Sleep Apnea

 

The presence of snoring can certainly be a significant social issue. However, as many as 60-80% of adults who snore routinely have sleep apnea. This can be true even in the absence of significant fatigue or witnessed apnea (stopping breathing) by the bed partner. Both snoring and sleep apnea occur when tissue surrounding the breathing tube relaxes, especially in deeper sleep. Partial obstruction may cause the tissue to simply vibrate- thus leading to snoring. However, more significant obstruction leads to difficulty in breathing- even complete blockage of the airway. Luckily, the brain will recognize this and move the patient into lighter sleep, allowing the airway to open again, but ruining deep sleep.

Untreated sleep apnea can increase the risk of heart attack, stroke, and even fatal car accidents. It can also contribute to fatigue, depression, poor concentration and memory issues.

Over twenty years experience in the evaluation and management of individuals with sleep disorders allows Dr. Hester to accurately diagnose the problem and then provide the patient with a comprehensive outline of options that are best suited to their individual condition. This approach has led to published surgical success rates of over 90% for those patients with sleep apnea.

Treatments provided include:

Non Surgical Treatment

  • Continuous positive airway pressure (CPAP): These devices are used while you sleep to maintain positive airway pressure, preventing the airway from collapsing. By keeping the airway from collapsing, snoring and sleep apnea resolve. This is often the first step in treating chronic snoring or sleep apnea.
  • Mandibular repositioning devices: These devices fit similarly to an orthodontic retainer. Worn during sleep, they slightly adjust the position of the jaw, which can also prevent the collapse of the tongue-minimalizing or eliminating snoring.

Minimally Invasive Treatment

  • Temperature controlled radiofrequency of the nasal turbinates, palate, and tongue: This treatment uses energy to ultimately create a reduction in the volume of the tissue treated without altering its function. It generally can be done in the office under local anesthesia allowing for immediate return to normal activity.
  • Pillar implants: These are structural implants that are placed into the soft palate tissue in the roof of the mouth. Once in place, the implants prevent the tissue from collapsing and/or vibrating, which can reduce or eliminate snoring. They can be used in conjunction with other treatments for more severe or complicated sleep apnea.

Surgical Procedures for Moderate to Severe Sleep Apnea

Commonly patients with this level of disease will have obstruction at more than one level of the airway. Without adequate experience and a thorough evaluation, this fact can be missed and inadequate treatment given- this is a common reason for “failure” of sleep apnea surgery.

  • Sleep endoscopy: This is a diagnostic procedure used to further define the levels of obstruction. A brief sedating anesthetic is given to mimic sleep. During this time a small scope is placed into the airway where areas of obstruction can actually be observed and video recorded to review with the patient at a later visit.
  • Septoplasty and Turbinate Reduction: Both of these surgeries are performed to improve the patientʼs ability to breathe through their nose. Septoplasty is used to correct a deviated septum-the bone and cartilage that separate the nasal passages in the middle. Turbinate reduction is used to reduce the size of these structures that are attached to the lateral walls inside the nose.
  • Airway surgery: There are several surgeries that can be used to amend the airway itself, depending on the area(s) of obstruction.
    • Uvulopalatal Flap: This procedure, developed by Dr. Nelson Powell, replaces the traditional uvulopalatalpharyngoplasty (UPPP). Instead of removing tissue, a folding technique is used to widen the airway in the back of the throat. This results in improved postoperative recovery and function.
    • Other surgeries include removal of the tonsils, re-anchoring the tongue in a more forward position (without changing function) so it does not collapse (performed by either genioglossus advancement or hyoid suspension) or repositioning the jaw to enlarge the airway and increase airflow (bimaxillary advancement).

The treatments listed above all have specific indications. A physician with extensive experience and an advanced understanding of the situation is necessary to guide the patient to arriving at the best treatment plan for them.

Contact our office to arrange a consultation to learn more about snoring and sleep apnea. A good nightʼs sleep-and your health- are worth it.