Diagnosing and Treating Sleep Apnea
If you believe you may have obstructive sleep apnea, a visit to the oral and maxillofacial surgeon (OMS) is recommended for a complete examination and an accurate diagnosis.
At your first visit, the doctor will take a medical history and perform a head and neck examination looking for problems that might contribute to sleep-related breathing problems. An interview with your bed partner or other household members about your sleeping and waking behavior may be in order. If the doctor suspects a sleep disorder, you will be referred to a sleep clinic, where your nighttime sleep patterns will be monitored through a special test called polysomnography (PSG).
Polysomnography is supervised by a trained technologist and measures various body functions. Patients undergoing PSG sleep at the clinic overnight while a video camera monitors sleep patterns and gathers data measuring airflow, blood oxygen levels, breathing patterns, electrical activity of the brain, eye movements, heart rate and muscle activity. After the study is completed, the technologist will be able to grade the severity of sleep apnea. Often a “split night” study is done during which a CPAP (continuous positive airway pressure) device is used to help open the collapsed airways.
Treatment of Sleep Apnea
If you are diagnosed with sleep apnea, your OMS will help you decide which treatment is best for you. Depending on the severity of your OSA, treatment may include behavior modification, oral appliances, a CPAP/BiPAP device or even surgery.
If you are diagnosed with mild sleep apnea, your doctor may suggest you employ non-medical treatments recommended to reduce snoring. In mild cases, these lifestyle interventions such as losing weight or change of sleeping position may improve or even cure snoring and sleep apnea.
If you have mild to moderate sleep apnea (or are unable to use devices), recent studies have shown that an oral appliance can be an effective first-line therapy. The oral appliance is a molded device that is placed in the mouth at night to position the lower jaw and bring the tongue forward, elevating the soft palate and keeping the tongue from falling back in the airway and blocking breathing. Although not as effective as CPAP devices, oral appliances may be beneficial for some patients or for those who fail treatment attempts with CPAP and lifestyle changes. Patients using an oral appliance should have regular follow-up office visits with their OMS to monitor compliance, to ensure the appliance is functioning correctly and to make sure their symptoms are not worsening.
CPAP (Continuous Positive Airway Pressure) and BiPAP (Bi-Level) Devices
A CPAP device is an effective treatment for patients with moderate OSA and the first-line treatment for those diagnosed with severe sleep apnea. Through a specially fitted mask that fits over the patient’s nose, the CPAP’s constant, prescribed flow of pressured air prevents the airway or throat from collapsing. In some cases, a BiPAP device – which has pressure settings for inhalation and exhalation – may be used. While CPAP and BiPAP devices keep the throat open and prevent snoring and interruptions in breathing, they only treat your condition and do not cure it. If you stop using the CPAP or BiPAP, your symptoms will return. Although CPAP and BiPAP are often the first treatments of choice, they may be difficult for some patients to accept and use. If you find you are unable to use these devices, do not discontinue their use without consulting your doctor. Your OMS can suggest other effective treatments.
Surgery may be a viable alternative for some patients, but it’s important to keep in mind that no surgical procedure is universally successful. Every patient has a differently shaped nose and throat, so before surgery is considered your OMS will measure the airway at several points and check for any abnormal flow of air from the nose to the lungs.
An OMS has the necessary skill, training and experience to perform the following surgical procedures:
Maxillomandibular Advancement (MMA)
MMA is a procedure that surgically moves the upper and lower jaws forward. As the bones are surgically advanced, the soft tissues of the tongue and palate are also moved forward, opening the upper airway. For some individuals, MMA is the only technique that can adequately open the airway to resolve their OSA condition.
If the airway collapses at the soft palate, a UPPP may be helpful. UPPP is usually performed on patients who are unable to tolerate the CPAP device. The UPPP procedure shortens and stiffens the soft palate by partially removing the uvula and reducing the edge of the soft palate.
If collapse occurs at the tongue base, a hyoid suspension may be indicated. The hyoid bone is a U-shaped bone in the neck located above the level of the thyroid cartilage (Adam’s apple) that has attachments to the muscles of the tongue as well as other muscles and soft tissues around the throat. The procedure secures the hyoid bone to either the thyroid cartilage or the lower jaw to help stabilize this region of the airway.
Genioglossus Advancement (GGA)
GGA was developed specifically to treat obstructive sleep apnea and is designed to open the upper breathing passage. This procedure pulls forward and tightens the muscles under the tongue, thereby keeping the tongue from falling back in the airway and blocking breathing. This operation is often performed in tandem with at least one other procedure such as the UPPP or hyoid suspension.