Obstructive Sleep Apnea

What is Obstructive Sleep Apnea (OSA)?

Obstructive Sleep Apnea (OSA) is a common sleep disorder that affects millions of people worldwide. It occurs when the airway becomes partially or completely blocked during sleep, leading to interruptions in breathing and frequent awakenings throughout the night.

OSA can have significant consequences on a person’s overall health, including excessive daytime sleepiness, difficulty concentrating, and increased risk of cardiovascular problems. Fortunately, there are effective treatments available to manage and alleviate the symptoms of OSA.

Whether you or a loved one are seeking answers, understanding, or guidance on managing OSA, this page aims to provide a valuable resource to help you navigate this sleep disorder and take the necessary steps towards better sleep. Keep reading to learn more about obstructive sleep apnea and the different non-surgical and surgical techniques to fix it.

About Obstructive Sleep Apnea

Obstructive Sleep Apnea (OSA) is the most common breathing and sleep disorder, although other types of sleep apnea do exist. Episodic pauses in breathing characterize the disorder, and they’re usually a result of either a total or partial collapse of the airway.

OSA is a sleep-breathing disorder. People who have OSA develop episodic short pauses in breathing while they sleep, and it’s often accompanied by loud snoring and daytime sleepiness.

The good news? Obstructive sleep apnea is treatable. Dr Kleid offers the most advanced surgical and non-surgical techniques to treat snoring and sleep apnea in his ENT clinic in Melbourne.

The cause of obstructive sleep apnea is, as the name suggests, an airway obstruction. This can be due to either abnormal growth of the structures that form the airway, or hypermobility of certain parts that move and block the air passage when we sleep (like the tongue or soft palate).

Our airway is divided into an upper and a lower airway system. The upper airway consists of the nose, pharynx (throat), and part of the oral cavity. Air turbulence at any level of the upper airway, for any reason, can result in snoring and OSA.

The problem with obstructive sleep apnea is it doesn’t end with snoring. The airway obstruction can lead to partial waking, which significantly lowers the quality of your sleep. This results in daytime sleepiness, moodiness, and inability to concentrate, it can also contribute to medical conditions like heart disease and hypertension.

What Causes Obstructive Sleep Apnea?

In children, obstructive sleep apnea is commonly due to the enlargement of the tonsils and adenoids as a result of infection.

• The tonsils are small pieces of tissue located at the back of the mouth on both sides of the throat.
• The adenoid is a clump of tissue above the roof of the mouth.

In adults, hypermobility of the tongue, soft palate, and throat tissue is usually the cause of obstructive sleep apnea. When your tongue and throat muscles relax during sleep, the soft tissue falls back and blocks the air from entering.

Moreover, there are certain health conditions and lifestyle factors that increase your risk of developing OSA. Some of these include the following;

• Medical conditions causing nasal congestion (a swollen nasal passage with accumulated fluid and mucus)
• Excess growth due to over secretion of growth hormones
• Family history of sleep apnea
• Diabetes
• Allergies
• Smoking
• Alcohol and drug abuse
• Sleeping pills or sedatives
• A narrow throat
• Macrognathia (large tongue)
• Hypothyroidism. This refers to low levels of the hormone thyroxine, which increases your chances of obesity.

Symptoms Of Obstructive Sleep Apnea

The symptoms of obstructive sleep apnea may vary depending on the cause and severity of your condition. These symptoms can affect the quality of your sleep as well as other areas of your life, including:

• Loud snoring
• Moments of halted breathing during sleep
• Sudden awakening accompanied by choking
• Daytime sleepiness
• Feeling excessively tired during the day
• Loss of concentration during the day
• Restlessness; either awake or asleep
• Morning headaches
• Mouth breathing
• Hyperactivity during the day
• Irritability

When To See Your Doctor?

Knowing when to seek medical attention for obstructive sleep apnea (OSA) is crucial for managing the condition and preventing potential complications. While not all snorers have OSA, it is important to consult an Ear, Nose, and Throat (ENT) specialist like Dr Stephen Kleid if certain symptoms are present, including;

• Loud and disruptive snoring:
  • If your snoring is loud enough to disturb your sleep and the sleep of those around you, it may indicate the presence of OSA.
  • Additionally, if your snoring intensifies when you sleep on your back and lessens when you sleep on your side, it is more likely to be associated with OSA.
• Excessive daytime sleepiness:
  • Feeling excessively sleepy during the day, to the point where it impairs your ability to stay awake while driving or working, can be a sign of OSA.
  • This level of daytime sleepiness requires immediate attention and evaluation.
• Awakening with gasping or choking:
  • If you often wake up abruptly feeling as though you are gasping for air or choking, it could be a symptom of OSA.
  • This indicates interrupted breathing during sleep and should be evaluated promptly.

Even if your snoring is not directly linked to OSA, Dr Kleid can provide various treatment options to address snoring issues and improve the quality of sleep for both you and your partner. Seeking appropriate assessment and guidance from an ENT specialist is crucial for accurate diagnosis, personalized treatment, and potential prevention of related health risks.

Remember, prompt medical attention and proper management of OSA can help reduce the risk of complications, such as heart disease, hypertension, lung disease, metabolic disorders, and stroke.

What Are The Complications Of Obstructive Sleep Apnea?

Diagnosing obstructive sleep apnea early on is crucial because it can worsen other severe medical conditions. If you leave OSA untreated, it can lead to greater complications, including:

• Cardiovascular Diseases
  • These are diseases of the heart and blood vessels.
  • The low blood oxygen level caused by airway obstruction can cause an increase in blood pressure (hypertension) and heart rate.
  • Hypertension is known to cause other cardiovascular diseases such as heart failure, heart attack, and stroke.

• Daytime Fatigue And Sleepiness
  • If you are suffering from OSA, it’s very likely that you’re not getting enough sleep.
  • Daytime sleepiness is one of the most common symptoms of sleep apnea. It can be particularly dangerous when navigating daily activities like driving or jobs that involve heavy machinery.
    
• Increased Surgical Risks
  • Medications like anaesthetic, analgesics, or sedatives can further relax your upper airway and worsen your obstructive sleep apnea.
  • It should be considered when undergoing major surgery, especially if you lie on your back for the procedure.

How Is Obstructive Sleep Apnea Diagnosed?

The early diagnosis of obstructive sleep apnea is essential for preventing further complications that may be life-threatening. Dr Stephen Kleid works with a team of specialists capable of diagnosing your condition and choosing the most effective treatment option for you.

After assessing your medical history and symptoms, he will carry out a physical examination to visually inspect your airway to check for any abnormalities or growths. Dr Kleid might order a series of tests to diagnose obstructive sleep apnea, these tests may include one or multiple of the following.

Sleep Studies (Polysomnography)

This is the most reliable test for diagnosing OSA. In polysomnography, you will be connected to a monitor while you sleep. The monitor measures your brain activity, the electrical activity of your heart, and your blood oxygen level. It also measures your chest, abdominal wall, arm, and leg muscle activity.

In polysomnography, the number of apneic episodes (total cessation of breathing) and hypopneic episodes (partial cessation of breathing) will be measured. If the sum of these episodes is greater than 30 in a night, it is regarded as severe sleep apnea.

Home Sleep Apnea Testing

In some cases, Dr Kleid may provide you with an at-home sleep study kit to diagnose your disorder. It’s a simple procedure. This kit includes a breathing monitor to wear that tracks your breathing pattern, your oxygen levels, and your breathing effort.

How Is Obstructive Sleep Apnea Treated?

The treatment of obstructive sleep apnea (OSA) aims to relieve symptoms, improve sleep quality, and reduce associated health risks. The specific treatment approach depends on;

1. The cause and severity of the condition
2. Your age
3. Your tolerance for procedures and medications
4. Your preferred choice of treatment

Lifestyle Changes

Dr Kleid may recommend lifestyle changes as an initial approach to prevent and treat your condition. Making certain modifications to your lifestyle can be effective in managing mild OSA and may help you avoid more invasive treatments such as surgery or appliances.

Dr Kleid may advise you to abstain from certain risk factors that can worsen OSA, such as smoking and alcohol consumption. These substances can relax the muscles in your throat and contribute to airway obstruction during sleep. Additionally, Dr Kleid may suggest achieving a healthy weight if you are overweight or obese. Weight loss can help reduce the severity of OSA symptoms by decreasing the amount of excess tissue that may block the airway.

By implementing these lifestyle changes, you can improve the quality of your sleep and potentially alleviate the symptoms of OSA

Therapy

Dr Kleid suggests conservative therapy in cases of moderate to severe obstructive sleep apnea that fails to respond to lifestyle changes alone. Non-surgical treatment of sleep apnea and snoring include:

Continuous Positive Airway Pressure (CPAP)

This is a breathing machine that delivers continuous air pressure to your nose at night –  just enough to keep your upper airway passages open and prevent obstructive sleep apnea. The air is pumped by a machine and goes through a plastic tube to reach the mouth/nose piece. The pressurized pumped air overrides any possible resistances along the airway.

Oral Appliances

These oral devices are designed to keep your throat open or bring your lower jaw forward to relieve obstructive sleep apnea and snoring. The devices prevent the tongue, upper jaw, or lower jaw from falling backwards once you sleep.

Dr Kleid will recommend the appropriate oral appliance for you at your consultation.

Adaptive Servo Ventilation (ASV)

The ASV machine is similar, but more advanced, compared to a CPAP machine. The ASV device has a computer that studies the abnormalities in your breathing and adapts with just enough pressure to relieve your obstructive sleep apnea. This advanced technology is not a fixed value, but rather it adjusts to the needs of your condition.

When your breathing problem ends, the ASV machine re-aligns to your regular breathing pattern.

Surgery

In some cases, surgical procedures may be considered to address anatomical abnormalities that contribute to airway obstruction. Surgical options include uvulopalatopharyngoplasty (UPPP), tonsillectomy, adenoidectomy, nasal surgery, or jaw surgery. These procedures aim to increase the size of the airway or correct structural issues that contribute to OSA.

Surgical treatment for sleep apnea is usually indicated when other non-surgical treatment options have failed.

Usually, non-surgical treatment of obstructive sleep apnea is tried for at least 3 months. If Dr Kleid notices no improvement, he might recommend one of the following operations depending on your specific condition:

Uvulopalatopharyngoplasty (UPPP)

This is the most commonly performed surgery to treat snoring and sleep apnea syndrome. During this surgery, Dr Kleid will remove excess tissue in your throat to make your airway wider. Tissue removal may include your tonsils, uvula, and a part of your soft palate. The procedure is performed under general anesthesia, .

Radiofrequency Ablation (RFA)

RFA involves using pulses of radiofrequency energy directed at the tissue, causing the cells to die, thereby reducing the tissue size. This is a minimally invasive procedure that clears up the airway from possible obstruction.

Palatoplasty with lateral tonsillopexy

Dr Kleid reshapes your soft palate (roof of the mouth) and shrinks your tonsils.

Maxillomandibular advancement (MMA)

Dr Kleid will advance the jaw and fix it in a forward position to stop it from falling backwards and causing airway obstruction during sleep. This is a common surgical treatment for apnea and snoring.

Genioglossus advancement

This surgery for sleep apnea is when Dr Kleid advances your tongue to prevent it from falling backwards during sleep.

Midline glossectomy and lingualplasty

In this surgical therapy for sleep apnea, Dr Kleid removes some bulk from the middle of your tongue to shrink it and reshape it.

Nose surgery

If the obstruction causing your sleep apnea is at the level of your nostrils, then nose reshaping surgery may help. This might include rhinoplasty, septoplasty, polyp removal, Alarplasty, and other surgical nose procedures.

The choice of surgery to treat obstructive sleep apnea depends on the specific cause of your condition, your anatomy, age, and many other factors.

Dr Kleid will explain your choices to you after he performs a full evaluation.

How Is Recovery After Surgery?

Surgical treatment of obstructive sleep apnea is usually reserved for more advanced or severe cases. That being said, recovering from surgery may involve some discomfort:

• Pain during swallowing and speaking
• Bleeding (not a frequent occurrence)
• Voice changes

To keep you as comfortable as possible, Dr Kleid suggests some precautions manage your discomfort:

• Take the prescribed pain medication as needed
• Drink plenty of fluids
• Avoid heavy or excessive activities

Minor side effects of surgery like those above usually resolve after one to two weeks. After that, you are free to return to your regular schedule.

Outlook

Obstructive sleep apnea has an overall favorable outlook as long as you get it diagnosed and treated as early as possible. The dangers of untreated sleep apnea can be detrimental to your health.

If you are concerned that you might have obstructive sleep apnea, set up an appointment at our ENT clinic in Melbourne.

FAQ

What is the best position to sleep in with sleep apnea?

The preferred sleeping position when you have obstructive sleep apnea is by lying on your right side. This can help reduce snoring and encourage better airflow.

How do I know if I have sleep apnea if I live alone?

You should look out for observable signs such as daytime fatigue and sleepiness, waking up suddenly and gasping, waking up with a sore throat, and recurrent morning headaches.

How much weight do you have to lose to cure sleep apnea?

Being overweight or obese is a significant risk factor for obstructive sleep apnea. To reduce sleep apnea symptoms, losing about 10-15 % of your body may be effective.

This is highly variable and depends on your specific condition. In some people, weight loss alone might not be enough to completely cure sleep apnea and snoring (although it might reduce it). In such cases, surgery, CPAP, and oral appliances are the only way to go.

What if I can’t sleep during a sleep study?

If you can’t sleep during your sleep study despite trying, you can take a light over-the-counter sleeping pill. This helps your body relax and puts it into a sleeping mood without affecting the results of the polysomnography.

When should I see a sleep specialist?

If you have trouble with sleep, snoring, daytime sleepiness, persistent fatigue, and this persists for a long time, you should consult a sleep specialist. They will evaluate the quality of your sleep and diagnose any sleep and breathing disorders like obstructive sleep apnea.

What is the common side effect of CPAP?

CPAP can be uncomfortable for many people. This leads to the inability to initiate sleep when needed. This is the only known side effect of CPAP. You should know, however, that most people quickly get used to CPAP and can easily incorporate it into their sleeping routines

Sources

• Obstructive Sleep Apnea
• Columbia University Department of Otolaryngology: Obstructive Sleep Apnea
• Diagnosis of Obstructive Sleep Apnea Syndrome in Adults
• What are the significant complications of obstructive sleep apnea (OSA)?

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Why Choose Dr Kleid for Ear, Nose and Throat Surgery?

Dr Stephen Kleid
Ear Nose and Throat Surgeon (Otolaryngologist)
MED0001052799

Masada Medical Centre
26 Balaclava Road,
East St Kilda, Victoria

Dr Stephen Kleid is an experienced Ear, Nose and Throat ENT Surgeon (Otolaryngologist) based in St Kilda.

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Dr Kleid’s Procedures

• Sinus Surgery
• Sleep Apnea Surgery
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• Reduction of Adams Apple
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Dr Kleid’s Team takes pleasure in assisting you with any questions when considering ENT surgery. Please call the Masada in Melbourne between 9 am – 5 pm on Weekdays.

Phone Masada Hospital 03 9038 1630 or Email Dr Kleid