Q: What is Sleep Apnea?
A: Apnea means stoppage or cessation of breathing that occurs during sleep. Typically cessation of breathing for two consecutive breaths or 10 seconds is considered significant from sleep perspective.
Q: How many types of Sleep Apnea are there?
A: Three varieties of Sleep Apnea are noted:
- Obstructive Sleep Apnea or OSA,
- Central Sleep Apnea or CSA,
- Mixed Sleep or Complex Sleep Apnea that has elements of central and obstructive apnea.
Q: How does Obstructive Sleep Apnea occur?
A: OSA is the most common type of sleep apnea in the US. It occurs due to obstruction or blockage of the upper air passage (not the lungs or voice box) by soft tissue in the back of the throat (the nasopharynx and the hypopharynx). Typically the uvula, soft palate, tonsils or tongue will collapse into the back of the throat during deep, especially REM, sleep and in supine position caused moderate to severe obstruction. During the obstruction episode, the level of oxygen in the body drops to below normal and this increases stress on all parts of the body especially the brain and heart.
Q: How do I know if my spouse, partner or I have Obstructive Sleep Apnea?
A: Typically the first sign of OSA is snoring. If you or your partner notices that you stop breathing during sleep or appear to be gasping or choking during sleep and wake up with a gasp, then most likely you have OSA. There may be arousals from sleep as well and you will not feel well rested and perhaps have day time sleepiness or early morning headaches. Children with OSA may suffer from ADHD.
Q: What are the health risks of OSA?
A: Many scientific studies have shown that moderate to severe sleep apnea significantly increases the risk of high blood pressure, heart attacks and heart disease, strokes, accidents, memory impairment, loss of concentration due to lack of sleep, increased risk of work related accidents especially when using machinery. Some driving accidents are known to be caused by drivers that fall asleep at he wheel when driving due to untreated OSA. Also OSA increases the risks of diabetes and impotence. Some studies indicate that the relative risk of heart problems and stroke is increased 5-7 times in individuals with moderate to severe sleep apnea. Therefore the condition is a significant health hazard with long term consequences to the individual, family and society.
Q: What does Dr Khetarpal call this disease?
A: He calls it a “ticking time bomb”. The effects of the condition, if left untreated, slowly accumulate unnoticed until they cause severe problems over years. However, the most encouraging message is that that with appropriate treatment and the individual taking a proactive and a personal responsible approach for their own treatment these effects on the heart, brain and body can be reversed, sometimes in their entirety.
Q: How does OSA get treated?
A: In general, there are four major treatment approaches:
- Weight loss in overweight individuals is critical in improving the condition and sometimes even reversing it in its entirety.
- Using a CPAP or continuous positive airway pressure device every night for more than 6 hours.
- Surgery, including nasal surgery to improve airway and CPAP compliance, palate and tonsil surgery or UPPP or palatoplasty or tongue-jaw surgery to advance the tongue forward or shrink the back of the tongue (radiofrequency ablation), have all shown benefit. Newer procedures such as hypoglossal nerve stimulator placement have also shown improvement but have not gone mainstream yet. In the well selected patient, a cure is possible with surgery. Advancing the maxilla and mandible, called MMA (maxillomandibular advancement) has shown greater than 90% success in some studies.
- Using an oral appliance, called OAT (oral appliance therapy) every night that advances the lower jaw forward and thereby the tongue forward and increases space in the back of the throat. This device is custom made for you after taking impressions of the teeth.
Q: How does CPAP work?
A: CPAP is a device that provides continuous positive pressure to your nose and throat during sleep. You will be fitted with a face or a nasal mask during your sleep study and provided with a device that generates positive pressure at a fixed pressure or an auto-PAP that generates variable pressure depending on the degree of obstruction. This must be used at least 6 hours every night or during sleep and at least 5 days during the week to be effective. Because the tissues in the back of the throat collapse to cause blockage or apnea, CPAP or auto-PAP open that air passage with positive pressure at the time of inspiration or breathing air in. This opens up the air passage and eliminates the apnea.
Q: What if I do not want a CPAP or do not tolerate it?
A: In this case, depending on severity of your OSA, surgery or oral appliance may be the other options. One such surgery is radiofrequency ablation or RFA of the tongue base that can be performed in the office under local anesthesia and IV sedation or IV anesthesia. Ask Dr Khetarpal about RFA ablation. One or more RFA treatments may be necessary to improve your OSA.
Q: Can surgery or RFA help me get rid of my CPAP device?
A: Sleep apnea surgery should improve your OSA but there is no guarantee of cure. In some individuals, it is possible that the improvement is sufficient to eliminate a need for CPAP.
Q: Why choose Dr Khetarpal for your Obstructive Sleep Apnea?
A: Obstructive Sleep Apnea is a condition that results from blockage of the upper air passage and is essentially the domain of ENT specialists. Dr Khetarpal is one of few surgeons in Texas performing RFA in his office. He belongs to a small group of ENT doctors or Otolaryngologists that is also Board Certified in Sleep Medicine besides being Board Certified in Otolaryngology-Head Neck and Facial Plastic Surgery. He has experience with all types of surgical procedures with Obstructive Sleep Apnea including tongue-jaw surgery.
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