Obstructive Sleep Apnea (Osa): Causes And Treatment Options

Obstructive sleep apnea (OSA) is a sleep disorder that can be potentially serious. It’s characterized by repetitive nocturnal breathing cessation episodes because of upper airway collapse. It’s linked with a significant cardiovascular mortality and morbidity. Fortunately, there are numerous treatment options available for efficient management of OSA.

Sleep apnea types include:

• Obstructive sleep apnea: OSA is the most common sleep apnea type where your airway becomes blocked, narrow or floppy.

• Central sleep apnea: Your brain doesn’t send a message signaling your respiratory muscles to breathe.

• Mixed sleep apnea: A combination of OSA and central sleep apnea.

Causes of OSA

OSA happens when your back throat muscles become overly relaxed, not allowing for normal breathing. These throat muscles support certain structures like your:

• Uvula (triangular tissue that hangs from your soft palate)

• Soft palate (flexible, fleshy part toward the back of the roof of your mouth)

• Tongue

• Tonsils

When your muscles relax, your airway closes or narrows as you inhale and your breathing might be inadequate for around 10 to 20 seconds. This might lower your oxygen level in your blood causing a carbon dioxide buildup.

The brain senses the breathing impairment and awakens you briefly from sleep so you can reopen your airway. You will likely not remember this awakening since it’s so brief.

You might make a choking, snorting or gasping sound when you awaken as your breathing tries to correct itself. This pattern may go on repeatedly five to 30 times or more every hour during the entire night. These sleep disruptions keep you from being able to reach a deep, restful sleep, leaving you feeling sleepy the next day, sometimes to the point of having excessive daytime drowsiness.

Individuals with OSA might not realize their sleep is being interrupted. Most people with OSA believe they’ve slept peacefully all night long.

OSA Treatment Options

A sleep apnea diagnosis starts with a comprehensive history and physical exam by the doctor. They’ll note if you have a history of snoring or daytime drowsiness which are important clues. They’ll examine your neck and head to identify any physical factors linked with sleep apnea. They could have you fill out a questionnaire about your quality of sleep, daytime drowsiness, and sleep habits. They’ll likely order a sleep study test from an accredited sleep lab as well.

Lifestyle Changes

The possible OSA lifestyle treatment options include:

• Avoiding sleeping pills and alcohol: These make it more likely for your airway to collapse while you’re sleeping and lengthen the times where you’re not properly breathing.

• Losing weight loss: If it’s needed, even if you lose 10 percent of your weight, it could make a big difference.

• Using nasal sprays: If you have nasal congestion or sinus problems it can make breathing harder for you when you’re sleeping.

Positional Therapy

For some people, the position they sleep regularly can contribute or exasperate their sleep apnea symptoms. Positional therapy can be effective, particularly if you have one of the mild obstructive sleep apnea types when you sleep on your back. It can involve:

• Wearing a backpack at night to make it uncomfortable for you to sleep on your back.

• Sewing a tennis ball into a t-shirt to force you to sleep on your side.

• Wearing a Zzoma positional therapy belt to discourage back sleeping.

• Sleeping on an adjustable bed to deter you from sleeping on your back.

• Wearing a night shift device that vibrates when you turn onto your back.

Positive Airway Pressure Devices

If the above lifestyle changes don’t resolve your obstructive sleep apnea, you may require positive airway pressure (PAP) therapy. PAP machines used with various types of breathing masks are the most common treatment option for individuals with moderate to severe sleep apnea.

You wear the mask snugly over your nose or over both your mouth and nose while you sleep. The machine provides pressurized air that flows intermittently or continuously into your throat. The increased pressure of air keeps your airway from collapsing.

The air is delivered through a flexible tube from one of the various types of devices such as:

• CPAP machine: Continuous positive airway pressure

• BiPAP machine: Bilevel positive airway pressure

• VPAP machine: Variable positive airway pressure

• APAP machine: Automatic Positive Airway Pressure

Studies show individuals with sleep apnea who use their PAP therapy machines consistently feel better due to the reduction of hypopnea (abnormally shallow or slow breathing) and apnea episodes while sleeping.

While PAP machines aren’t used for treating snoring by itself, they do help eliminate the snoring along with treating OSA.

Oral Appliances

Oral appliances can help treat OSA and are gaining popularity as more and more people become aware of their effectiveness as a first line treatment for sleep apnea. More than a hundred types of oral appliances are approved by the FDA for treating OSA and snoring.

The American Academy of Sleep Medicine (AASM) approves of oral appliance therapy for patients as a first-line treatment for mild to moderate OSA. They also recommend oral appliances for individuals with severe OSA, who can’t tolerate and can’t wear CPAP devices. Oral appliances can also be combined with CPAP to help reduce the CPAP machine’s pressure, making the user more comfortable.

You wear the oral appliances in your mouth like you would an orthodontic appliance or sports mouth guard while you’re sleeping. They hold your lower jaw forward enough so your airway stays open, keeping your tongue and upper airway muscles from blocking or collapsing your airway. This enables proper blood oxygen and helping to provide you with a restful night’s sleep.

Surgery

Surgery is a treatment option for individuals who have misshapen or extra tissue blocking airflow through the nose and throat. For instance, a patient with a deviated nasal septum, small lower jaw or enlarged adenoids and tonsils causing the throat to become too narrow could benefit from surgery.

Types of Surgery

Different types of surgery include:

• Upper airway stimulator: This device has a small pulse generator the surgeon places in your upper chest under the skin. There’s a wire that leads to your lung which detects the natural pattern of your breathing. Another wire that leads up to your neck delivers mild stimulation to your nerves in charge of controlling airway muscles, keeping them open. The doctor can even program this device from a remote location.

• Somnoplasty: Radiofrequency energy is used by the doctor to tighten your soft palate at the back of your throat.

• Uvulopalatopharyngoplasty (UPPP or UP3): This is a procedure that eliminates the soft tissue in the back of your palate and throat, increasing your airway width at the opening of your throat.

• Mandibular/maxillary advancement surgery: Your doctor moves your facial bones and jaw bone forward to ensure there’s more room in the back of your throat. Doctors will typically only perform this procedure on individuals with severe sleep apnea and problems with their face and head.

• Nasal surgery: This procedure corrects nose obstructions like a deviated septum.

Always consult with your doctor if you’re consistently having troubles sleeping or are experiencing daytime drowsiness. There are numerous treatment options for OSA that can help manage your symptoms. Your doctor will tailor up a treatment plan that combines treatment and lifestyle changes.

Get Treated for Obstructive Sleep Apnea

If you would like an OSA treatment consultation with one of our dental sleep medicine experts, Steve Carstensen, DDS or Carrie Magnuson, DDS in the Bellevue or Seattle area, complete our online form to schedule an appointment or contact us here at Premier Sleep Associates today at (425) 698-1732.

Both Dr. Steve and Dr. Carrie are highly qualified sleep dentists who treat patients with sleep-related breathing disorders at Premier Sleep Associates, offering a wide selection of clinically validated and FDA-cleared sleep apnea and snoring appliances.