Ask The Doctor

If you feel as though you never really get a good night’s sleep, if your snoring has become disruptive, if you just can’t seem to stay awake on the job, you aren’t alone. You may be one of the 18 million Americans who suffer from sleep apnea, a potentially serious medical condition. Dr. Patrick C. Melder, an otolaryngologist — head & neck surgeon (ENT) — with the Maryland Sinus and Sleep Surgery Center at Suburban ENT Associates, explains what sleep apnea is and what you can do about it.

What is sleep apnea?

Sleep apnea is a sleep disorder defined by the cessation of breathing for 10 or more seconds. There are three types of sleep apnea. The most common type is called obstructive sleep apnea (OSA); it occurs when there are obstructive tissues in the back of the throat that close off the airway so that you inhale against a closed structure. With the second type of sleep apnea, central sleep apnea, the brain doesn’t send the necessary signal to breathe. Finally, mixed sleep apnea occurs when you experience a combination of OSA and central sleep apnea.

I snore. Does that mean I have sleep apnea?

Not necessarily. Snoring is typically related to turbulent airflow. You may have an obstruction of the nose, such as a deviated septum, or something may be wrong with your palate or uvula. When it comes to diagnosing sleep apnea, snoring may be like an alarm bell. Not all snorers suffer from sleep apnea, but sleep apnea is almost always associated with snoring. To find out whether your snoring is something more serious, you need to get a sleep study. If you are diagnosed with sleep apnea, the next step should be to see an otolaryngologist (ear, nose, and throat surgeon) who will perform a complete head and neck examination to find the cause of the sleep apnea and to determine treatment options.

What causes sleep apnea and who is at risk for the condition?

Sleep apnea is caused by a number of factors. It may be caused by physical characteristics such as weight. Other factors like alcohol and sedative use before bed can exacerbate symptoms. There are also a variety of anatomic factors that lead to apnea. The otolaryngologist will evaluate the nose, mouth, and throat, looking for such things as a deviated septum, enlarged nasal turbinates (structures in the nose), and/or an enlarged adenoid, which occurs primarily in children. There may be a problem with the position of your jaw or you may have an enlarged tongue or tonsils. (Enlarged tonsils affect adults as well as children.) Finally, there may be a problem with the anatomy of the back of the throat. While overweight men and older adults are generally considered more at risk for sleep apnea, the condition can occur in women and even children.

What are the signs and symptoms of sleep apnea?

Symptoms of sleep apnea include daytime sleepiness, irritability, decreased concentration and sex drive, morning headaches, and dry mouth. For children, symptoms can include decreased growth, a decline in school performance, and an increase in bed-wetting.

How is sleep apnea diagnosed?

The gold standard in the diagnosis of sleep apnea is a sleep study. This study can be conducted at the National Capital Sleep Center at Suburban Hospital or, in some cases, in the patient’s home. A patient’s symptoms are not always a reliable indicator of apnea. Even if you don’t think you have apnea, a sleep study should be performed to ensure your snoring is not an indicator of something more serious.

Why is it important to diagnose sleep apnea?

Approximately 18 million people suffer from obstructive sleep apnea but only 5 percent of those who have it have been diagnosed. Untreated sleep apnea can exacerbate a number of other medical conditions that could be controlled more easily if the sleep apnea is properly diagnosed and treated. In addition, sleep apnea is very much a quality-of-life issue, especially for aging baby boomers. More frequent leisure travel in this population may make the snorer an unwelcome companion. With proper treatment, those who suffer from sleep apnea can experience enhanced quality of life.

If I don’t have sleep apnea, can my snoring be cured?

Some of the same conditions that cause sleep apnea also cause snoring, so in some cases snoring can easily be corrected with minimally invasive procedures that are performed right in the physician’s office. While some of these procedures require multiple treatments, the success rate approaches 90 percent.

What are the treatments for sleep apnea?

For mild sleep apnea, your doctor may recommend lifestyle changes such as losing weight, quitting smoking, avoiding alcohol and sedatives, and not sleeping on your back. If lifestyle changes don’t improve sleep apnea, there are other alternatives, such as oral appliances, continuous positive airway pressure (CPAP) masks, and surgery.

What does a CPAP mask do?

The CPAP mask and its newer alternative, the BiPAP mask, ensure the flow of air into the mouth so that the throat stays open. These masks are worn at night and cover your nose and mouth. With a CPAP mask, the flow of air out of the mask is continuous. With BiPAP, the air flow increases or decreases depending on whether you are breathing in or out — this is more natural than CPAP. While these masks can be very effective when used properly, their success rate is greatly dependent on patient compliance and some patients do report that they are unable to sleep with the masks.

I’ve been diagnosed with sleep apnea and I can’t wear a CPAP mask. What else can I do?

First, it’s extremely important that you get a complete head and neck exam by an otolaryngologist. The surgeon will look for easily correctable anatomic defects that can greatly minimize the level of apnea or cure the apnea without the need for a CPAP device — or increase compliance by surgically correcting simple nasal problems that may affect the comfort of wearing these devices.

Who would be a candidate for surgery?

With any anatomic obstruction, there are a variety of procedures that can be performed, from minimally invasive surgery to treatments that are more invasive. The surgeon will evaluate a mix of factors, including how bad the apnea is, your anatomy, and your body features. Surgery is approached in stages, with many procedures performed in the surgeon’s office under local anesthesia. For example, radiofrequency ablation can be performed to shrink the turbinates or to shrink and stiffen the palate or the back of the tongue. These types of procedures are performed in the doctor’s office, with the patient returning to work the day of the procedure in some cases. Palatal implants are another treatment option to help stiffen the palate.

Even the more invasive surgical procedures are often performed on an outpatient basis, either at Suburban Hospital or the Suburban Outpatient Medical Center. At most, these procedures would require no more than an overnight stay. One such procedure, uvulopalatopharyngoplasty (UPPP), is a standard surgical therapy where the surgeon removes part of the soft palate, the uvula, and/or the tonsils. UPPP usually requires approximately six to seven days to recover fully and pain after surgery is the biggest complaint. Newer medicines have helped greatly with pain control after surgery.

Do people with sleep apnea need to be concerned about anesthesia?

People who suffer from sleep apnea have an increased risk of post-operative complications, and intraoperative complications like post-obstructive pulmonary edema. That’s another reason why it’s so important to diagnose and treat sleep apnea.

What can happen if I don’t treat my sleep apnea?

Early recognition and treatment of sleep apnea is important because the condition may cause irregular heartbeat, heart disease, hypertension, or even stroke. These diseases develop because patients with OSA cannot breathe properly while sleeping. OSA causes oxygen levels to fall to dangerously low levels. As the lungs struggle to provide appropriate respiration, the heart has to work overtime to deliver oxygenated blood to the lungs. This can impose a severe stress on the heart. Sleep apnea also increases your risk of falling asleep while driving. It is estimated that approximately 80,000 drivers fall asleep at the wheel every day, accounting for 20% of all accidents.

Snoring in children is not normal and shouldn’t be ignored. Any obstructive symptoms in children should be addressed by an otolaryngologist.

About Dr. Patrick C. Melder

Dr. Melder, a board-certified otolaryngologist — head & neck surgeon — received his undergraduate degree from Houston Baptist University and his medical degree from Texas Tech Health Sciences Center. He served active duty in the U.S. Army, completing a general surgical internship at William Beaumont Army Medical Center in El Paso, Texas. He completed his training in Otolaryngology-Head and Neck Surgery at Walter Reed Army Medical Center, where he was later named chief of the Otolaryngology-Head and Neck Surgery Service.

Dr. Melder’s practice interests include pediatric ENT disorders and a special expertise in treating adult snoring and surgical sleep disorders of the head and neck. He is with the Maryland Sinus and Sleep Surgery Center at Suburban ENT Associates. Dr. Melder can be reached at 301.896.6840.