Sleep Apnea

People with Obstructive Sleep Apnea (OSA) have chronically disrupted sleep and low blood oxygen levels due to blockages to airflow in the upper airway. These blockages can caused by nasal obstruction, by the tongue, by the palate, or by some combination of the three. These obstructions to the upper airway cause airflow to the lungs to stop. When the oxygen level in the brain becomes low enough, the sleeper partially awakens and opens their airway at the site of the obstruction, and the flow of air starts again, usually with a loud gasp.

Repeated cycles of decreased oxygenation lead to very serious cardiovascular problems and stroke. Additionally, these individuals suffer from excessive daytime sleepiness, depression, and loss of concentration.

Some patients have obstructions that are less severe called Upper Airway Resistance Syndrome (UARS). In either case, the individuals suffer many of the same symptoms.

The first step in treatment resides in recognition of the symptoms and seeking appropriate consultation. Dr. Nail is qualified to offer consultation and treatment options.

In addition to a detailed history, the doctors will assess the anatomic relationships in the maxillofacial region. With a detailed clinical exam and a cephalometic (skull x-ray) analysis, Dr. Nail can determine the level of obstruction. Sometimes a naso-pharyngeal exam is done with a flexible fiber-optic camera. To confirm the amount of cardiovascular compromise and decreased oxygenation levels, a sleep study may be recommended to monitor an individual overnight.

There are several treatment options available. An initial treatment may consist of using a nasal CPAP machine that delivers pressurized oxygen through a nasal mask to limit obstruction at night. Surgical options include a uvulo-palato-pharyngo-plasty (UPPP), which is performed in the back of the soft palate and throat or a similar procedure done with the assistance of a laser called a “laser assisted uvulo-palatoplasty” (LAUP). In select cases, small flexible palatal inserts can be placed to stiffen the soft palate and limit its vibration during sleep (Pillar Procedure). These procedures can usually be performed under monitored intravenous sedation in the office.

In more complex cases, the bones of the upper and lower jaw may be repositioned to increase the size of the airway (orthognathic surgery). This procedure is done in the hospital under general anesthesia and requires a one to two day overnight stay in the hospital.

OSA is a very serious condition that needs careful attention and treatment. If you have excessive daytime sleepiness, poor sleep, loud snoring, morning headaches, or witnessed pauses in breathing or gasping during sleep, call Dr. Nail for a sleep apnea evaluation.