Sleep Apnea

More than 100 different sleeping and waking disorders have been identified and can range from insomnia to sleep walking to sleep apnea. Ear nose and throat doctors, or ENT physicians, can diagnose and treat sleep disorders, which are grouped in four main categories:

• Problems with falling and staying asleep
• Problems with staying awake
• Problems with sticking to a regular sleep schedule
• Sleep-disruptive behaviors

You should call for an appointment with your WakeMed Physician Practices - ENT physician if either a lack of sleep or too much sleep are interfering with daily living, and especially if you experience excessive daytime sleepiness.

Sleep Disorders

Sleep disorders involve any difficulties related to sleeping, including difficulty falling or staying asleep, falling asleep at inappropriate times, excessive total sleep time, or abnormal behaviors associated with sleep. Disorders like insomnia have a wide range of contributing factors, including physical illness, depression, anxiety or stress, use of alcohol or other drugs, and heavy smoking.

Sleep Apnea and Sleep Apnea Solutions

Sleep apnea is a more serious disorder, causing problems with normal breathing during sleep. Two types of sleep apnea are central sleep apnea, which often occurs in people who are seriously ill, and obstructive sleep apnea, which is due to a blockage in the airway. Sleep apnea is often characterized by loud snoring, and causes fatigue, daytime sleepiness, morning headaches, poor concentration or memory difficulties, and sometimes, depression.

Persons with central sleep apnea have episodes of stopped breathing during sleep. Central sleep apnea can develop in persons who have life-threatening problems with the brainstem. Some conditions that cause it include complications associated with cervical spine surgery, encephalitis affecting the brainstem, severe arthritis or degenerative changes in the cervical spine or base of the skull, and use of certain medications, such as painkillers.

Normally, the muscles of the upper part of the throat help keep the airway open and allow air to flow into the lungs. Even though these muscles usually relax during sleep, the upper throat remains open enough to let air pass by.

However, some people have a narrower throat area, and, during sleep, relaxation of the muscles causes the passage to completely close. This prevents air from getting into the lungs. Loud snoring and labored breathing occur. During deep sleep, breathing can stop for a short period of time (often more than 10 seconds). This is called apnea.

An apnea episode is followed by a sudden attempt to breathe, and a change to a lighter stage of sleep. The result is fragmented sleep that is not restful, leading to excessive daytime drowsiness.

Some factors that contribute to obstructive sleep apnea include:

• Certain shapes of the palate and jaw
• Large tonsils and adenoids in children
• Large neck or collar size
• Large tongue
• Narrow airway
• Nasal obstruction
• Recent weight gain
• Drinking alcohol or using sedatives before sleep may make you more likely to have an episode of apnea.

Exams and Tests

Your ear nose & throat specialist will perform a physical exam. This will involve carefully checking your mouth, neck, and throat. You will be asked about your medical history. Often, a survey that asks a series of questions about daytime sleepiness, sleep quality, and bedtime habits is given. Tests will be done to diagnose an underlying medical condition. A sleep study (polysomnogram) can confirm sleep apnea.

Other tests may be performed:

• Lung function studies
• MRI
• Arterial blood gases
• Electrocardiogram (ECG)
• Echocardiogram
• Thyroid function studies

Sleep Apnea Solutions

Oxygen, nasal CPAP, or bilevel positive airway pressure (BiPAP) may be used for some types of central sleep apnea, and some types are treated with drugs that stimulate breathing. If central sleep apnea is due to heart failure, the goal is to treat the heart failure itself. Some obstructive sleep apnea solutions include:

• Avoiding alcohol or sedatives at bedtime
• Dental devices inserted into the mouth at night to keep the jaw forward
• Weight management or weight loss

If these measures do not help, your ENT physicians may recommend continuous positive airway pressure (CPAP) therapy. CPAP is the first-line treatment for obstructive sleep apnea.

Surgery, which may involve one of the following, may be an option in some cases:

• Uvulopalatopharyngoplasty (UPPP) to removing excess tissue at the back of the throat.
• Tracheostomy to create an opening in the windpipe to bypass the blocked airway if anatomical causes are present (rarely done).

Surgery to remove the tonsils and adenoids may cure the condition in children; it does not seem to help most adults.