What is Sleep Apnea?
As the name implies, this condition happens during sleep. Apnea refers to the cessation of breathing. So the individual literally stops breathing during his sleep. The sleep apnea must be at least 10s in duration for it to be considered. Most time the individual suffering this does not realise the condition. It is usually brought to their attention by their sleeping partner or if they have loud snoring.
Sleep Apnea can affect both adults and children.
Types of Sleep Apnea
There are 2 types of sleep apnea. The Obstructive Sleep Apnea and the Central Sleep Apnea. The Etiology is very different for the two and a sleep apnea specialist will be able to differentiate the two and advise on appropriate sleep apnea treatment.
9 of 10 individuals with sleep apnea has obstructive sleep apnea (OSA). OSA occurs when there is a blockage or a narrowing in the upper airway reducing the airflow. In an attempt to overcome the narrowing, air is forced pass the obstruction resulting in a turbulent airflow which we interpret as snoring. The narrower the passage the louder the snoring. Hence snoring can indicate an underlying sleep apnea. When air cannot find its way pass the obstruction, apnea takes place. This is the silent aspect of the sleep and has been described as choking during sleep. It can be frightening to the observer or the individual if he wakes up during this episode.
Central Sleep Apnea takes place when the sleep centre in the brain stops sending signal for the body to sleep. It is due to lack of effort to breath vs that of OSA where the individual makes an attempt to breathe but is unable to fore air into the airway.
Who are the Sleep Apnea Specialists?
Sleep Apnea Treatment is usually prescribed by 2 main group of physicians. They are the ENT specialists and the Respiratory physician with an interest in sleep. The ENT specialist looks after the upper airway and hence has the expertise as a sleep apnea specialist to deal with sleep apnea treatment involving OSA. The central sleep apnea is mainly looked after by the sleep physician.
What are the Sleep Apnea Symptoms?
Most will present at the sleep apnea specialist with loud or heroic snoring. They are usually brought in by the partners or family.
The other symptoms in the night include choking or gasping during sleep. Frequent wakefulness and restless sleep. Frequent urination can also be a symptoms.
In the daytime, there can be daytime sleepiness, poor concentration, poor memory, morning headaches, irritability and mood changes.
In children, poor academic performance may be a result.
Medical Complications from untreated Sleep Apnea
Sleep Apnea patients are at increased risk of
- High Blood Pressure
- Heart Diseases
Increased risk of sudden death
These conditions are potentially preventable if one seek sleep apnea treatment early with a sleep apnea specialist.
Diagnosis of Sleep Apnea
After a detailed interview, the sleep apnea specialist will perform a video nasendoscopy to determine if there are obstructions in the upper airway. The mouth, neck and position the jaw are also examined. Allergy test can be performed when indicated.
Sleep study is the definitive way to objectively determine if someone has sleep apnea. The Sleep Apnea Specialist will organise the sleep study for you. There are 2 types of sleep study. The ambulatory sleep study can be performed at home whilst the polysomnography is performed at the hospital or special facility with overnight monitoring. The sleep study results will guide sleep apnea treatment.
Sleep Apnea Treatment
After reviewing all the results, the sleep apnea specialist may prescribe some of the following sleep apnea treatment. This include
Life style Modification in Sleep Apnea Treatment
Most sleep apneic patients may higher than the recommended BMI. Weight management can decrease sleep apnea. Together with regular exercise, reducing alcohol intake and smoking they form an integral part of sleep apnea treatment.
Medication in Sleep Apnea Treatment
Medication such as antihistamine and nasal spray forms part of sleep apnea treatment in patient that has allergic rhinitis. Other forms of medication tends not to be so helpful in sleep apnea treatment.
In suitable patient, the sleep apnea specialist may recommend CPAP and dental appliances in sleep apnea treatment. The CPAP treatment involve the wearing of a mask over the nose and mouth area to forms a seal. The machine detects if the individual is having an apiece spell. If that happens, the pressure in the tubing increases to keep the upper airway open. Individuals that have severe structural nasal obstruction and allergic rhinitis may not be able to adapt to this form of sleep apnea treatment.
Dental Appliances in sleep apnea treatment are placed in the mouth to push mandible forward to open up the oral airway at the level of the tongue. This is worn during sleep.
Both the CPAP and oral appliances require a period of usage before one is comfortable with the devices in sleep apnea treatment.
The sleep apnea specialist may recommend surgical procedures for certain individuals that have tried the above conservatives sleep apnea treatment and who are unable to tolerate or gain sufficient improvement.
Surgery in sleep apnea treatment targets the narrowed passages in the air way. It can be minimally invasive like turbinate reduction, palatal stiffening, uvulectomy to more extensive procedure in the palate, septum, tonsil and tongue base. In general, the sleep apnea specialist would be able to judge which procedures are suitable. The different areas of narrowing can typically be addressed in one surgery.
In children, the typical cause is enlarged tonsils, adenoids and turbinates. Sleep apnea treatment therefore involve in the removal of these structures or shrinking the turbinates will improve the condition and can be curative.
Snoring is a common symptom. Most of us do not pay attention to it until it disturb our sleeping partner or family. Loud snoring may actually indicate a more sinister condition called sleep apnea where we actually stop breathing many times during our sleep. This can lead to medical issues like high blood pressure, heart disease, diabetes, stoke and even sudden death.
Our ENT specialist Dr YT Pang is also a “Snoring Doctor”. He consults with patient with loud snoring who either come in voluntarily or is persuaded by their sleep partner or family because they want them to stop snoring.
As a Snoring Doctor and an ENT specialist, Dr YT Pang has great experience dealing with ENT Snoring issues. While the initial presentation is snoring, the snoring doctor will probe into the state of the nose, the throat, allergy issues, sleeping position etc. Only by understanding these factors can the snoring doctor give a holistic assessment and recommendation of treatment to stop snoring.
What are the causes of Snoring?
Snoring is caused by interruption or obstruction of the airway during sleep. This create a situation when one will have to increase the airway pressure to bring air into the lungs. This sets up vibrations in the soft tissues of the nose, palate, mouth and pharynx. These vibrations is the snoring that we hear. To stop snoring, the snoring doctor needs to identify the causes of the blockage. This brings his skills and training as an ENT doctor into play. ENT snoring is therefore closely intertwined.
How do we stop snoring?
The airway starts from the nostril, spans the nasal passages, passing through the postnasal space, partially interrupted by the palate, tonsil and the base of tongue before entering the larynx and into our lungs. This area of the airway is dynamically changing with each breath and position. Any of these area can therefore disrupt breathing and caused snoring. To stop snoring, the snoring doctor must identify the areas of obstruction.
At the initial consultation, the Snoring Doctor who is also an ENT specialist will take a detailed history. The history will look into your lifestyle, allergies, sleep hygiene, position of breathing, any ENT issues like sore throat, tonsillitis and mouth breathing. This is followed by a nasendoscopy which will look at the upper airway from the nose to the voice box. The mouth and jaw will also be examined. Allergy tests may be done to assess if allergy is a contributing factor.
Sleep study may be advised to determine if there is evidence of sleep apnea.
In general, ENT snoring can be treated in the following broad categories.
Lifestyle modification to Stop Snoring
A healthy lifestyle with low calorie diet for weight reduction, exercise and healthy diet is important. Alcohol and sedatives should be avoided.
Medication to Stop Snoring
is useful if there is allergies or infection. This will depend on the individual assessment.
CPAP machine to Stop Snoring
This is useful if the patient is found to have sleep apnea. This would require daily use of the CPAP machine during sleep.
Surgery to Stop Snoring
Surgery is useful if one can identify definite areas of narrowing such as a deviated nasal septum, hypertrophy of the turbinates, enlarged palate or tonsils. Widening the airway will give excellent results in this individual.
As you can see there are numerous ways that the individual can be helped. It is therefore important to have a consultation with the Snoring Doctor who will be able to give appropriate treatment to stop snoring,
For more information on snoring and how to stop snoring , please visit www.snoring.sg.
If you have concerns with yours or your partner or family sleep condition especially with snoring or sleep apnea, please make an appointment with DR YT Pang our Snoring Doctor and Sleep Apnea Specialist.