Obstructive Sleep Apnea
What is Sleep Apnea?
The incidence of obstructive sleep apnea (OSA) is approximately 24% in men and 9% in women. Individuals who suffer from OSA have disrupted sleep and low blood oxygen levels. When obstructive sleep apnea occurs, the upper airway can be obstructed by excess tissue, large tonsils and/or a large tongue. This stops airflow to the lungs, depriving the circulation from adequate oxygen. When the oxygen level in the brain becomes low enough, the sleeper partially awakens, the obstruction in the throat clears, and the flow of air starts again, usually with a loud gasp. This cycle repeats itself many times during the night and may result in sleep deprivation and a number of health-related problems.
Examples of such serious health problems include memory loss, depression, hypertension, erectile dysfunction, stroke, cardiovascular dysrhythmias, myocardial infarction, and sudden death.
Sleep apnea causes excessive daytime sleepiness. People with sleep apnea are 10 times more likely to die in a car accident than someone without sleep apnea. People with OSA can also suffer from memory loss, poor judgment, loss of concentration, depression, headaches and decreased mental function.
Dr. Skigen specializes in the treatment of obstructive sleep apnea. The first step in treatment resides in recognition of the symptoms and seeking appropriate consultation and diagnosis. To determine the severity of your sleep apnea, a sleep study, or polysomnography, will be recommended. This is a special overnight test that monitors your nighttime sleep patterns and gathers data about the number and length of each breathing cessation that disturbs your sleep. There are several sleep centers in the Jacksonville area where this can be performed; our office will be happy to assist you in scheduling your sleep study if necessary.
In addition to a detailed medical history, the doctors will perform a head and neck examination looking for problems that might contribute to sleep-related breathing problems. Anatomical features which can contribute to OSA may be the airway muscles which collapse during sleep, the nasal passages which may be narrow and the position of the upper and lower jaw. Dr. Skigen will assess the anatomic relationships in the maxillofacial region using cephalometric analysis and three dimensional reconstruction of your airway anatomy. Sometimes a naso-pharyngeal exam is done with a flexible fiber-optic camera.
Treatment for Sleep Apnea
There are several treatment options available, depending on whether your OSA is mild, moderate or severe. Non-medical treatment such as weight loss, change of sleeping position, as well as avoiding alcohol, caffeine and heavy meals within 2 hours of bedtime can improve your symptoms.
Nasal CPAP (Continuous Positive Airway Pressure) is considered the first line treatment for moderate to severe sleep apnea. CPAP delivers pressurized oxygen through a nasal mask to limit obstruction at night. CPAP can effectively treat sleep apnea but it does not cure OSA as the efficacy of CPAP is dependent on use of the machine every night. Some people complain of nasal congestion, throat dryness, eye irritation, mask discomfort and hissing noises from use of their CPAP machine.
Oral Appliances are a non-surgical treatment option for patients who do not tolerate CPAP. The appliance is placed in the mouth at night to hold the lower jaw and tongue forward. This elevates the soft palate and prevents the tissue collapse over the airway. There are several appliances on the market. Dr. Skigen will determine which appliance is best suited for you.
The most successful surgical treatment option for OSA is maxillomandibular advancement surgery. The bones of the upper and lower jaw are brought forward to increase the size of the airway. This procedure is done in the hospital under general anesthesia and requires a one to two day overnight stay in the hospital. Surgical plates and screws will be used to hold the upper and lower jaw in their new positions, avoiding the need to have your jaw wired shut. All incisions are made inside the mouth to avoid unwanted scarring. Pain after surgery is easily controlled with medication and most patients return to work within 2 weeks.
Every patient Dr. Skigen has treated for sleep apnea has noticed a significant improvement in their snoring and breathing immediately after surgery!