Obstructive sleep apnea (OSA) is a complex subject that whole
books have been written about. Thus, what follows is a brief description
of OSA and hopefully some direction on whether you should see a doctor
for it or not.
What Is OSA?
“Apnea” means to stop breathing, and can be either central
(the part of your brain that controls breathing isn’t working properly)
or obstructive (you’re trying to take a breath, but your airway
is blocked). The majority of apneas are obstructive and occur at night
while we’re asleep. There are two main reasons for this: first,
when you lay your head down, the soft palate and the uvula (the thing
that hangs down in the back of your throat) tend to fall backwards and
block your airway. The same thing happens to the back of your tongue.
The second reason has to do with sleep: ordinarily there is some baseline
muscle tone that keeps the palate and tongue from falling backwards. However,
when we’re in deep sleep, this muscle tone is relaxed, so that if
these structures are going to fall back, this is when it will occur. This
probably occurs to some degree in almost everyone, but in general, someone
is said to have significant sleep apnea if they have more than five episodes
of apnea per hour that are at least 10 seconds long.
The most common symptom of OSA is the feeling that you’re not getting
a good night’s sleep, even if you feel you’re sleeping through
the night. Usually accompanying this is what we call “daytime somnolence”,
or falling asleep during the day. Heavy snoring may or may not indicate
that you have OSA, although it is somewhat more common in people who snore.
OSA is also more common in people who are overweight and in males more
How Do I Find Out If
I Have OSA?
The first step is to see your family doctor and discuss your concerns
with him/her. Before seeing them, one thing you can do is have your sleep
partner observe your sleep patterns and time any apneic spells you may
have. Your sleep partner may also want to accompany you to the doctor.
Unfortunately, a number of studies have shown that we are not very good
at diagnosing OSA on the basis of patient history or even an exam of your
nose, mouth, and throat. Thus, something called a “sleep study”
will probably be neccessary if your doctor thinks you may have OSA. This
is usually done at a local hospital and requires an overnight stay.
There is no medicine that cures or even helps OSA. Since OSA is more common
in obese people, the best initial treatment is a weight-loss program if
you are overweight. Other treatments are Continuous Positive Airway Pressure
(CPAP) or Biphasic Positive Airway Pressure (BiPAP), both of which involve
the use of breathing masks that you wear at night, and Uvulopalatalpharyngoplasy
(UPPP), a surgical procedure in which your uvula, part of your soft palate,
and your tonsils are removed. The advantage of CPAP or BiPAP is that they
are >90% effective in curing OSA. The disadvantage is that many patients
have trouble tolerating the breathing mask every night. The advantage
of UPPP is that if it works, you are presumably cured, at least as long
as you don’t put on any more weight. The disadvantage is that it
only works in 55%-60% of patients, and right now we can’t predict
whom it’s going to work on and who not.