’s hard to know whether or not you stop breathing or make choking sounds during sleep, ask your partner to look out for these warning signs:

  • Loud snoring
  • Involuntary pauses in breathing during sleep
  • Choking sounds

If you don’t have someone to observe you during sleep but feel excessively tired or fall asleep easily during the day, consult a medical professional who can test you for sleep apnea.

 

Sleep Apnea Treatments

Mild Cases

Sleep apnea treatments for mild cases of sleep apnea include simple changes that can easily be made to stop the problem. These changes include the following:

  1. Sleeping on your side, which can help prevent the throat from collapsing and blocking your airway.
  2. Avoiding alcohol, sleeping pills, and sedatives that relax your muscles and contribute to the collapse of tissues in and around your throat.

 

Mild to Moderate Cases

For mild to moderate cases, apnea suffers can use an Oral Appliance Therapy (OAT). OAT uses a custom made mouthpiece to shift the lower jaw forward, further opening the airway and decreasing the chance for obstruction. The mouthpiece only needs to worn while sleeping.

 

Moderate to Severe Cases

Non-surgical Options

Sleep Apnea Treatments

Sleep apnea treatments for moderate to severe sleep apnea sufferers are more involved than those for other forms. Moderate to severe cases of sleep apnea typically require the use of a Continuous Positive Airway Pressure (CPAP) device. The CPAP supplies a positive flow of air through a facial mask or nasal tube, preventing airway obstruction. Keeping the airway open prevents episodes of oxygen deprivation thus eliminating nighttime awakenings and allowing you to get the restorative sleep you need.

While CPAP devices are effective, they are not for everyone. If you do not want to consider wearing a mask to bed or if you have tried and stopped, other options are available. Specifically, surgical options are available, although the procedures can be very invasive and their success rates are not always great. It is important to discuss the various surgical options with your physician to determine whether or not one of these options is right for you.

Surgical Options

The two most common types of surgical procedures for obstructive sleep apnea are uvulopalatopharyngoplasty (UPPP) and corrective jaw surgery.

  • Uvulopalatopharyngoplasty: UPPP is a procedure to remove soft tissue in the throat. UPPP as a stand alone surgery generally produces somewhat disappointing results. It is generally effective in only 40-60% of cases.5 The reason for this lower rate of success is that sleep apnea is usually caused by multiple sites of airway obstruction such as the nasal cavity and base of the tongue. Therefore, soft tissue surgery to correct sleep apnea now usually combines UPPP along with tongue advancement and surgery for nasal obstruction correction based on the patient anatomical abnormalities. The poor results of UPPP also lead to the establishment of a staging system for ideal patient selection. The staging system is based on palate position, tonsil size, and body mass index. The best-qualified candidates’ success rates approach 80%.6,7
  • Sleep Apnea Treatments 1Jaw surgery: Jaw surgery aka maxillomandibular advancement (MMA) is a procedure to move the upper or lower jaw forward to enlarge the upper airway. This is basically a permanent form of the Oral Appliance Therapy. Maxillomandibular advancement is considered the most effective surgery for curing sleep apnea because it permanently increases the airway space.8 Success rates are regularly better than surgeries to remove soft tissue in the throat like UPPP. Unfortunately, the surgery itself is highly invasive and the full recovery time can be up 4-6 weeks long.

 

A Special Note: Sleep apnea is a serious health problem. Please use this section to gain a basic understanding of treatment options, but consult a sleep specialist and/or surgeon to hear about all available options.

EMG’s Sleep Homepage: Importance of Sleep

External Resources:

Updated: April 10th, 2015

 


1. Morgenthaler TI, Kagramanov V, Hanak V, Decker PA. Complex sleep apnea syndrome: is it a unique clinical syndrome? Sleep. Sep 2006; 29 (9): 1203-1209.

2. Luboshitzky R, Lavie L, Shen-Orr Z, Herer P. Altered luteinizing hormone and testosterone secretion in middle-aged obese men with obstructive sleep apnea. Obes Res. Apr 2005; 13 (4): 780-786.

3. Gianotti L, Pivetti S, Lanfranco F, et al. Concomitant impairment of growth hormone secretion and peripheral sensitivity in obese patients with obstructive sleep apnea syndrome. J Clin Endocrinol Metab. Nov 2002; 87 (11): 5052-5057.

4. LJ E. Harvard Medical School Guide to a Good Night’s Sleep. New York, NY: McGraw-Hill; 2007.

5. Sher AE, Schechtman KB, Piccirillo JF. The efficacy of surgical modifications of the upper airway in adults with obstructive sleep apnea syndrome. Sleep. Feb 1996; 19 (2): 156-177.

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7. Friedman M, Ibrahim H, Bass L. Clinical staging for sleep-disordered breathing. Otolaryngol Head Neck Surg. Jul 2002; 127 (1): 13-21.

8. Prinsell JR. Maxillomandibular advancement surgery for obstructive sleep apnea syndrome. J Am Dent Assoc. Nov 2002; 133 (11) : 1489-1497.