If you fall asleep reading this article, cut it out and see your doctor. Doing so may extend your life.
Approximately 50 million Americans of all ages suffer from sleep related problems. One of the more common disorders is obstructive sleep apnea. Obstructive sleep apnea (OSA) is a disease characterized by repetitive collapse of the airway while sleeping, closing off the airway and blocking airflow. Although the majority of people suffering with this problem are middle aged and overweight, anyone of any age may experience this problem. It is estimated that 2-3% of children suffer from OSA.
Although not everyone who snores suffers from OSA, most people who have OSA are impressive snorers. The snoring tends to get louder and more extreme until breathing stops completely for a short period. The individual will then usually recommence breathing with a loud start. Often times those who suffer from this disease experience serious social consequences of these obnoxious sleeping characteristics.
OSA occurs when affected individuals reach a deep enough level of sleep that the muscles in the airway relax. Sufferers have a combination of smaller than normal airway passages, abnormal anatomy of the airway, or excessive laxity in the muscles and other soft tissues surrounding the airway. The vibration of air passing through these tissues is what creates the loud snoring characteristic of victims of OSA.
When the airway relaxes enough, the opening shuts off completely and the passage of air is blocked. This causes the body to be deprived of oxygen. The body then emerges from the sleep state as a survival mechanism and breathing starts again. This cycle continues throughout the sleep period, creating a state of chronic oxygen deprivation and ineffective sleep.
The first symptoms the OSA sufferer usually notices are the result of sleep deprivation. Many individuals are not aware of the disturbances in their sleep patterns. They are however chronically fatigued and never feel well rested. They often have complaints such as depression, irritability, memory and learning difficulty, lack of concentration, sexual dysfunction and inability to stay awake while driving, reading, watching television, working, etc.
Individuals with OSA are at risk for numerous related medical complications including but not limited to depression, high blood pressure, cardiac arrhythmia and heart attack and stroke. OSA also has the potential to exacerbate other systemic illnesses such as diabetes, and affected individuals have even been shown to be at increased risk of death from various types of cancer. Various studies have shown individuals under fifty years of age with OSA to have a life expectancy that is reduced by 8 to 18 years.
Diagnosis of OSA usually starts with an evaluation from the primary care physician. Risk factors coupled with the patient’s history will often give the physician a high degree of suspicion leading toward the diagnosis. The primary care doctor will then typically refer the patient to a sleep center for a comprehensive evaluation. The sleep center is typically associated with a physician who specializes in the diagnosis and medical management of sleep disorders.
The major component of the sleep center evaluation is the sleep study. This study most frequently involves the patient actually sleeping in the center while the patient’s vital signs, brain activity, eye movement, oxygen levels and respiratory activity are monitored. This allows the sleep physician to diagnose the nature and severity of the patient’s sleep disorder. We are fortunate to have a state of the art sleep center right here in the Bitterroot Valley adjacent to Marcus Daly Memorial Hospital, the Marcus Daly Sleep Center.
The first line of management of OSA is to council the patient to reduce risk factors. The most common of these is weight reduction, and the elimination of depressants like alcohol that further suppress respirations during sleep. In situations where these are major contributors, compliance from the patient can dramatically improve symptoms of the disease.
Medical management of OSA most commonly begins with the use of a breathing assistance device called a CPAP, or continuous positive airway pressure device. This device consists of a mask over the patient’s nose that forces air into the patient’s airway during sleep. This is a very effective tool for managing OSA for those patients who can tolerate it.
Unfortunately, many patients are not able or willing to comply with use of the CPAP. For these individuals, surgery becomes the best option. There are many surgical procedures that have been utilized to help manage OSA, most of which are not reliable in curing the patient’s disease. There are currently two surgical procedures that are understood to be effective and even curative for OSA. These are tracheotomy, and bimaxillary advancement.
Tracheotomy is a procedure that involves completely bypassing the upper airway by making an opening in the trachea just above the sternum in the lower neck. This of course completely eliminates any of the obstruction concerns and is curative for OSA. As one might imagine however, this comes with the serious downside of living the rest of one’s life breathing through a hole in the neck. This procedure is rarely used.
Bimaxillary advancement is a procedure that involves moving the both the upper and lower jaws forward. Doing this also moves all of the soft tissues of the throat forward, thus making the airway much larger. Historically this procedure was also reserved for the most severe cases because it was a lengthy procedure requiring long hospital stays and long recuperation.
Our practice here in Western Montana is proud to be included among a small group of doctors nationally with a wide level of experience in this type of surgery who have developed improved techniques for this procedure. Using a combination of three dimensional computer assisted surgical planning, advanced surgical techniques, sophisticated anesthetic care, and stringent post-surgical care, most patients require only one nights stay after surgery. Most patients are back to work in one week.
If the description above sounds like your sleep experience, it is critical that you seek evaluation and treatment. If you already know you suffer with sleep apnea and would like to discuss your best options for surgical correction, we look forward to meeting you helping you and your loved ones enjoy a restful and healthy nights sleep.
Questions or comments can be addressed to John Holtzen, D.M.D, c/o Cosmetic Surgical Arts Centre, 1201 Westwood Drive, Suite A, Hamilton, MT 59840.