OBSTRUCTIVE SLEEP APNEA

Obstructive sleep apnea (OSA) is caused by a blockage of the upper airway while asleep. The uvula and soft pallet collapses on the back wall of the upper airway and the tongue falls backward forming a tight blockage which prevents air from entering the lungs. In the process of breathing, the diaphragm, the chest and the abdomen only cause the blockage to seal tighter. The failure of air reaching the lungs causes the person to arouse or awaken and gasp for air. The resulting tension in the tongue opens the airway and allows air to pass into the lungs.

bullet point Symptoms

snoring keeps partner awakeMost prominent symptoms are snoring, not breathing while asleep, excessive daytime sleepiness and obesity. Other symptoms include lack of concentration, forgetfulness, uncharacteristically irritable, anxiety, depression, mood and/or behavioral changes, morning headaches, disorientation at awakening and loss of sexual interest.

bullet point Diagnosis

Diagnosis is made by a physician specially trained in sleep medicine. After a physical examination of the upper airway and an interview with lots of questions, if it is determined that you might have a sleep disorder, you will be asked to take a polysomnogram (sleep test). Most sleep centers and labs monitor 16 different sleep parameters including EEG, EKG, eye movement, chin movement, air flow, chest effort, abdomen effort, SaO2, snoring and leg movement. Each parameter serves to help the physician make a correct diagnosis.

Sleep testing is performed in a comfortable bedroom settingTest are conducted in a sleep room much like a motel room. A technician will paste electrodes at certain points on your head, face, body and legs. Those electrodes will be hooked to monitoring equipment that will record the entire night study. Most patients do not experience anxiety or difficulty in going to sleep. They are extremely sleepy and will be asleep in just a few minutes. Test results are generally available in a few days. A follow up consultation with your physician will determine your next course of action.

One possibility may be a second sleep test to determine if your sleep disorder can be treated with continuous positive airway pressure (CPAP). You will be fitted with a CPAP breathing circuit, hooked up with electrodes and put back in bed. While you are asleep the technician will adjust the CPAP pressure trying to eliminate all obstructive sleep apnea and snoring. If the procedure proves to be helpful, you will be referred to an equipment provider that will supply the equipment and fit you with a regular breathing circuit. You will then be on your way to a normal life.

bullet point Treatment

CPAP in useContinuous Positive Airway Pressure (CPAP) appears to be the best and most effective treatment for obstructive sleep apnea. The problem is patient compliancee. CPAP flow generators develop a constant, controllable pressure to keep your upper airway open so that you can breath normally. CPAP is effective on 95% of the patients with obstructive sleep apnea, but long term studies have determined that a minority of patients continue appropriate use of their CPAP machine 5 years after starting.

For Patients with a mild to moderate form of obstructive sleep apnea, and for patients who cannot tolerate their CPAP there is an alternative. The Mandiblar Advancement Splint (MAS). The MAS works to effect the same result as the CPAP, but does this mechanically rather than with air pressure. Since a MAS is a mechanical device it doesn’t need electricity, air compressors and external tubing. As a result a MAS is more comfortable, more convenient, more portable and less claustrophobic. Over the life of the appliance the MAS is also less expensive.

The National Institutes of Health and the American Academy of Sleep Medicine have approved the MAS as a first line treatment for mild and moderate forms of sleep apnea. 

bullet point For more OSA and CPAP information

Examples of an obstructive airway: The Vancouver Sleep & Breathing Centre
www.sleep-breathing.bc.ca