You’ve probably heard of sleep apnea, and if you haven’t already, chances are you will. Sleep apnea is a common disorder that affects one in five adults, afflicting more men than women. What many don’t realize is that sleep apnea can lead to serious health issues, even death, if left undiagnosed and untreated.
What is sleep apnea and how could it affect my health?
Simply put, sleep apnea is a disorder that affects breathing during sleep. The condition is characterized by abnormal pauses in breathing (apneas) or abnormally low breathing during sleep. The pauses can last anywhere from ten to thirty seconds and upward to as many as four hundred per night or more, in those with severe sleep apnea.
Sleep apnea has many possible causes. The most common type of apnea, called Obstructive Sleep Apnea (OSA), occurs when there is a physical blockage of airflow. People who are overweight are at an increased risk of OSA, often caused by physical obstructions in the mouth and throat. During sleep, when your soft palate and tongue muscles are more relaxed, this soft tissue can collapse and cause the airway to become blocked.
If left untreated, OSA can cause serious long term health issues including:
· High blood pressure. If you already have high blood pressure, sleep apnea can make it worse. When you wake up often during the night, your body gets stressed. That makes your hormones go into overdrive, which boosts your blood pressure levels. Also, the level of oxygen in your blood drops when you can’t breathe well, which may add to the problem.
· Heart disease. People with OSA are more likely to have heart attacks. The causes may be low oxygen or the stress of waking up often. Strokes and atrial fibrillation -- a fast, fluttering heartbeat -- are also linked with the condition. Sleep apnea disrupts how your body takes in oxygen, which makes it hard for your brain to control how blood flows in your arteries and the brain itself. People with sleep apnea aren’t just sleep deprived; they’re also oxygen deprived.
· Weight gain. Extra weight increases your chances of getting sleep apnea, and the condition also makes it harder to slim down. OSA can also make your body release more of a hormone called ghrelin, which makes you crave carbs and sweets. When you're tired all the time, you might not be able to turn the food you eat into energy as efficiently, which can lead to weight gain.
· Type 2 diabetes. Sleep apnea is common among people with Type 2 diabetes. Untreated OSA results in increased levels of cortisol, the hormones that are released in response to stress. Prolonged exposure to elevated levels of cortisol leads to hyperglycemia or elevated blood sugar levels. OSA has also been linked to insulin resistance, a precursor to diabetes.
· Depression and anxiety. When your body releases large amounts of stress hormones such as cortisol and adrenaline while asleep, this can cause or exacerbate conditions such as depression and anxiety.
What are the symptoms of sleep apnea? Individuals with OSA are rarely aware of having difficulty breathing. In fact, the problem is often recognized by the person’s significant other. Patients suffering from OSA frequently feel fatigued during the day and report daytime sleepiness. Additional symptoms of sleep apnea may include:
· Loud snoring
· Waking up with a sore or dry throat
· Occasionally waking up with a choking or gasping sensation
· Sleepiness while driving or sitting as a passenger in a car
· Morning headaches
· Restless sleep
· Forgetfulness, mood changes, and a decreased interest in sex
· Recurrent awakenings or insomnia
How is sleep apnea diagnosed?
A polysomnogram is the most common sleep study for diagnosing sleep apnea. This study records data such as brain activity, hear rate, oxygen concentration in your blood, air movement, snoring level, blood pressure, and eye movement. While traditionally this required patients to spend the night in a sleep center to undergo a sleep study, today many patients are able to undergo a home sleep test, in their own home, in the comfort of their own bed. The results are then reviewed by a sleep specialist, who will review the data collected during the sleep study and make a diagnosis.
What are the treatment options for sleep apnea?
Treatment options for those suffering from OSA vary a great deal, from conservative to invasive surgical treatment. If you’re overweight, the best place to start is a lifestyle change including healthier eating habits and daily exercise. If you are not overweight or weight loss alone doesn’t help resolve your condition, your physician may recommend any of the following treatments:
· Continuous Positive Airway Pressure device (CPAP). This is a machine that keeps your airway open during sleep by delivering a continuous flow of pressurized air into the throat. CPAP requires the use of a mask that is connected to the actual machine. If you use CPAP to treat your OSA, you must use it every night. If you don’t, your symptoms will return right away. Many use CPAP with great results, but others can’t get used to wearing a mask while sleeping, even after making adjustments or changing to a different style of mask. Also, using CPAP means you must travel with it on trips or any overnight excursions. For these reasons, many prefer an alternative treatment solution.
· Custom oral appliance. A custom-fit oral sleep appliance is an effective treatment option for OSA and snoring. Worn only during sleep, the oral appliance fits like a sports mouth guard or an orthodontic retainer and supports the lower jaw in a forward position to help maintain an open airway. Many patients prefer oral appliances because they are effective, non-invasive, comfortable, quiet, portable, convenient for travel, and easy to maintain. If you and your doctor decide that an oral appliance is your best option, a qualified dentist can create the appliance for you.
· Surgery. When other treatments have failed or you decide not to use other treatments such as CPAP or a custom appliance, your doctor may recommend surgery. There are many surgical options for the treatment of OSA, such as uvulopalatopharyngoplasty (UPPP), genioglossus advancement, hyoid suspension, and jaw surgery. The goal of all these procedures is to allow air to move through the throat more easily when you breathe, thereby reducing the severity of OSA. Although typically a last resort to treat sleep apnea, surgery can offer a long-term solution and with a high success rate.
Who should you see for the diagnosis and treatment of sleep apnea?
In most case, it’s your primary care doctor (i.e. internist) who will recognize the symptoms and refer you to a sleep specialist for a sleep study and diagnosis. For treatment, most sleep specialists will provide you with a CPAP machine. If you prefer an oral appliance, a sleep specialist may have you see a dentist or an oral surgeon they work with.
Another option for treatment after you receive your diagnosis is to see an oral surgeon who has experience treating OSA. While an oral surgeon does not usually prescribe or sell CPAP machines, they do specialize in the mouth, head, neck and facial bones, so they are well-versed in treating OSA with custom oral appliances or surgery. So, if your preference for treatment is an oral appliance or surgery, a reputable and board-certified oral & maxillofacial surgeon is a good place to turn.
Is sleep apnea treatment covered by medical insurance?
The short answer is YES -- both sleep studies and treatment are covered by almost all insurance plans. However, as with any health-related matter, some insurance plans have different guidelines. You should always check to see your plan’s requirements and criteria.
Don’t let sleep apnea ruin your life!
Sleep apnea is a condition to take very seriously. Not only can it be life threatening, but the sleep deprivation, daily fatigue and other symptoms will make your life miserable if not properly treated.
With insurance coverage readily available for diagnosis and treatment, there’s every reason to see your doctor and start to sleep soundly and wake up healthy, happy and refreshed!
Ruben Cohen, D.D.S. is a Diplomate of the American Board of Oral and Maxillofacial Surgery. Dr. Cohen is the founder of Park Avenue Oral & Facial Surgery, P.C., located in the Upper East Side of New York City. He was named in 2017 by The New York Times Magazine as one of the top 20 oral surgeons and “Super Specialists” in New York City – selected by his peers.
For more information on Dr. Cohen’s sleep apnea treatment options, including custom oral appliances and surgery, please visit his website at www.ParkAvenueFaces.com.