Sleep Apnea

Unfortunately, obstructive sleep apnea is a rather common occurrence in our changing society. It is also a complex issue, one with many approaches to treatment. Basically, the patient who snores heavily may also have so much obstruction deep in the pharyngeal tissues that the airway is frequently blocked when deeply asleep. It is more frequently seen with obese patients. Obesity, in itself, has become a major problem in our country–and others! Not all people who suffer sleep apnea are obese, however, and this is why it is often difficult to diagnose and treat. It has many factors. When the soft tissues – muscles and overlying tissues– cannot be maintained when asleep, there is obstruction. Air cannot get to the lungs effectively. When the oxygen levels fall precariously low, or when the person just cannot take in a breath of air, the person will usually wake up and take a huge breath. This can go on all night long with many, many episodes throughout the night. The patient with sleep apnea may never be aware that all of this is happening. He or she is awakened– falls immediately back to sleep- and is again awakened because of major obstruction. A spouse may be acutely aware of it. Or, often, the spouse chooses to sleep elsewhere– so he or she can get a good night’s sleep. Sleep apnea can persist for years without proper diagnosis and intervention.

There are major issues of health arising from sleep apnea. First, the patient never gets a good night’s sleep. He or she can fall asleep at the drop of a hat. These people often fall asleep during the day, in class, at work OR at the wheel of a car. The person who suffers from sleep apnea is a hazard to himself and others because of this tendency to fall asleep all of the time. In fact, some professions will not allow recognized sleep apnea patients to work– such as pilots! Treatment is not easy. Management of the problem requires a correct diagnosis. Obstruction might occur in the UPPER airway- and a septo-rhinoplasty might be required for normal breathing. Or– it might require the advancement of a very small lower jaw to keep the tongue from falling back and obstructing the airway.

For most patients, it is best to start with your medical doctor and seek advice. Your physician may not know exactly what may need to be done, but most of the time it will start with a good sleep study. The most common way to approach airway obstruction problems is with the use of machines to force air in the lungs with inspiration. C-PAP machines are often prescribed by sleep medicine physicians and internal medicine physicians They are difficult to wear, but are effective. Some general dentists provide special night guard appliances that “may” help the situation by pulling the jaw forward and getting the tongue off of the back of the throat. Many different types of doctors offer all kinds of remedies–so caution is the word when selecting treatment! There is definitely a place for surgical management of sleep apnea problems. However, in the last few years there has also been controversy about the long term effectiveness of some surgical procedures. Orthognathic procedures to advance both the upper and lower jaws have been done for many years. There have been procedures done on the uvula. All kinds of surgery has been done. But, the outcomes have been mixed.

Probably the best approach is to—lose the weight that seems to precipitate sleep apnea. Success in weight loss has been—dismal. Very obese patients or morbidly obese patients just cannot take off that weight and keep it off.

The patient with sleep apnea puts tremendous pressures on the cardiac system. Hypertension is common. Untreated, severe sleep apnea can lead to an early death.

Dr. Buche does not do surgical procedures to manage sleep apnea. BUT there is a definite place for some surgical procedures in the management of sleep apnea. Again, it might be best to work through your primary care physician first, and then referrals can be made. Dr. Buche may be able to help sort some of these questions out for you and help you with a referral to the right doctor, including your primary care physician.

Sleep apnea is a major problem and is not simple to manage. But– your well-being may depend on your pursuit of proper care. Getting the right information and referral is essential.