What are Snoring and Sleep Apnea?Snoring is the loud, bothersome noise created by vibrating soft tissues in the throat of someone who is asleep. Obstructive Sleep Apnea is a serious medical condition in which the soft tissues of the throat, known as your airway, collapse and impede breathing for 10 seconds or longer while asleep. During such an apneic episode, the oxygen levels in the bloodstream drop and eventually may lead to harmful health problems and early death. Although most patients diagnosed with sleep apnea snore loudly, everyone who snores does not necessarily suffer from sleep apnea.
WHY SHOULD I BE CONCERNED ABOUT POSSIBLY HAVING SLEEP APNEA?Medical studies have shown that Obstructive Sleep Apnea increases the mortality rate; that is, people die sooner than if they did not have the problem. Apnea interrupts the normal pattern of sleep, which causes tiredness and immediately increases the likelihood of having accidents while driving or operating machinery. Over many years, the stress created by low oxygen levels magnifies the risk of developing high blood pressure and suffering a heart attack or stroke.
Possible increased risk for:
- High blood pressure
- Heart disease and heart attack
- Fatigue-related motor vehicle and work accidents
- Decreased quality of life
HOW CAN I TELL IF I HAVE SLEEP APNEA?
Dr. Brodner is Board Certified in Sleep Medicine, which qualifies him with the expertise to ask pertinent questions about the typical symptoms listed above. He will perform a complete physical examination to evaluate for common anatomic abnormalities associated with sleep apnea. This examination will include flexible fiberoptic endoscopy a tiny camera utilized to fully visualize the inside of your throat and localize the sites of obstruction. Finally, Dr. Brodner will send you for a sleep study (polysomnogram) to accurately diagnose the presence or absence of sleep apnea.
AM I AT RISK FOR SLEEP APNEA?
8% of men and 4% of women are estimated to have Obstructive Sleep Apnea. Risk factors associated with suffering from sleep apnea include:
- Anatomic abnormalities
- Enlarged tonsils
- Enlarged tongue
- Excess tissue in the soft palate (roof of the mouth)
- Family history
- Neuromuscular disorders
- Sleep position (on your back)
- Use of alcohol or sedative
Weight Loss - Weight loss is a great idea; how much do I have to lose and how can I achieve my goal?
For some patients, 10% to 20% weight loss can greatly improve, or even resolve, their sleep apnea. This depends on height and weight, as well as their airway anatomy. After a thorough evaluation, Dr. Brodner can explain how weight loss will fit into your individual treatment strategy. Fortunately, there are many popular diet plans to choose from in the media so please discuss which one, if any, is right for your personal needs. Dr. Brodner may also recommend a nutrition and weight management program available in your area.
- Lifestyle changes
During sleep apnea throat muscles relax, allowing soft tissues to collapse and block the air passages. Anything that increases the relaxation of these muscles will worsen the problem. As a result, lifestyle changes such as avoiding alcohol and sedating medications can greatly reduce the severity of sleep apnea. Since lying on your back also worsens this collapse, sleeping on your side or propped up on several pillows can also help.
- Oral dental appliances
- CPAP mask
Sleep apnea can be treated with CPAP (Continuous Positive Airway Pressure), a machine that uses air pressure to prevent the tissues in the throat from collapsing while you sleep. The air is blown through a mask fitted over your nose, and sometimes mouth, that is worn while sleeping.
How well does CPAP work in treating sleep apnea?
If used properly, CPAP resolves sleep apnea in nearly 100% of patients. CPAP needs to be worn all night, every night, in order to be effective or else the symptoms and harmful medical effects of sleep apnea will return immediately. To help patients get comfortable with their treatment, Dr. Brodner moderates monthly CPAP Support Group meetings to discuss the latest technology, offer guidance, and allow patients to share their experiences and advice.
WHO SHOULD HAVE SURGERY FOR SLEEP APNEA?
Surgery is considered when weight-loss has failed and the patient cannot tolerate or chooses not to wear CPAP. As with all surgical treatment, success depends on choosing the right combination of procedures to effectively correct the anatomic abnormalities unique to the patient. Dr. Brodner is experienced in performing multi-level surgery to correct areas of airway collapse and prevent the obstruction causing sleep apnea. These treatments, often used in combination, include: UvuloPalatoPharyngoPlasty (UPPP), tonsillectomy, bony reconstruction of the face and jaw, reduction of the tongue, tracheotomy, and nasal procedures such as septoplasty, shrinking of the turbinates, and removal of polyps.
HOW EFFECTIVE IS SURGERY IN TREATING SLEEP APNEA?
UPPP is successful in stopping snoring in 90% to 95% of patients. Dr. Brodner utilizes the cutting-edge Friedman criteria, combined with advanced multi-level surgery, to achieve higher rates of improvement or resolution of Sleep Apnea than traditionally reported. Subjectively, the vast majority of patients experience relief of their symptoms gaining more energy, improving memory and concentration, and finally enjoying the feelings of a good night's sleep.
The most commonly performed surgery for treatment of Obstructive Sleep Apnea is the UvuloPalatoPharyngoPlasty (UPPP). This procedure removes the uvula, trims the redundant tissue of the soft palate, and widens the air passage at the back of the throat. When enlarged tonsils are present, these are also removed as part of the procedure. Dr. Brodner has developed a new variation of this traditional surgery to improve results; he also utilizes cutting-edge PEAK technology which allows him to operate using very low heat to reduce tissue damage -- lessening pain for his patients.
Reducing the muscle bulk at the back of the tongue is utilized in cases of severe sleep apnea and in patients with an over-sized tongue, which contributes to the blockage of airflow during sleep. This may be achieved with removal of tongue muscle or by using newer radio-frequency technology, which shrinks the tongue at low heat, allowing for less pain and postoperative swelling.
For patients with extremely severe sleep apnea not amenable to other treatments, tracheotomy is used to bypass the areas of collapse in the throat. By placing a plastic tube in the throat, directly into the trachea (windpipe), sleep apnea is cured. Given the reluctance of most patients to undergo such an extreme procedure, this is rarely performed, but for the unfortunate few who suffer extremely severe sleep apnea, it remains the only option that guarantees 100% success.
CORRECTION OF NASAL OBSTRUCTION:
Why would Dr. Brodner want to fix my nose? We normally breathe through our nose while asleep. Anything that blocks airflow through the nose, such as a deviated septum (crookedness in the middle partition of the nose), enlarged turbinates (structures inside the nose responsible for heating and filtering air), or polyps (fluid-filled sacs often associated with allergies) can worsen snoring and sleep apnea. By correcting these deformities, Dr. Brodner can improve, though usually not cure, sleep apnea. Also, maximizing airflow through the nose may allow a person to use CPAP more easily and thus treat sleep apnea non-invasively.
What is Sleep Apnea?
Sleep apnea is a condition in which a person stops breathing repeatedly through the night Breathing stops because the throat or “airway” collapses and prevents air from getting into the lungs. Sleep patterns are disrupted, resulting in excessive sleepiness or fatigue during the day.
Symptoms of Sleep Apnea:
- Loud snoring
- Excessive daytime sleepiness
- Awaking feeling unrefreshed after sleep
- Morning headaches
- Problems with memory or concentration
- Sexual dysfunction