What is OSA?
Obstructive Sleep Apnea (OSA) is a disorder in which patients snore and hold their breath during sleep. The reason for both the snoring and the breath holds or apneas is that patients with OSA have extra tissue in their upper airway (from the nose to the vocal cords). The airway of patients with OSA is also loose, floppy and more easily collapsible than the airway of persons without OSA. Think of the airway of the sleep apnea patient as a thin, flimsy straw and the airway of a person without sleep apnea as a thick rigid lead pipe. The OSA patient has to “suck harder” to get air past the extra tissue and into the lungs. If you think of the straw analogy, what happens when you “suck hard” on a paper straw? It collapses! This is a simple explanation of what happens to the airway of a sleep apnea patient when they go to sleep. When a patient stops breathing (because the airway is obstructed) the oxygen level drops, sometimes to very dangerous levels.
Since our brain does not like to be deprived of oxygen, the brain sends out a signal to wake you up and start to breathe again. Once you awaken and return your oxygen level back to normal (usually within a few breaths) you quickly fall back asleep. Most patients are not awake long enough to remember awakening. The problem is that many patients may awaken hundreds of times throughout their sleep with the result that their sleep quality is affected. This is why many patients with OSA complain of restless, non-refreshing sleep, daytime fatigue or daytime sleepiness, even in the face of a normal quantity of sleep. Daytime sleepiness contributes to difficulty with concentration and motivation, depression, poor job performance and a 4-7 fold increased risk of motor vehicle accidents. Untreated sleep apnea also increases the risk for high blood pressure, heart attack, stroke, congestive heart failure, atrial fibrillation, diabetes and even sudden death during sleep. Please take our Sleep Apnea Quiz to see if you might have Obstructive Sleep Apnea.
So you think you might have OSA? What happens next?
The first step is to have a comprehensive sleep center consultation with Dr. Popper, a Board Certified Sleep Specialist, at our Accredited Sleep Center (serving Los Angeles, Malibu, Thousand Oaks and the rest of Southern California). You will be asked to complete a comprehensive sleep center questionnaire to aid Dr. Popper in performing an exhaustive evaluation to determine your overall general health status and determine if there are additional factors affecting your sleep. It is important to completely fill out the questionnaire and return it to us prior to scheduling your consultation as the length of your consultation is in part determined by the complexity of your particular sleep disorder(s). Dr. Popper will review your comprehensive sleep center questionnaire and one of our office staff members will contact you to schedule your consultation. Download our Comprehensive Sleep Center Questionnaire.
What’s the next step if Dr. Popper feels that I have sleep apnea?
Patients with suspected OSA will require a Sleep Study or polysomnogram. Most patients will require this to be done overnight in the sleep center. A home sleep study can be performed in some patients, if the only concern is OSA and they do not have other significant medical conditions or additional sleep concerns that require an in-center study.
If I am diagnosed with OSA, what are my treatment options?
Treatment recommendations are based upon the results from your sleep study and will be discussed in great detail with you upon your follow-up visit with Dr. Popper. A brief listing of available options is below:
- Weight loss – sometimes as little as a 5-10 lb weight loss can make a difference. However, weight is only one factor. Even a “skinny” patient can have OSA if there is obstruction of the upper airway as discussed previously.
- Positional therapy – some patients only have OSA when they sleep on their back. In such cases, learning to sleep on your sides may be all that is required. Sleeping with a couple of tennis balls sewn into the back of a T-shirt or the use of a belt or vest with built in balls may allow a patient to be “trained” to avoid sleeping on their back.
- Continuous Positive Airway Pressure (CPAP) – is a medical air compressor. Remember the analogy of the upper airway being sucked closed like a paper straw (discussed above)? When we inhale, we generate negative airway pressure (the suction). CPAP blows positively pressurized air into the upper air airway to balance the airway pressure and “splint open” the airway, thus eliminating both snoring and OSA. CPAP is virtually 100% effective at eliminating both snoring and OSA when a comfortable mask and an appropriate pressure level are prescribed. CPAP is the “gold standard” for the treatment of OSA. To see examples of CPAP units CLICK HERE. For a variety of mask styles CLICK HERE.
- Provent Therapy EPAP – this is a novel relatively new treatment option. It is similar to CPAP in that positive airway pressure is applied to keep the airway open. It is different from CPAP in that it does not require the use of a compressor or a mask. Positive airway pressure is applied only during expiration by applying a small adhesive bandage with a built-in-valve over each nostril. The valve allows the patient to breathe in effortlessly. During exhalation, the valve creates resistance to exhalation causing pressure to back up into the airway (much like the CPAP does, but without the requirement for an air compressor). To see an example of Provent Therapy EPAP CLICK HERE.
- Oral Appliances (OA) – these are medical devices made by dentists that fit into your mouth and over your teeth. Although there are numerous styles of OA there are basically 2 different methods by which they work. One method pulls the tongue forward, either with a suction device or a built-in tongue depressor. The other method pulls the lower jaw forward and as a consequence the tongue moves forward. To see examples of various Oral Appliances CLICK HERE.
- Surgery – A variety of surgical procedures have been developed over the years, all designed to remove or shrink the tissues that block the upper airway in patients with OSA. To learn more about the surgical treatment of OSA CLICK HERE.
- Combination treatment – sometimes various combinations of the above treatments are required to adequately control OSA.
Are You at Risk?
To find out if you are at risk for obstructive sleep apnea CLICK HERE to take our quiz.
To open and view the PDF documents available from this site, download a free copy of the latest version of ADOBE READER.