Does your bed partner complain that you snore loudly? Do you suffer from
daytime sleepiness even after a full night’s sleep? These are the
warning signs of sleep apnea — a medical condition that causes you
to repeatedly stop breathing for brief moments during sleep. If left untreated,
sleep apnea increases your risk for a number of serious conditions, including
high blood pressure, coronary artery disease, stroke, heart failure, irregular
heartbeat, dementia and type 2 diabetes.
Fortunately, sleep apnea is easily diagnosed, and there are a variety of
effective treatments that will help you restore a restful night’s sleep.
During an online health lecture,
Anthony Barber, DO, a fellowship-trained and board-certified sleep medicine specialist at
Colorado Sleep Institute, discussed the symptoms, health risks, diagnostic
tools and treatments for this serious condition.
What Is Sleep Apnea?
“Sleep apnea occurs when muscles at the back of the throat, mainly
the tongue or the soft palate, collapse while you’re sleeping,”
said Dr. Barber. “When we sleep at night, those muscles relax and
lose tone. If your airway doesn’t have a lot of room when the muscles
collapse, the airway becomes closed and you experience sleep apnea.”
There are several different ways this can occur:
- Partial collapse – The back throat is partially closed, causing a
period of shallow breathing
- Complete collapse – The back of the throat completely closes and
causes breathing to stop entirely
Dr. Barber explained that both of these issues can cause your oxygen levels
to drop and your CO2 levels to rise. “That ends up causing your
brain to wake up for a second or two to reopen that airway and put tone
back into those muscles. Then you go right back to sleep,” he said.
In addition, Dr. Barber stated that if this occurs frequently enough,
it can disrupt your sleep cycle, resulting in both next-day neurocognitive
impairment and an increase in stress on the body.
VIDEO ALERT: Watch Dr. Barber’s lecture on sleep apnea in our
Common Signs and Symptoms of Sleep Apnea
Snoring is the most common symptom of sleep apnea. “Snoring occurs
when that back portion of the throat becomes narrowed and you get a wind
tunnel effect. You’re forcing a ton of air down through that tight,
narrow space and it creates a chaotic airflow pattern. If that chaotic
airflow pattern starts rattling your soft palate, that’s where the
sound of a snore comes from,” Dr. Barber explained.
Other symptoms of sleep apnea include:
- Periodic gasping or snorting noises, during which sleep is momentarily
interrupted (commonly witnessed by your bed partner)
- Waking up with your heart racing
- Waking up sweating
- Excessive daytime sleepiness
- Morning headaches
- Memory and concentration issues
- ADHD (commonly experienced in children with sleep apnea)
- Frequent urination at night
Diagnosing Sleep Apnea
Dr. Barber explained that the first option for diagnosing the condition
is to administer a home sleep apnea test. “It’s a basic diagnostic
test that is measuring your breathing and your oxygen levels. It has a
very good positive predictive value, so if you’re diagnosed with
sleep apnea on a home test, you have the condition. However, if you get
a normal score on the test, it does not mean you don’t have sleep
apnea. This is because the home diagnostic test has a very high false
negative rate, upwards of 24 percent.”
Another diagnostic tool is the polysomnogram. Dr. Barber considers this
to be the gold standard way to diagnose sleep apnea. It records your brain
waves, oxygen levels in your blood, heart rate, breathing and eye movements
while you sleep. According to Dr. Barber, a polysomnogram is the only
way to conclusively rule out sleep apnea.
Treatment Options for Sleep Apnea
Dr. Barber discussed the most common treatments for sleep apnea:
CPAP (continuous positive airway pressure) – Air pressure is delivered via a mask. This helps keep your airspace
open during sleep. Dr. Barber considers this to be the gold standard of
sleep apnea treatment because it works well and there are relatively no
Oral appliance therapy – According to Dr. Barber, this the best alternative to a CPAP machine
for mild to moderate cases of sleep apnea. Oral appliance devices pull
your jaw slightly forward to increase space at the back of the throat
and prevent the collapse of the jaw. It also will increase the muscle
tone in the tongue to prevent the collapse of your airway.
Hypoglossal nerve stimulation “INSPIRE” device – Dr. Barber referred to this treatment option as “the new
kid on the block.” A pacemaker-like battery device gets implanted
under the right side of the chest wall. It is timed with your breathing
in order to send a stimulus to the nerve controlling your tongue. This
forces your tongue forward, which helps open up the back of the throat.
This treatment is effective for patients with moderate to severe sleep apnea.
Nasal reconstruction surgery – This can be used for mild cases of sleep apnea. Dr. Barber only
recommends this option when nasal breathing is a problem during the day.
Tonsillectomy and adenoidectomy – This is a common first-treatment option for children diagnosed
with sleep apnea.
Uvulo/palatal pharyngoplasty (UPPP) – The soft palate is cut out to widen the back of the throat. Dr.
Barber said this treatment isn’t performed very often since it is
only 40 to 50 percent effective.
Maxillofacial surgery – This procedure involves breaking the lower jaw in order to pull
the lower and/or upper jaw forward. This helps to physically increase
the size in the back of the throat.
In addition, Dr. Barber recommends weight loss as part of sleep apnea treatment
for overweight or obese patients. “Weight loss can help improve
your sleep apnea symptoms, but it doesn’t always get rid of the
condition,” he said.
Another lifestyle treatment that can help improve sleep apnea is positional
therapy. This involves wearing a device to prevent you from sleeping on
your back. “Being on your back is typically the worst position for
sleep apnea. Some folks only have sleep apnea when they’re on their
back and, if they’re on their side, they’re fine,” Dr.
To make an appointment with
Anthony Barber, DO,
Click here to view a PDF of slides from the lecture.
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