Category: Sleep Disorders

Quackery is thriving in a new field of medicine. People’s fears and hopes are often exploited by unscrupulous individuals. “Alternative” medical professionals are already claiming miracle cures when the miracle you might need is surgery for sleep apnea.

Sleep Apnea: Who Can Diagnose It?

Let’s not forget this. An overnight sleep test is required to diagnose sleep apnea accurately. It must be done according to established procedures. A well-trained and accredited sleep specialist should evaluate the results and recommend treatment.

An alert doctor might suspect that you have sleep apnea. They will examine you and ask you whether you snore. A sleep test is required to determine the exact diagnosis and provide appropriate treatment.

Alternative Medicines for Sleep Apnea can be used to treat or cure it.

Alternative medicine can’t treat or cure sleep disordered breathing. Sleep apnea is not a cure. Although there is an effective treatment for sleep apnea, it is not permanent. Sleep apnea can be a complex disorder. The right treatment depends on many factors. One or more of these is the only effective treatment for sleep apnea.

Some people may experience weight loss. Some medications may be prescribed for certain people. Some people may need certain surgeries. A dental appliance for some people

Rules of Thumb for Quack Detection

Quacks can appeal to our natural desire to find a quick cure. Mr. Chambers was not interested in using a CPAP machine to sleep. Chambers was disappointed that the initial CPAP treatment didn’t work as well as he expected.

He was looking for a simple solution. He was swayed by a quack. How do you identify a quack? Who are you to believe? Is it really important if you feel better than Mr. It does matter if, like Mr., It does matter for two reasons:

• Quacky can be expensive. Quack remedies can be expensive if you have a tight budget.
• Quackery can cause death, directly or indirectly through the use of a dangerous product. Here are some guidelines to help you avoid quackery and the associated risks.
• Be skeptical. Be skeptical of anything that sounds too good to be true.
• Check for the credentials of the person making the claims. Is he able to document any training that qualifies him/her to give medical advice?
• Ask questions about the research. Are the results repeated and verified by other researchers? Are the results peer-reviewed and published in respected medical journals by other scientists?
• Follow the money. Is it a good idea to spend money on this product? Is it reasonable or are you being offered a $50 dime-store item? These are the rules of thumb. How does magnetism stand up to them?
• It seems too good to be true, that small magnetic fields could eliminate the effects of sleep apnea. Yes.
• Does the “authority” who sells this theory have any medical credentials? Is the research valid?

Alternative Medicine: What It Can and Can’t Do

Except for a few cases, most alternative medical treatments are safe and effective, as long as they are not used to replace good primary care. You should be scientific if you are interested in trying alternative methods. Talk to your doctor about your ideas, then do a controlled experiment. Then, return to the sleep laboratory and see if there is a significant improvement in your sleep apnea.

Two very bad decisions

It is a bad idea to discontinue using the sleep treatment that your doctor prescribed and try a different one. You can experiment with other treatments, provided they aren’t harmful. However, you should still use your CPAP device at all times. Your sleep apnea will return if you stop using CPAP. It will get worse.

A second dangerous decision is to choose an alternative practitioner for your primary or sole doctor. Many alternative doctors have little medical training. If they fail to properly treat a serious condition (diabetes or cancer), it could prove fatal. You should also seek out alternative treatments if you are forced to.

Perhaps this is the cure.

The cure for sleep apnea might be found in an obscure alternative medical treatment. Many scientific discoveries have been made outside of the traditional medical establishment. The medical establishment is slow to accept new ideas. Unconventional treatments are treated with suspicion and skepticism and are often rejected by the medical community.

It takes a long time to incorporate a new concept in mainstream medicine. This is evident in the case of sleep disorders medicine. Although sleep disorders research has been ongoing for over 40 years, it is only now that the subject of sleep disorders medicine can be taught in medical schools. This skepticism protects the public against falsehoods.

The peer review and scientific method must be used to validate new medicine. This prevents the misuse and exploitation by unscrupulous companies, incompetent scientists, and personal greed. It is not perfect.

There are some bad scientific articles in medical journals. Sometimes, good treatments take longer to reach patients than they should. Although progress seems slow, there are still significant advances being made. When the review process fails, we are reminded how important it is to be skeptical and cautious.

Pregnant women were recommended thalidomide in 1950 to treat morning sickness. It was not well tested and caused severe birth defects. The medical community has not heard of a cure for sleep apnea, and even if it exists, it hasn’t had the chance to test it scientifically. Prudence suggests we continue to use our CPAP units, and that we remain patient and skeptical.

Summary

• Guidelines for diagnosing medical quackery are asking for certificates.
• Find out who the profits are and whether the service or product is worth the investment.
• Find out if the research was conducted using a scientific method.
• If you are interested in other therapies, your CPAP should be used.
• Don’t use an alternative practitioner as your primary or sole physician.

It is important to find a certified sleep specialist, as sleep disorder medicine is relatively new, and very few doctors have been trained in it. According to a survey, 20 minutes was the average time spent teaching sleep medicine, and sleep apnea surgery in medical schools.

Your doctor might want to refer you to someone who isn’t board-certified in sleep medicine, or doesn’t practice it full time because of financial arrangements and managed care. Check to see if your plan is “capitated”.

This means that each time your doctor orders a test, it costs the clinic money. Capitated settings are more likely to deny you care or offer lower quality or unproven services. Although the doctor may not be conscious of trying to save money, they may be too eager to believe that some service is “cheaper” or “just as good.”

But do you really want to be the exception? Most established specialties, such as pediatrics, obstetrics/gynecology, otolaryngology psychiatry, and so on, have their own departments in hospitals and medical schools. Specialists in these fields teach medical students, who learn how to diagnose and treat illnesses. Doctors can spend many years in residency programs after graduation to perfect their skills in the chosen specialty.

However, there are very few schools that offer programs or courses in sleep disorders medicine. Therefore, only a few doctors are qualified to diagnose and treat sleep disorders. Early sleep medicine specialists created a professional organization in order to set the standard for professionalism in this field. The American Academy of Sleep Medicine (www.aasmnet.org), today establishes standards for evaluation and treatment of sleeping disorders and gives accreditation to sleep disorder centers.

The American Board of Sleep Medicine certifies and tests sleep medicine specialists. The field of sleep disorders medicine is expanding rapidly. The AASM hopes that within a few years, all major medical schools will offer programs on sleep disorders. The public will need to be careful to find a qualified sleep specialist until systematic sleep medicine training is integrated into the medical school curriculum.

Qualifications for a Sleep Specialist

The AASM defines a sleep specialist to be “a doctor who is. . . AASM members include more than 6,000 doctors, researchers, and other health care, professionals.

Find a Board Certified Sleep Specialist

Specialists in sleep medicine are doctors who have completed medical school to continue their studies and then enrolled in graduate courses or fellowship programs. The American Board of Sleep Medicine (ABSM) certifies a physician to be a sleep specialist.

He is now a board-certified sleep specialist (BCSS). The American Board of Sleep Medicine has a list of certified sleep specialists that you can find online at www.absm.org. You can also call the American Board of Sleep Medicine (507 287-9819) to inquire if a specific doctor is certified in sleep medicine.

Many doctors who have been trained in sleep medicine are not certified. They may still be knowledgeable about sleep disorders. As with any medical specialty, board certification in sleep medicine ensures that you, the patient, have received specific training and are qualified to perform sleep testing and interpret the results. A sleep study at an accredited clinic is a must before you begin a treatment program. This is especially true if surgery is involved.

Standards for Accredited Sleep Centers

An AASM-accredited sleep center is one that meets the requirements. There were over 1,000 accredited laboratories and sleep centers in the United States as of summer 2007. There were also thousands of accredited sleep laboratories that are not recognized by the AASM. Although no one knows how many of these sleep laboratories are accredited, the AASM has received thousands upon thousands of inquiries from sleep laboratories seeking information on accreditation.

Although a non-accredited laboratory might be reputable, you don’t have the ability to verify this. Your family physician may not be familiar with all aspects of quality sleep medicine and may refer you to someone from his group.

There is a wide variety of quality, from reputable sleep labs to those on the street. The AASM does not have the resources, staff, or mandate to “police the whole field of sleep medicine beyond its membership. Until now, however, there has been no other agency or organization that is monitoring the quality of the sleep testing performed in non-AASM-accredited labs.

Find a Accredited Sleep Center

You can be a responsible consumer and choose an AASM-accredited sleep center if you are looking for assurances of professionalism in this new field. The Internet allows you to find accredited centers for sleep disorders in your state at www.aasmnet.org. Click on Patients and Public then click on Find a Sleep Center. There are two types of accreditation standards: specialty laboratories and full-service centers.

All-Service Sleep Centers

Accreditation for a full-service center for sleep disorders ensures that it can deal with all types of sleep disorders professionally. These are the AASM’s primary requirements for a full-service sleep center.

• The center must have an ABSM-accredited medical polysomnographer (MD) or Ph.D. on staff to interpret and read the sleep recordings.
• The center must have a full-time doctor who is an expert in sleep physiology. It must be able to provide sleep testing services by certified technicians. It is a good idea to have at minimum one registered polysomnographic technologist in a sleep center.
• Each patient must have their own private room with sound, light, and temperature control. They also need easy communication with the attendant.
• All facilities, procedures, and patient care must conform to the standards of the ABSM. A two-member accreditation committee must inspect the sleep center every five years to ensure that it is not disqualified.

Laboratories of Specialty

While the standards for specialty laboratories are similar, they are tailored to sleep testing roles. The majority of specialty laboratories deal with pulmonary medicine (breathing problems), and their diagnostic testing is primarily for sleep apnea. A specialty laboratory must have at minimum one pulmonary specialist.

• Staff must have knowledge about the procedures and practices of sleep disorders medicine.
• All aspects of patient care, including the physical environment, facilities, testing procedures, and patient care, must be in line with ABSM standards.

What to do if you are denied referral to a qualified sleep specialist or laboratory

It is important to be aware of these guidelines when you are receiving a denial, delay, or other administrative notice regarding your health care.

• First, if you have an urgent need or it is an emergency, you should immediately seek the treatment you require and not delay in seeking referrals or insurance coverage.
• Second, remain calm. You’re not the only one. Healthcare is complex and large. It can sometimes take patience to navigate the healthcare system.
• Third, continue calling your insurance company, follow up with their processes, and keep track of names, claim numbers, and other details.

The following guidelines apply to sleep disorders. Sleep problems are not usually life-threatening. However, if you have an urgent need for medical attention, it is a good idea to get it. When the staff at the office ask for billing information or a referral, tell them about the situation and promise to follow up. Take all information that you can, such as your cards and health insurance, doctor visits information, bills, and other pertinent information. Tell the insurance company about your situation as soon as you can.

Keep the name of the person with whom you spoke. It may not seem like much, but it could make a difference in the future. Prepare to tell your story to many people. Before you start, a speakerphone or another hands-free phone is a good investment.

It’s not uncommon to spend a lot of time on your phone. Be persistent. Be persistent if you don’t get the answer you want. Sometimes, your primary care physician can help you appeal. Your doctor might be able to write a letter for you or can send your medical records to your insurer.

Do not give up and just go anywhere!

If appeals fail, you can write to your state’s insurance commissioner. You can find their number by calling the government information number in your state capital. Each state has an office or individual who supervises insurance plans and HMOs. Insurance commissioners are keen to identify these kinds of issues due to well-publicized cases of abuse.

How to Find the nearest Accredited Sleep Center or Sleep Specialist

A booklet with a list of accredited American sleep centers will be mailed by the AASM. The following address is where you can write to the AASM. Include a large, self-addressed, stamped envelope.

• American Academy of Sleep Medicine
• 1610 14th Street NW Suite 300
• Rochester MN 55901-2200
• (507) 287-6006
• www.aasmnet.org

• American Board of Sleep Medicine
• (507) 287-9819
• www.absm.org

• Sleep patterns in older people are more irregular and lighter.
• Sleep disturbances can be caused by movement disorders, sleep apnea, and pain.
• Schedule a sleep study if you suspect that you may have sleep apnea.
• A good sleep routine can improve your quality of sleep.
• Seniors can benefit from exposure to the morning light (outdoors or indoors with an LED box).
• This regulates the sleep-wake cycle and helps them sleep thru the nite.

It is common for older people to sleep less at night than younger ones. This assumption is often accompanied by the belief that older people don’t require as much sleep. However, both assumptions can be questioned. People over 50 get 7 hours sleep per night, whereas people between 19 and 30 have 8 hours.

This may be partly due to the fact that older people wake up earlier in the mornings and because they are more likely to get up at night. But, it is possible that older people take more frequent daytime naps than younger people.

This means that an older person may get 8 hours of sleep in a 24-hour time period, which could be comparable to a younger person. The quality of older people’s sleep isn’t as good as that of younger people.

You can see that sleep quality is affected by the amount of wakefulness during the night. The sleep of older people is less dense and fragmented due to wakefulness than that of younger people. Older people experience less deep sleep. Although they get more REM sleep than younger people, it is less intense.

Napping may be an option for older people to make up for the sleep they have lost over the night. Some people may find that naps can make up the sleep loss, but they don’t make up the quality of their sleep at night. Naps may actually make the problem worse in some cases. They can make the person feel less tired at night or confuse their internal clock. It is unclear what the difference in sleep between older and younger people means. It is not known why deep sleep is necessary and REM sleep is important. Therefore, the reason for the decline in these stages with age remains a mystery.

Myths About Aging and Sleep

Most older adults are in good health and complain about sleeping disturbances very little. Although their sleep is less consistent than when they were younger they don’t seem to be too bothered. Some older adults have severe sleep problems. Some myths about sleeping and aging may discourage them from seeking help.

Being tired is not a sign of aging. Don’t believe that feeling sleepy during the day means you are old. You may have a sleep disorder that can be treated if you feel tired and unable to concentrate for more than an hour. Poor or disturbed sleep is not normal. Don’t believe excuses that poor or disturbed nighttime sleep is normal. Do not be discouraged if you feel your quality of life has been affected by sleep problems.

Why Older Adults Have Trouble Sleeping

Sleep Apnea

Sleep apnea can be a serious condition that can disrupt the sleep of elderly people. According to studies, sleep apnea was reported in up to 30% of healthy older adults. It is likely caused by the progressive loss of muscle tone in the upper airway, which occurs with age. Sleep apnea in older adults is often mild to moderate.

It is often not severe enough or barely severe enough to be considered clinical sleep apnea. This means that there are fewer than five events of apnea lasting more than 10 seconds per hour or 30 events in a single night.

A mild case of sleep apnea in healthy older adults is not usually a sign that they need treatment. As long as they are well-rested, it seems the consensus is that this level is normal. But, sleep apnea symptoms should not be overlooked. Healthy seniors should not be afflicted by drowsiness or loss of mental alertness.

They must strive to stay as active and alert as possible. Apnea episodes can cause sleep fragmentation and a decrease of oxygen in the blood. This can lead to daytime drowsiness or loss of alertness. Daytime drowsiness is less common in seniors with restless legs or other sleep disorders like apnea.

Sleep apnea could be the cause of daytime drowsiness in seniors. You may contact a sleep center if you suspect that your sleep is being disturbed by apnea. If you have trouble sleeping at night and your partner is snoring, somnoplasty might be an option..

Leg Movements During Sleep

About 40% of older adults experience involuntary movements of the legs during sleep. Restless legs syndrome is a condition where a person feels uncomfortable or achy and has a strong urge to move their legs. This can make it difficult to fall asleep. These are repetitive kicking movements that occur during sleep.

They are called nocturnal myoclonus (periodic leg movements). They may wake the sleeper but are often more disruptive for the bedmate. Talk to a sleep specialist if you or your partner experience any of these disorders.

Medical Problems and Depression

Older adults who are less healthy may experience sleep problems such as pain from arthritis, respiratory issues, leg cramps, and frequent urination. Another condition that can impact sleep is depression. Depression symptoms can be attributed to “just growing old”.

They include insomnia, pessimism, loss of interest, decreased self-esteem, poor sexual function, increased health problems such as constipation and back pain, abdominal pain, headaches, social withdrawal, decreased appetite, and weight loss.

These symptoms are not inevitable with aging. These symptoms are rare in healthy older adults. If you have symptoms like poor sleep or other signs of depression, then it is important to treat the depression and not just the symptoms. As some treatments can cause sleep problems, it is better to consult a sleep specialist before treating medical issues or depression.

A Good Night’s Rest

One of the most common complaints about older adults is their inability to sleep well. This is a common problem that people have become concerned about. The worry of not getting enough sleep can keep them awake at night. Here are some things you can do if you’re a senior experiencing frequent nighttime awakenings and sleepiness.

Good sleep hygiene is a way to make your day more pleasant. Regular meals are a must. b. Get more exercise each day, but don’t do it right before bed. c. Get outside every morning. To regulate your sleep-wake cycle, your biological clock requires light signals every day. Indoor lighting is too dim to be effective. Even on cloudy days, morning light can help to reset your sleep-wake rhythm and improve your sleep quality.

These are often more due to boredom than sleepiness. Instead of snoring, find something to do. e. Create evening activities with friends, or alone. Enjoy a relaxing evening. You should limit your intake of caffeine (coffee and tea, cocoa, cocoa, and cola), and drink moderate amounts of alcohol (alcohol interferes with sleep).

You will feel less need to urinate at night if you limit your intake of fluid after 7 p.m. Get out of bed at a specific time every morning, such as 6:30 or 7 AM. I. Relaxation techniques can be used to ease tension and worries that might keep you awake at night.

You can rest assured that your nighttime awakenings may be normal and that you are getting enough sleep. This information alone can help you relax and stop worrying about whether or not you are getting enough sleep.

This knowledge will allow you to sleep better. These suggestions may not be effective. You should seek professional help. These suggestions should be tried for several weeks in a controlled manner. If they fail to work, you should consult your doctor. If you are still having trouble sleeping, your doctor may refer you to a sleep clinic.

Talk to a sleep specialist if you suspect that you may have a medical condition that is interfering with your ability to sleep. Sometimes, the treatment of one medical condition may not be the same as the treatment of another.

Some drugs that are prescribed for heart conditions can make sleep apnea worse. Sleeping pills, like alcohol, almost always make sleep apnea worse. Side effects of some antidepressants and barbiturates can have a negative impact on sleep.

Your family doctor may not be as familiar with these sleep effects, so a sleep specialist will likely know more. Together, they can find the best way to improve your sleep. The sleep specialist might recommend sleep apnea surgery if your sleep apnea is severe or moderately serious. The severity and type of your apnea will determine the treatment you need.

Summary

• Many older people get the same amount of sleep per night as young people.
• The quality of older adults’ sleep may be less than that of younger people. This is because it is more disturbed by prolonged periods of wakefulness.
• Sleep apnea and leg movement syndromes can all interfere with seniors’ sleep.
• If you feel tired or your quality of living is declining, seek help.
• For testing and an interview, visit an accredited sleep center.
• A program of good sleep hygiene can often solve mild sleep problems.

Although women’s sleep has only been studied since the 1990s there is much more to be learned. It is clear that women’s sleeping patterns are more complex than those of men. This is due to the physiological changes that begin with puberty, continue throughout life, including pregnancy, childbirth, menopause, and menstruation.

One theory suggests that evolution may have favored women’s ability to alternate between waking up quickly to care for their infants and then grabbing a brief, deep, “power” sleep before being awakened for the next round of infant care. Fatigue and insomnia are more common in women than in men.

Insomnia is three to four times more common in women. Variations in women’s sleep patterns and ability to stay asleep are due to hormonal fluctuations. Premenstrual women are more likely to experience insomnia and fragmented sleep.

In the postmenstrual phase, however, falling asleep is usually easier. Women who have gone through menopause or older men may have a shorter sleep time and experience a lighter sleep cycle. Hot flashes can cause sleep disruptions in women during their hormonal transition years.

Hot flashes can cause daytime fatigue in women, which can have negative consequences for overall health. The effects of pregnancy on sleep are devastating. After childbirth, a woman may not experience the same quality of sleep she had before. Women are more likely to experience periodic limb movement during sleep (PLMS) and restless legs syndrome (RLS).

Sleep Apnea looks different in women

Sleep apnea has been a common condition in men for many years. It was 10 times more common than it was in women. The ratio of men and women with sleep apnea was closer to three to 1. 28 percent of middle-aged females snore regularly, compared to 44 percent of men. The rate of sleep apnea triples after menopause.

No longer is sleep apnea confined to men. Women may not experience the same symptoms of sleep apnea as men, which is why it has been so underdiagnosed in women. Men tend to snore loudly, and they have apneas that go on and off throughout the night. One in four women also snore, but this is usually limited to rapid eye movement (REM).

Women may also experience a quiet form of sleep apnea known as upper airway resistance syndrome (UARS). UARS can be more subtle than snoring but has the same long-term effects as obstructive sleeping apnea.

UARS causes a struggle to breathe, disrupts sleep, and lowers oxygen levels. UARS can be treated with continuous positive pressure (CPAP) just like obstructive sleeping apnea. UARS and sleep apnea may lead to hypertension and diabetes.

Women, Obesity and Sleep Apnea

Overweight adults account for one-third of all adults. Obese women are more likely than others to suffer from sleep apnea and other health risks associated with excess weight. The metabolic syndrome is a deadly mix of obesity, high blood pressure, diabetes, and high cholesterol that can lead to high mortality rates. It should be addressed from all angles.

Obstructive sleep apnea is a contributing factor to metabolic disorder. Treatment of sleep apnea must be included in a treatment plan that focuses on weight management, diabetes control, blood pressure, cholesterol, controlling blood pressure and maybe even sleep apnea surgery. How can you determine if you are obese?

Anyone with a BMI greater than 25 is considered obese according to the standard Body Mass Index (BMI). Your waist measurement should be less than 4 inches wider than your hips. This is called “central” obesity. It is more dangerous than the hips and thighs pattern of excess weight. You or someone you love falls into one of these categories.

It is a good idea to find out if you are suffering from sleep apnea. Ask your doctor to refer you to wellness programs that focus on weight management and lowering your cardiovascular risk. These programs are offered by most medical centers, and often insurance will cover them.

Pregnancy can be complicated by sleep apnea

Women often experience sleep apnea during pregnancy. About 25% of pregnant women experience sleep apnea episodes, especially in the third trimester. It is possible to snore lightly, but it is not usually a problem.

Heavy snoring can increase the risk of pregnancy complications. Snoring, in particular, can increase your chances of preeclampsia and hypertension.

The fetus’ growth can be impeded by excessive snoring from the mother. A visit to a specialist in sleep medicine is recommended if a woman is snoring during pregnancy or if her breathing becomes difficult. Pre- prescriptions can be made for CPAP therapy during pregnancy and it can be stopped if the baby is born.

Menopause Is More Common for Sleep Apnea

Hot flashes may not be enough to bother you, but menopausal women might have sleep apnea. After menopause, the chances of developing sleep apnea increase by three times. Normal women with an average weight can experience sleep apnea symptoms.

They may wake up at night and feel fatigued, coughing, or choking. Half of the women complain about their sleep after and during menopause. These sleep problems were once considered normal after menopause.

Under the assumption that low or fluctuating hormones cause sleep problems, hormone replacement therapy was prescribed. We now know that hormone replacement therapy does not reduce hot flashes or other sleep problems.

As symptoms of sleep disturbances after menopause, you should take them seriously as they could be signs of sleep apnea. A sleep study can help you determine if there are any issues. A researcher who studies women’s sleep cautions doctors that menopausal women should take the same seriousness to signs and symptoms that could normally prompt a complete sleep evaluation. Don’t wait for your family doctor or specialist to recommend a sleep study. They may not even think of it.

Summary

• While women are more likely to experience insomnia than men, they are about one-third less likely to suffer from sleep apnea. After menopause, sleep apnea is more common.
• Obesity and weight gain increase the severity of sleep apnea.
• Sleep apnea is often associated with metabolic syndrome (obesity and diabetes, hypertension, and high cholesterol). This should be treated using CPAP and management weight, diabetes, and cholesterol.
• Sleep apnea is when you wake up coughing, choking, or stopping breathing while you sleep. You should schedule a sleep study.

• One in three adults is obese.
• Obesity can increase the chances of developing an obstructive sleep disorder.
• Metabolic Syndrome is a deadly combination of sleep apnea and hypertension.
• Diabetes, obesity, hypertension, high cholesterol, and hypertension.
• Weight management and treatment of sleep apnea are key to success in overcoming metabolic syndrome.

Sleep apnea is a common condition in overweight people. You don’t need to be overweight to experience sleep apnea. However, some people who are obese do not suffer from it. However, the correlation between obesity & sleep apnea can be very strong. Obesity can be a serious medical problem.

Obesity isn’t about reducing weight or changing your clothes size. Obesity and sleep apnea both contribute to a host of medical conditions that can lead to worsening of your health.

Why should you care if your obesity is a problem? The Sinking Spiral

Three reasons why obesity and sleep apnea often go hand-in-hand are: Fat deposits build up in the tissues of the neck and cause obesity. This can cause constriction of your airway, which can lead to sleep apnea and snoring. Obese people are more likely to have excess fat tissue in their abdomen, which can cause abnormal loading and interfere with normal breathing. A sinking spiral develops. Sleep apnea is a sleep disorder that causes sleep to be interrupted. It results in poor quality sleep at night and daytime sleepiness.

Recurrent awakenings can stress the sympathetic nervous system. Hypertension is caused by this and extra weight. As the body loses its ability to handle carbohydrates, it can slip into insulin resistance. This is adult-onset diabetes. Continued weight gain. The levels of cholesterol rise and cardiovascular disease take its toll. Excessive daytime sleepiness (EDS), which is a result of sleep apnea, also increases. A person becomes less active, consumes less energy, and is more likely to have a stroke or heart attack. Breaking the cycle is key. This can be achieved by weight loss, but it’s extremely difficult to lose weight and maintain it in the face of all the other obstacles. If sleep apnea remains untreated, weight loss can be difficult or impossible. The spiral can be stopped by treating sleep apnea. This will allow you to regain your total good health.

How do you know if you’re obese?

Waist circumference is the simplest indicator of central obesity. Central obesity is defined as a waist measurement greater than 40 inches for men and 34 inches for women. Central obesity can lead to serious medical conditions such as heart disease, diabetes, sleep apnea, and hypertension. Extra weight on the hips and thighs is not a concern.

You can also measure your hips and waist by comparing them. You have central obesity if your hips and waist measurements are less than 4 inches. The Body Mass Index (BMI), a more accurate measure of obesity, is shown on page 105. The Body Mass Index is calculated simply by multiplying body weight by the square root of your height. You can find your precise BMI at the following National Institutes of Health website, by typing in your height and weight: www.nhlbisupport.com/bmi/bmicalc.htm.

The Metabolic Syndrome, Sleep Apnea and the Metabolic Syndrome

Metabolic Syndrome is a group of disorders that can often be combined and feed off each other, leading to a downward spiral in health. These conditions include:

• Adult-onset Diabetes (also known as type 2)
• Insulin resistance (the body doesn’t use insulin properly)
• Central Obesity (extra weight is concentrated on the abdomen)
• High blood pressure (higher than 140/90mm Hg)
• High cholesterol.

A person with three or more of these conditions is called the Metabolic Syndrome. The Metabolic Syndrome also includes sleep apnea.

This is because sleep apnea can be treated in people with Metabolic Syndrome to improve insulin use, lower blood pressure, or improve cholesterol. The Metabolic Syndrome, if not treated, can lead to permanent damage to the kidneys, blood circulation, eyes, and brain. . . and premature death. Obese people should find out if they have sleep apnea and get it treated. CPAP removes obstructive apnea. This allows for more restful sleep, better blood oxygen levels, and higher metabolism, which can boost one’s energy level. This can help with weight loss by increasing energy and activity.

The Obesity Hypoventilation Syndrome or the “Pickwickian Syndrome”,

Pickwickian syndrome, which is a combination of severe sleep disorder and obesity, can be accompanied by hypoventilation or heart failure. This syndrome affects approximately 5 percent of patients with sleep apnea. William Wadd (a surgeon to King George III) connected obesity, lethargy, and breathing difficulties in 1816. Three patients were described by Wadd as “suffocated” by fat. A second medical man, A. Morison reported a case in 1889 of an obese and drowsy patient whose drowsiness increased after he lost weight.

The Pickwickian syndrome was first described by anyone in the 1950s. The first person to link obesity and breathing difficulties was a respiratory physiologist. He suggested that obesity causes extra strain on the respiratory system and that this can lead to sleepiness and lethargy. However, he did not connect sleep apnea to the whole picture. Gastaut, in 1965, demonstrated the link between excessive daytime sleepiness and sleep apnea. In 1910, Bramwell published the first medical term Pickwickian. He was reminded by one of his patient’s symptoms of the behavior and description of Joe in Dickens’s The Posthumous Papers of the Pickwick Club (1837). Joe was a “wonderfully obese boy” who would sleep so well that he could stand up. This idea might seem absurd to someone who is not familiar with Pickwickian Syndrome. This may seem strange to someone who has never experienced Pickwickian syndrome.

What is the Pickwickian Syndrome and How Can It Be Treated?

Pickwickian Syndrome results from multiple conditions: obesity, sleep apnea, and abnormal breathing patterns. A few people have a low breathing reflex that allows carbon dioxide (which is a waste gas) to build up in their blood. If the person’s breath is shallow, this tendency can get worse. Obesity can cause shallow breathing because it interferes with the function of the breathing muscles.

When a person lies down, this abnormally shallow breathing pattern can lead to symptoms such as frequent awakenings and sleep apnea. This vicious circle is known as the obesity-hypoventilation syndrome or Pickwickian Syndrome. Pickwickian Syndrome can develop in childhood and may also occur in older adults who were thin.

What are the effects of Pickwickian Syndrome?

Pickwickian Syndrome can cause the same problems as other types of sleep apnea. Pickwickian Syndrome causes fragmented sleep. Deep sleep and rapid eye movements (REM) are often reduced to almost zero. Because the person’s shallow breathing doesn’t take in enough oxygen at night, it can lead to a form of slow asphyxiation. It is not uncommon to experience excessive drowsiness in the daytime. Pickwickian Syndrome sufferers have a remarkable tendency not to fall asleep when there is any relaxation.

Pickwickian Syndrome sufferers often fall asleep while at work, driving, or in a conversation. Roberts recalls how he used to drive to work every day and then fall asleep in the parking lot. He would fall asleep in the parking lot, so his coworkers would find him and take him to his office. One Pickwickian doctor said that he fell asleep while examining a patient. His head was resting on the shoulder of the patient when he awoke. After falling asleep in a weekly game of poker, a Pickwickian business executive sought treatment. He had drawn a full house (kings over aces) and then fell asleep again.

Pickwickian Syndrome is closely linked to serious heart disease. Along with the risk of stroke, hypertension, and coronary heart disease, obesity is closely associated with the Pickwickian Syndrome. There are also risks of heart enlargement and arrhythmias that can be caused by sleep apnea. The rate of sudden death in obese people is high. Pickwickian Syndrome is a serious condition that can be life-threatening.

The Pickwickian Syndrome: How to Treat It

The most conservative treatment is continuous positive airway pressure (CPAP), combined with weight loss, otherwise your doctor might recommend sleep apnea surgery. A temporary tracheostomy may be considered if CPAP fails to eliminate sleep apnea or low blood oxygen levels. There are mixed reports in the medical literature about weight loss’s effectiveness in relieving symptoms of this syndrome. It is possible that the individual’s apnea may improve if they lose more weight. There may be a threshold weight at which Pickwickian Syndrome symptoms can manifest. Weight improvement is possible below this point.

A good example is Mr. Roberts, who has seen a positive outcome with CPAP and weight loss. Pickwickian Syndrome patients who are treated this way may experience a complete “remission”. They can stop using CPAP and appear to be cured of sleep apnea. Gastric bypass, which is weight loss surgery, has been shown to be effective in treating Pickwickian Syndrome. It reduces sleep apnea to a minimum level and restores deep sleep and REM sleep. Gastric bypass surgery should not be considered a routine operation.

Summary

• Obesity is a common complication in patients with obstructive sleep apnea.
• Metabolic syndrome can be described as a combination of obesity, diabetes, and hypertension. It is possible to treat sleep apnea.
• The Pickwickian Syndrome refers to a type of sleep apnea that is caused by obesity and an abnormally shallow breathing mechanism. The Pickwickian Syndrome is characterized by:
  • Obesity
  • daytime drowsiness
  • falling asleep during routine activities
  • sleep apnea
  • Treatment options include CPAP and weight loss

• During sleep, breathing stops several times.
• Each time you stop breathing, oxygen in your bloodstream decreases.
• The person awakens many times during the night to breathe.
• This led to poor sleep and not enough oxygen.
• People with sleep apnea are often unaware of it.
• Sleep apnea is usually noticed by the partner who is sleeping.
• Low oxygen levels, strenuous breathing, and sudden awakenings during the night can all contribute to high blood pressure and heart disease.

The Three Types of Sleep Apnea

There are three types of sleep apnea. They can be classified according to the cause: central sleep apnea (obstructive), central sleep apnea (central), and mixed apnea. Treatment depends on the cause. Let’s examine the causes of each type.

Obstructive sleep apnea

Obstructive sleep apnea is a condition where the upper airway becomes blocked by tissue from the tongue, throat, soft palate, and throat. The blockage may be caused by combination of anatomical factors and irregularities in breathing reflex.

Obstructive sleep apnea is a condition that makes it difficult for a person to breathe due to an obstruction in their airway. Although his chest moves in and outside, the obstruction prevents air from flowing into or out of the lungs. Finally, his oxygen level drops to the point that he can no longer breathe due to his arousal reflex.

Obstructive apnea patients may be affected by anatomical abnormalities in the upper airway, such as passages in the nose or pharynx (throat). These abnormalities can be observed in the head radiographs of many people suffering from obstructive sleeping apnea.

The abnormal nasal structure could be due to a nasal septum defect or chronic swelling from allergies.

Obstructions in the upper pharynx could include enlarged tonsils, adenoids, a long or fleshy soft palate, or a large Uvula (the fleshy tab that hangs from the back of the throat). The problem in the lower pharynx could be a large or unusually long tongue, a tongue that is too far back or down, a small airway opening, a shorter neck, or a very short lower jaw.

Obstructive sleep apnea can be caused by any one of these structural features or a combination thereof.

Obstructive sleep apnea is often caused by body weight. Half to three-quarters of patients suffering from obstructive sleeping apnea have a bodyweight greater than their ideal weight. For several reasons, obstructive sleep apnea can be common among overweight people. People who have more weight often have fatty deposits in their throat tissue that narrow the upper airway. A second reason is that extra weight can cause breathing problems in heavy people.

Obstructive sleep apnea can also be caused by age. The shape and tone of the upper airway muscles tend to change with aging. While many people don’t experience obstructive sleeping apnea while they are young, others develop it during their 60s and 70s.

Also, gender is a factor. Obstructive sleep apnea occurs three times more frequently in men than it is in women. After menopause, however, the likelihood of developing obstructive sleeping apnea in women increases dramatically.

Obstructive sleep apnea can be treated by removing obstructions to the airway.

You can do this by using a breathing device or surgery. Weight loss is often helpful if obesity is not a problem.

It is crucial that a doctor determines the exact cause of obstructive sleeping apnea before recommending the best treatment or sleep apnea surgery.

Central Sleep Apnea

Pure central apnea, which is the most common type of sleep apnea, is the least common. Central apnea refers to the central nervous system or brain that is responsible for the breathing problem. Central apnea is a condition in which the brain’s respiratory control center, which controls breathing, may stop functioning during sleep. It does not signal the chest muscles to make breathing movements. Researchers believe that this could be due to a variety of disorders in the sleep system.

Breathing reflex. It could be an inherited neurological disorder or a neuromuscular disorder that develops later in life.

Pure central apnea can make it difficult to sleep and breathe at the same moment. The person’s breathing stops as soon as they fall asleep. The person wakes up with a startled gasp and an emergency arousal reaction. A person with severe central apnea may not get enough sleep. This can be a very distressing condition and may last many years before it is properly diagnosed.

People with a psychological disorder called sleep-onset anxiety may experience central apnea. People suffering from sleep-onset anxiety have a tendency to panic about falling asleep. They are able to breathe faster and more deeply, which causes a drop in blood carbon dioxide. They fall asleep quickly and their breathing reflex is not activated for long periods of time due to the low-level carbon dioxide. They end up experiencing central apnea and then awakening to breath.

A person suffering from central apnea usually complains about not getting enough sleep. His problem may be described as “insomnia.” This is due to his nightly awakenings. Only 5% of people suffering from insomnia have sleep apnea.

For people with central apnea, obstruction of the airway is usually not a problem.

Research suggests that central apnea can sometimes be triggered by obstructive airway obstruction. If the obstruction of the airway is treated, central apnea can disappear. Central sleep apnea is common in people with heart disease. Central sleep apnea can be treated with continuous positive pressure (CPAP).

Long-term effects from central apnea can be similar to those of obstructive. These include enlargement of the heart, lung complications, and heart failure.

Central sleep apnea can be treated with bilevel positive airway pressure (bilevel PAP). Drug therapy is promising. If there are any airway obstructions, surgery may be an option. A nighttime ventilator device might also be used. The diaphragm pacemakers have been also developed. They may be an acceptable treatment for central apnea.

Mixed Apnea

Mixed apnea refers to a combination or central and obstructive hypopnea. Many people suffering from sleep apnea have some type of mixed apnea. Some sleep researchers believe that most people with obstructive sleeping apnea have a central component. Additionally, abnormalities in the brain’s breathing reflex often accompany the development of obstructive.

Different people interpret mixed apnea differently.

According to them, when a person recovers from an obstructional apnea episode, she often “over breathes,” which causes a low blood level of carbon dioxide. This lower level of carbon dioxide can trigger a central event that causes mixed apnea. The more severe the obstruction, the more likely it is that there will be “over-breathing”, and the more apparent the central apnea component.

No matter what the cause or effect of mixed apnea may be, treatment is generally done first. The central apnea can often disappear once the breathing obstruction has been treated.

Summary

• Sleep apnea is when your breathing becomes difficult.
• Sleep apnea can lead to cardiovascular problems, high blood pressure, and higher chances of stroke and heart attack.
• There are three types of sleep apnea.
• The brain is the origin of central apnea (the least common type).
• Obstructive sleep apnea can be caused by an obstruction in the airway.
• Mixed apnea is the most common type. It includes central and obstructive.
• The type of apnea will determine the treatment that is chosen.

Why do we sleep?

No one knows why we sleep. People used to believe that sleep was a time for resting our brains. Polysomnography was then developed. This technology allows scientists to make electrical recordings of brain activity during sleep. Scientists were shocked to find that brains do not remain inactive during sleep.

One theory suggested that sleep is necessary to combat body fatigue. Although our bodies seem to be able to recover from fatigue while we sleep, studies have shown that our brains, and not our muscles, require sleep to function properly.

How much sleep do we need?

There are many factors that influence how much sleep you need.

We used to believe that babies required 21 hours of sleep each night. But, we now know that infants’ sleep requirements vary greatly from one infant to the next. Sixteen-year-olds need about 10 to 11 hours of sleep per night, while an adult needs around 8 hours.

Occasionally, healthy and alert adults can get 4 hours of sleep but this is very rare. Habitually, the average amount of sleep is about 3 hours per night. It has never been proven that anyone needs no sleep.

What happens when people are repeatedly deprived of sleep? The body’s physiological systems are affected by sleep deprivation: hormones and immune system, blood pressure regulation as well as the digestive system and urine production.

Many of our physiological functions have a 24-hour rhythm. Our biological clock is synchronized by the rhythms of going to bed and getting up in the morning. If a person is having trouble sleeping or has an irregular sleep schedule (for example, shift work), it does not send signals to the biological clock to reset its own clock each day and maintain synchronized rhythms.

The body will show signs of a disturbance if the daily rhythms don’t match, such as when someone works the night shift. Shift workers are more likely to suffer from digestive problems, headaches, or other types of cancer.

People who are sleep-deprived experience drowsiness from time to time. This is because their biological clock attempts to get them to go to sleep. Their ability to concentrate and ability to think dullens. Teenagers and school-age children are particularly affected by sleep deprivation. Many of them are severely sleep-deprived.

People who are sleep-deprived may also experience irritability, disorientation, and dreamlike hallucinations. The body’s reactions become slower and more erratic. Sleep-deprived drivers are more likely to cause accidents in their cars. Studies show that driving tasks like driving can be impeded by a person who sleeps only 7 hours per night. For one to have a high level of reaction time, nine hours must sleep every night.

Partial sleep deprivation by itself is not fatal. It can lead to fatalities if it affects the ability of the driver or passenger to drive safely on the highway. An average of four people are killed each time a long-haul truck driver crashes and falls asleep behind the wheel. Driving drunk while asleep is the same as driving drunk.

Sleep quantity, sleep quality and sleep debt

Each person needs to get a certain amount of sleep each night in order to be at their best. We can build up debt if we don’t get enough sleep. This can lead to feeling drowsy throughout the day and a greater likelihood of falling asleep quickly.

However, the quality of our sleep is only one aspect. Quality of sleep is equally important. Is it in long, uninterrupted blocks or broken up into smaller pieces? Is there enough deep sleep?

Sleep apnea is a condition that causes sleep to be interrupted repeatedly during the night. This reduces sleep quality and quantity. It also breaks down the structure and continuity of sleep. Sleep apnea causes people to miss some important and normal stages of sleep.

Let’s take a closer look at what happens in your brain when you sleep.

The Stages of Normal Sleep

The sequence of stages the brain goes through in the night determines the quality of sleep.

Your brain and body begin to settle down after you go to bed. There are two types of sleep: REM (rapid-eye movement) and nonREM (or NREM). REM and NREM sleep alternate during the night.

NREM sleep is quiet sleep. Your brain activity and breathing are slow and steady, and your body is calm and relaxed. Although you may have dreams, they will likely be more thought-like than emotionally.

Active sleep is REM sleep. REM sleep causes active changes to your physiology. Your breathing may become irregular. For several seconds, you may find your breathing stops. Your body temperature increases and blood circulation to your brain increases.

Your large muscles, your leg and arm muscles become paralyzed. You can’t move them other than a few twitches of the fingertips and face. Your eye muscles are activated and your eyes move back and forth like they’re playing ping-pong.

This is what gave rise to the term REM (rapid eye movement) sleep. REM sleep is where most of your dreams occur. REM sleep is where you will experience the most vivid, intense, and emotional dreams.

NREM is the first stage of a typical night’s sleep. NREM sleep progresses through four stages during the first hour, from light to deep sleep. Then, around 70 to 90 minutes after the start of sleep, the deepest levels of sleep begin to light to allow for the first REM phase. The first REM period lasts approximately 10 minutes. This is when the sleep cycle shifts into stage 2 NREM sleep. After that, the cycle begins all over again.

This process takes approximately 90 minutes and continues throughout the night. The REM periods are shorter in the morning. REM periods get longer in the second half of a night. They can last up to 60 minutes. Short periods of stage 2 NREM are also common.

Age affects the amount of REM sleep that a person gets during a normal night. Newborn babies sleep in REM for approximately half of their time. REM sleep is now less than one-quarter of the total time we sleep.

We all need REM sleep. However, we don’t know why. It could be related to REM dreams, which are when we “process” our emotions from waking life.

Our bodies seem to have an automatic mechanism that tries our best to get the right amount of REM sleep. People who are deprived REM sleep but then allowed to go to sleep normally often experience REM rebound.

This is when they have REM-like sleep for a prolonged period of time. It’s as if the bodies are catching up on what they missed and a sense that they have been deprived. People who experience REM rebound often dream more vividly and often have scarier dreams than usual.

Normal breathing during sleep

Breathing Centers and Reflexes

Automatic reflexes control your breathing during sleep. These reflexes are controlled by nerve system sensors that continuously monitor your blood chemistry and send signals to your brain’s breathing centers. Your breathing muscles are then able to control how strong and fast you can breathe at any given time. The brain’s respiratory centers regulate this activity, which is one reason for sleep apnea.

Sensors and “Setpoints”

Your carotid bodies are a group of sensors that monitor your blood chemistry. They are located in your neck’s carotid veins. They detect oxygen levels in your blood and react to low oxygen levels. These sensors aren’t the most important for your breathing reflex, even though oxygen is vital for life, especially for brain cells.

The medulla, a primitive and deep part of your brain, has a more powerful set of sensors. These sensors detect an increase in carbon dioxide levels in your cerebrospinal liquid (the fluid that bathes you brain and spinal cord).

Your body produces carbon dioxide as a waste gas when it uses up oxygen. Your cerebrospinal fluid has a high level of carbon dioxide. This is a sign that your body requires to breathe. You inhale carbon dioxide when you breathe and then exhale it immediately to get fresh air.

The “setpoint” is the concentration of carbon dioxide at which the sensors are activated. Although oxygen sensors work in the same way, their setpoints are less sensitive during sleep.

Depending on whether you are awake, asleep, or between, the setpoints that trigger your breath reflexes can change. The setpoints that trigger your breathing reflexes during sleep are not as sensitive to low oxygen or high carbon dioxide as when you’re awake.

This is because your body is less dependent on oxygen and your breathing is more shallow. Also, the air in your lungs is exchanging less vigorously. As you go from sleeping to waking, your setpoints change.

The setpoints can change even during sleep. REM sleep is characterized by a decrease in the sensitivity of breathing. It is possible to tolerate more carbon dioxide, and oxygen concentrations can drop very low during REM sleep before breathing reflexes are triggered.

Another factor that contributes to sleep apnea is the sensitivity of the setpoints.

Breathing Muscles

Breathing requires several muscle groups to be used in many places. These include the diaphragm (the intercostal and other muscles attached to the ribs), rib cage (the intercostal, rib and other muscles), the soft palate, tongue, upper and lower pharynx, the throat area behind your mouth, and the voice box (the larynx).

These muscles work together to ensure normal breathing. When you inhale, for example, your rib muscles contract and your tongue muscles stabilize your tongue position. Your soft palate muscles then become taut to keep your airway open.

Another factor that contributes to sleep apnea is the coordination of these muscle groups during breathing.

Snoring

Snoring is when your soft palate vibrates (the back of your mouth). This can be caused by a variety of factors. During sleep, your soft palate and tongue muscle tone tend to decrease. They can become more relaxed and collapse together.

This can lead to snoring. Tonsils and the tongue can also produce sounds that alter or enhance the quality of snoring.

Snoring is affected by the position of the sleeper. Your tongue can fall toward your throat when you lie on your stomach. This will cause your airway to be blocked.

Snoring can also be caused by obstructions to your airway. You are more likely to snore when you have large adenoids, a large tongue, or your nasal passages become swollen due to allergies or colds.

Snoring can be caused by weight gain. This is because fat tissue builds up in the neck, which can narrow the airway.

Age can also play a role. Because muscle tone decreases with age, older people are more likely to snore.

After menopause, women are more likely to snore.

Snoring can also be aggravated by alcohol, certain medications, or physical exhaustion.

Sleep apnea is more than mere snoring. People snore even if they don’t experience the sleep-related interruptions and breathing problems that can be associated with sleep apnea. Although it isn’t a serious health risk, occasional or light snoring that doesn’t interrupt breathing can cause significant discomfort for a partner. Here are some solutions for occasional, harmless snoring:

• You can sleep on your side. Asleep position monitor can be used to train you to sleep on your side.
• Before you go to bed, avoid alcohol.
• Talk to your doctor if you have any prescriptions or over-the-counter medications that may be aggravating your snoring.
• Ask your doctor for an antihistamine if you have nasal congestion. There are also nasal strips that can be used to relieve congestion. These nasal strips can be purchased at pharmacies.
• Reduce your body weight.
• If necessary, the partner sleeping beside you can use soft foam earplugs. These earplugs are available at many pharmacies and industrial safety shops.

Simple Snoring can turn into sleep apnea

When the vibrations of the throat and tongue are accompanied by a variety of factors discussed earlier in this article, such as an instability in the breathing reflexes or a structural narrowing (for example, due to weight gain or enlarged tonsils), then snoring can turn into sleep apnea.

Sleep-disordered sleeping can be very severe and vary from person to person. Some people may experience snoring, which can be mild or occasional, that gradually becomes more severe and frequent, which could indicate sleep apnea.

This is often seen in adolescents when there is heavy snoring and, occasionally, brief apnea events. The picture can change gradually to more severe snoring and longer periods of nonbreathing. The pattern can become obstructive sleep apnea later in life.

This may lead to a longer period of nonbreathing and disrupted sleep patterns, as well as fluctuations in blood oxygen, daytime drowsiness, and a disruption in the structure of sleep. Even if you have never suffered from sleep apnea in your life, some people over 50 may experience a loss of muscle tone as a trigger for the development of sleep disorder.

It is possible for snoring to progress to sleep apnea in certain people, and you may end up needing sleep apnea surgery. This depends on all the factors that we have discussed here: breathing reflexes and the structure of the lungs, muscle coordination and inherited tendencies.

Summary

These are the most important aspects to sleep:

• How much sleep do you get
• Quality of sleep
• The amount of rapid eye movement (REM) sleep
• Sleep apnea can interfere with any of these.
• Sleep apnea can be caused by an abnormality in the breathing reflex.
• A loss of muscle tone in the throat and tongue can cause snoring.
• The vibration of the soft tongue is responsible for most of the sounds associated with snoring.
• It is possible to have snoring that doesn’t stop your breathing. These tips can help you reduce or eliminate snoring.

Drugs

The most commonly used treatment for central apnea are drugs that stimulate breathing reflexes.

Some drugs are not very efficient; others work for a time, but people may become more sensitive to the drug over time.

Others have unwanted side effects. The current central sleep apnea treatment should only be used as a temporary measure. We can only hope that experts will do more research in this area.

Acetazolamide has been the most popular drug. Acetazolamide makes blood more acidic which stimulates the breathing reflex. Studies have shown that Acetazolamide can reduce the frequency of apnea episodes and cause a slight decrease in daytime sleepiness.

Some studies have not been as positive, and reports indicate that the drug can cause obstructive sleep apnea. Although more research is required, Acetazolamide appears to be the most promising drug for central sleep apnea treatment.

Clomipramine, an antidepressant, has also been shown to improve central apnea. Although it has only been administered to a small number of patients, it has positively affected sleep and respiration and has fewer apnea episodes. Some patients became tolerant to the drug within 6-12 months. After that, it was no longer effective. Clomipramine can also cause impotence, which is one of the side effects.

Doxapram, a respiratory stimulant that can treat central sleep apnea treatment, has also been tested experimentally. This drug is intended to stimulate patients’ breathing while still recovering from anesthesia.

It is not recommended for long-term usage. Some side effects include hyperactivity, irregular heartbeats, high blood pressure, nausea, diarrhea, and urinary retention. People with high blood pressure, heart disease, and irregular heartbeats should not use it. Many people with central sleep apnea treatment have serious complications. This drug’s effectiveness remains to be determined.

Theophylline and aminophylline are both bronchodilators used to treat asthma and emphysema. Also, theophylline and almitrine treat depression in the breathing reflexes due to certain drugs like morphine or codeine.

Medroxyprogesterone is a hormone similar to female progesterone and stimulates respiration. Tryptophan is an amino acid that is said to be an antidepressant. None of these drugs have had a dramatic effect on central sleep apnea treatment. Side effects can be severe for all but tryptophan.

Mixed results have also been reported for oxygen. You can use it in severe cases with CPAP or bi-level PAP (CPAP)

There are many medications available, and more are being developed every year. One hopes that there will soon be a drug that can provide central sleep apnea treatment without side effects. This field requires more research.

Breathing devices

Newer Continuous Positive Airway Pressure (CPAP) Technology

Many CPAP variations have been developed thanks to technological advances. These can be used to help those suffering from central sleep apnea. AutoNation-servo devices are a new type of breathing device that can analyze a person’s breath and mimic it or improve when their breathing becomes irregular.

People suffering from central apnea, particularly those who have had poor results with CPAP, should consult their sleep center to inquire about the auto-servo-type CPAPs, which are currently available at Respironics, Inc. in Pittsburgh, PA and ResMed Corp. in San Diego, CA. You may use an auto-servo device in some cases instead of a heavier mechanical ventilator.

See the section earlier on treating obstructive sleep apnea for more information about CPAP or bilevel PAP. After a consultation with your sleep specialist, you should only make the decision about central sleep apnea treatment.

Diaphragmatic Pacemaker

The diaphragmatic pacemaker functions in the same way as a heart pacemaker. The pacemaker stimulates rhythmic muscle contractions using tiny pulses of rhythmic electric current.

The first diaphragmatic pacemakers were developed for patients with poliomyelitis whose breathing reflexes had been damaged. The “iron lungs,” which were soon developed, meant that you no longer needed the device.

Since then, some work has been done using diaphragmatic pacemakers for spinal cord injuries whose breathing reflexes were disrupted and infants with bad breathing reflexes. Some diaphragmatic pacemakers were tested on adults with central sleep apnea.

This seems ideal in theory. The absence of the nerve signal to the diaphragm tells it to breathe during sleep. The pacemaker used in rest should be capable of providing this signal. This technology is not very advanced, and the diaphragmatic pulse maker has not yet been widely available.

This may be partly due to the lack of demand. With better recognition of central sleeping apnea, demand may rise. The delicate surgery required to implant the pacemaker is necessary to place two tiny electrodes near the phrenic nerves, which control the diaphragm.

You can either inject the local anesthetic in the neck or use general anesthesia in the chest cavity. It is common to stimulate both sides of the body’s nerves rather than one.

This would cause diaphragm stimulation to only one side. During surgery, a tiny receiver is also placed under the skin. A radiofrequency generator is used to stimulate the pacemaker.

It is placed on the skin above the receiver. There are some risks and problems with using a diaphragmatic pacemaker for sleep apnea. It can also cause obstruction apnea, which could lead to new situations.

The most serious risk is that the phrenic nervous could be damaged during surgery or later. The person would be paralyzed and unable to breathe independently if they lost both of the phrenic nerves.

It is essential to perform the surgery with great care to avoid any nerve damage. It is a wise decision to consider this type of surgery. It would be best to look for a hospital with a history of using diaphragmatic pacemakers.

Also, seek out the most familiar surgeon with the procedure. A diaphragmatic pacemaker is currently not an option for many people suffering from central apnea. However, it might be possible for some patients. These devices could become more appealing as research continues and more experience is gained.

Mechanical Ventilators

People with central apnea can use various mechanical breathing systems to aid their sleep. You can use these devices to force air into the lungs using “positive pressure,” which mimics the rhythmic breathing pattern.

A positive-pressure ventilator is a device that continuously pushes air through a tube into the airway. You can supply air via a nasal mask, face mask, or tube.

It may also enter the body through a tracheostomy (an opening at the throat) or the nose or mouth. The use of a positive-pressure ventilator is more straightforward than that of a negative-pressure ventilator.

A negative-pressure ventilator functions differently. A negative-pressure ventilator works differently. The “iron lung” is probably the most well-known example. It was created in the 1930s to help polio victims “breathe” after losing their ability to breathe. The iron lung has been reduced to a smaller size and is now limited to the chest.

There have been problems with mechanical ventilators. It can be challenging to regulate the rhythm.

You should closely monitor blood oxygen and carbon dioxide levels to ensure those ventilator settings are safe and effective. A mechanical system that controls all breathing is uncomfortable for people who can breathe normally and are somewhat independent.

The latest generation of ventilators is small and portable. They minimize discomfort by allowing the individual to breathe naturally and stopping breathing.

These ventilators are small and portable and can be very effective for people with central apnea who cannot sleep or breathe simultaneously.

Summary

• The most effective central sleep apnea treatment is the conservative one and will work for you.
• Treatments for mixed apnea or obstructive sleeping apnea
  • Weight loss
  • Breathing devices like CPAP
  • Oral appliances, such as jaw or tongue retainers
  • Medication
  • Sleep apnea surgery
• Before you agree to have surgery:
  • Ask a sleep specialist for an estimate of the likelihood that surgery can eliminate your sleep apnea.
• Treatments for central hypopnea
  • Medication
  • Ask for a second opinion by an ENT surgeon who has experience and skill in treating sleep apnea.

Sources:

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• Choose Your Country/language | Philips Respironics. (n.d.). Philips. https://www.usa.philips.com/healthcare/resources/landing/experience-catalog/respironics.
• Oxygen Therapy for Sleep Apnea. (2020, June 5). Verywell Health. https://www.verywellhealth.com/oxygen-therapy-in-sleep-apnea-3015220.
• Effects Of Medroxyprogesterone Acetate In Obstructive Sleep Apnea – PubMed. (1986, December 1). PubMed. https://pubmed.ncbi.nlm.nih.gov/2946559/.
• The Effects Of Aminophylline On Sleep And Sleep-disordered Breathing In Patients With Obstructive Sleep Apnea Syndrome – PubMed. (1987, July 1). PubMed. https://pubmed.ncbi.nlm.nih.gov/3300449/.
• The Effect Of Theophylline On Sleep-disordered Breathing In Patients With Stable Chronic Congestive Heart Failure – PubMed. (2003, November 1). PubMed. https://pubmed.ncbi.nlm.nih.gov/14642143/.
• Effect Of Doxapram On Obstructive Sleep Apnea – PubMed. (1986, April 1). PubMed. https://pubmed.ncbi.nlm.nih.gov/3708186/.
• [The Effects Of Clomipramine On Diurnal Sleepiness And Respiratory Parameters In a a Case Of Prader-Willi Syndrome] – PubMed. (1998, December 1). PubMed. https://pubmed.ncbi.nlm.nih.gov/9894231/.
• Acetazolamide Attenuates the Ventilatory Response To Arousal In Patients With Obstructive Sleep Apnea. (2013, February 1). PubMed Central (PMC). https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3543060/.
• The Effect Of Acetazolamide On Sleep Apnea At High Altitude: a Systematic Review And Meta-analysis – PubMed. (2017, January 1). PubMed. https://pubmed.ncbi.nlm.nih.gov/28043212/.
• Which Medications Are Used In the Treatment Of Central Sleep Apnea (CSA) Syndromes?. (2022, January 25). Which medications are used in the treatment of central sleep apnea (CSA) syndromes?. https://www.medscape.com/answers/304967-114309/which-medications-are-used-in-the-treatment-of-central-sleep-apnea-csa-syndromes.

Surgery for Obstructive Sleep Apnea

Take into account the surgical risks

Surgery is the most conservative treatment for obstructive sleeping apnea. However, for most people, it is not as effective as CPAP. Before making a decision, it is wise to look at all the options. Before you decide on surgery, it is a good idea to get another opinion from a physician. Surgery is not required for the most conservative treatment of sleep apnea. While they may require some effort or perseverance, they are not as painful or dangerous as any surgical procedure. The following criteria are met if a conservative surgery procedure is performed:

• This is a common procedure that has been performed for years and is not a new or experimental type.
• It doesn’t involve cutting major blood vessels, nerves, or dealing with major organs. There are usually no complications after surgery.
• This procedure can be done by an experienced surgeon without any variation in the outcome.
• You can do it on your own or with minimal hospitalization.

There are many possible pitfalls in surgery: excessive bleeding, side effects from medications, pain, swelling, drug reactions, nerve or muscle damage, and infection. General anesthesia is one of the greatest risks in surgery. General anesthesia is a particularly dangerous option for people with sleep apnea. Anesthesia can depress the breathing reflexes and people with sleep apnea have already experienced some respiratory difficulties. Anybody with sleep apnea should inform the surgeon before he undergoes surgery. The surgeon could also consult with the patient if the individual has sleep apnea. Both the surgeon and anesthesiologist need to know that the patient’s breathing needs will be closely monitored during and immediately following surgery.

Even “simple” surgery must be carefully considered. For someone who has suffered from sleep apnea, surgery may be the best option. In some cases, it may even be necessary to save their lives. Some surgical procedures can pose a risk to people who aren’t in immediate danger of severe long-term effects or just want to stop snoring.

Can Surgery Cure Sleep Apnea

Help versus Cure? It is important to know the difference between treatment for sleep apnea or a cure. This means that you can eliminate all diseases including stroke, heart attack, and other complications caused by sleep apnea. Patients A and B may both experience significant sleep apnea reductions after surgery. Patient A may have mild apnea at the beginning and may not require further treatment. An example of this would be a patient who is now alert and has an AHI of 10, from being a sleepy patient before surgery. Patient B might have had more severe apnea at the beginning and may still require CPAP. An example of this would be Patient B, who has an AHI of 60 and has it improved to 30 after surgery, but still has low blood oxygen at night, is at high risk for cardiovascular disease, and is still drowsy.

The results of each individual vary. All people are different and the results of surgery for sleep apnea may not be equal. For example, an early surgical procedure that was used for sleep apnea and is still being used today is uvulopalatopharyngoplasty (UPPP) (described later). UPPP is a treatment for sleep apnea that has a 50% failure rate. After 5 years, it may have a 25% success rate. This means that 50% of those who have undergone UPPP surgery still suffer from sleep apnea. The percentage will rise over time. The rate of success for lower jaw surgery (mandibular advancement or its variations) is high, but it can help people with severe sleep apnea when combined with maxillary. The failure to perform surgery to correct sleep apnea can be due to many reasons. One reason is that the treatment chosen is not appropriate.

Some patients can be pre-empted that UPPP will not cure their apnea. Some patients opt to have surgery regardless. Many times, a person with sleep apnea isn’t ready to face the fact that she has a long-term condition. Or, a family doctor may refer the patient directly to a surgeon who is familiar with nonsurgical treatment options. Many people who are not qualified to be surgeons find their sleep apnea recurs after surgery, and they need ongoing treatment. The newness of surgery to treat sleep apnea is another reason for low success rates.

Unfortunately, there is not enough data available to accurately predict which patients will benefit from a particular reconstruction procedure. Ask your sleep specialist for advice before you make a decision about surgery to treat sleep apnea. Before you accept the risk of any type of surgery, make sure that you are a good candidate. It is strongly recommended that you get a second opinion from a qualified specialist in sleep medicine who will not be performing the operation. A final note on choosing conservative treatment. Medical schools might be more open to more radical, experimental, and conservative options. This is fine for the advancement of medical science. However, it should be questioned if you are willing to take on that risk.

There are five types of surgery for sleep apnea

There are five main types of surgery that can be used to treat sleep apnea.

1. Nasal surgery
2. Surgery of the tongue and palate
   • UPPP (uvulopalatopharyngoplasty)
   • LAUP (laser-assisted uvulopalatoplasty for sleep)
   • Radiofrequency thermal ablation (somnoplasty)
3. Jaw surgery and other maxillofacial procedures
4. Tracheostomy
5. Weight loss surgery

Nasal Surgery Nasal surgery can refer to a variety of ear, nose, and throat (ENT), procedures. These include surgery to repair the nasal septum, which is the wall that divides your left and right nostril passages. Some people may need to have their nasal surgery done before they can use CPAP. People suffering from nasal obstructions might feel “claustrophobic” and suffocated when using CPAP. They may also unconsciously remove the CPAP mask while they sleep. These problems can make CPAP users uncomfortable. Ask your sleep specialist if nasal surgery may be an option.

A person may be able to wear an oral appliance (mandibular advance device) after nasal surgery. This is something that was impossible before surgery. An oral appliance can make a person feel constricted if they have poor nasal airflow. Nasal surgery is usually not an effective treatment for sleep-disordered breathing or snoring. Sometimes, people report a reduction in their snoring following surgery to the nose. However, symptoms can return after a few months. The improvement in airflow through your nose can have a significant impact on overall airflow. This should be considered part of a comprehensive surgical approach if you are going to have palate surgery (see next section).

Surgery of the Tongue and Palate. UPPP

This was the first and most popular type of surgery to treat sleep apnea. A scalpel is used under general anesthesia to remove the rear third of your soft palate. It is important to keep the back of your soft palate in a straight line so that it will not collapse while you sleep.

Who can benefit from UPPP?

Whether a person is eligible for UPPP will depend on the purpose of the surgery and how the individual defines “helped”. If a sleep study shows that the patient has only snoring, UPPP has a 90% chance of success.

The fact that a bedmate reports that snoring has stopped after UPPP doesn’t necessarily mean that sleep apnea is gone. The chance of success for surgery to remove sleep apnea entirely is lower. It is also more difficult and harder to predict. However, it is likely to be less than 20%. These are the criteria that make this type of surgery most successful:

1. They do not weigh more than 25 to 30 percent above their ideal weight and they don’t gain weight after surgery.
2. They only have mild to moderate apnea and none of it is obstructive.
3. A majority of their apnea is caused by an obvious anatomical obstruction in the upper part (throat) of the pharynx (throat). This includes the soft palate and upper throat area.

People with enlarged tonsils, adenoids (tonsils are often removed during UPPP); those with a long soft palate or large fleshy uvula; as well as people who have excess fleshy tissue in their throat. Combining UPPP with tonsillectomy may result in the best results. UPPP is not recommended for people suffering from severe apnea, or those whose apnea originates in other areas than the soft palate.

Those who have a very small or curved lower jaw, or a large tongue, or are positioned low in the neck or at the back of the neck, are less likely to succeed with UPPP. UPPP’s success is dependent on your weight. UPPP can be hindered by extra loading on the abdomen. People who undergo UPPP and gain weight will likely experience a return of obstructive apnea.

Until recently, little was known about the best people who could be assisted by UPPP. Cephalometry, which measures the size and position of structures in the head using radiographs (CT), magnetic resonance imaging (MRI) or computed tomography(CT), and fiberoptic examinations of the inside and airway, allows doctors to gain more information about how to select the best candidates for UPPP success (26-30). However, it is impossible to predict whether UPPP will succeed. You must consult your sleep specialist and an ENT specialist who is familiar with both sleep apnea and eliminating snoring. Your throat should be examined by an otolaryngologist.

For example, he may request a CT scan, MRI, or radiograph of your head to determine the relationships and sizes between different anatomical features that can cause your obstructive apnea. This will allow you to assess your chances of receiving UPPP treatment. What Are the Drawbacks to Uvulopalatopharyngoplasty? Compared with many surgical procedures, uvulopalatopharyngoplasty is not particularly risky. It doesn’t involve any major arteries or nerves. In healthy cases, it can be done as an outpatient procedure.

Some patients may require a hospital stay lasting 1 to 2 days. The anesthesia is the most dangerous. Preoperative medication, anesthetics, and painkillers, as well as sedatives and painkillers, can increase the risk of narrowing the airway. Anesthetics, along with other drugs, can cause breathing reflexes to be impaired. Sleep apnea means that your breathing reflexes may not function as normal if you have it. This is a higher risk than normal for anesthesia. This combined with existing apnea and possible obstruction of the throat from postoperative swelling, as well as pain medication, could lead to serious complications. UPPP can also cause pain. People who have undergone UPPP say that they feel more pain than they expected after the procedure (e.g., it is more painful than a tonsillectomy).

Severe pain may last up to a week. Patients report difficulty swallowing after surgery. It is easier to swallow food and liquid from the mouth by removing the uvula. It is common for 2 weeks following surgery. However, it will resolve with time if the surgeon has experience and skill with the procedure. Some people have swallowing difficulties. Most people who have difficulty swallowing will find they can overcome their problem by practicing and eating properly (20,23). There have been cases where airway obstruction has become more severe or more difficult after UPPP.

Why Have Uvulopalatopharyngoplasty If the Odds Are Poor? You may choose to have uvulopalatopharyngoplasty even if your chances of success are slim. This is because you can avoid other treatment options such as CPAP or oral appliances. UPPP is very safe when it’s performed on patients who have been thoroughly tested in a good sleep center and when the surgery has been performed by an experienced ENT doctor. We are unaware of any surgical complications or fatalities at the Swedish Medical Center.

How Can You Arrange for Uvulopalatopharyngoplasty? Until you have had a thorough examination by a doctor who is familiar with the causes of sleep apnea, and can weigh the benefits and risks for your case, it’s not a good idea to use UPPP to treat the condition. If you are a candidate for successful treatment with UPPP, the sleep specialist can refer you to a skilled surgeon.

Laser-assisted Uvulopalatoplasty

LAUP is a soft palate surgery that can be used to alleviate snoring. Snoring is a sign of sleep apnea. However, LAUP has not been proven to be an effective treatment. It is difficult to distinguish between simple snoring from sleep apnea. Many people who seem to have “simple” snoring often have severe sleep apnea. LAUP surgeons will often screen those patients by using a questionnaire about snoring.

Questionnaires can’t diagnose sleep apnea accurately and are often underestimated. Many patients who have undiagnosed sleep disorders have undergone LAUP surgery, and are now left with serious complications. People who snore need to be examined by a sleep specialist in order to rule out sleep disorders. After sleep apnea is ruled out, LAUP should only be considered. LAUP is promoted as a replacement for conventional palate surgery (that’s, UPPP), as previously described. Patients who are considered good candidates by their ENT and sleep specialists for UPPP to treat snoring might consider LAUP. However, LAUP is not recommended to treat sleep apnea.

What is LAUP? LAUP is a series of laser cuts that are measured in length. These “cuts” create a V-shaped pattern on your soft palate. It is common to require several sessions. The laser cauterizes the tissue and leaves narrow scars. These scars can stiffen the soft palate, which may reduce snoring.

Does LAUP Eliminate Snoring? Although it is claimed that it eliminates snoring in 80 to 90% of cases, there have been reports that snoring can return up to 2 years after the surgery. What is LAUP’s Comparative Advantage to Conventional UPPP. LAUP is safer because it requires less time, less bleeding, and does not require hospitalization. It is slightly less expensive. Expect to pay approximately $1,600 for the surgeon and an additional fee for the facility. Conventional UPPP requires a general anesthetic, possibly a hospital stay, significant pain, risks from bleeding and infection, as well as general anesthesia. UPPP can cost as high as $3,000.

Is LAUP able to cure sleep apnea? According to published studies, no. LAUP can be used as an adjunct therapy for mild to moderate sleep apnea. About 50 percent of patients experience a 50 percent improvement. People with poor outcomes may be identified by careful examination of their airways. Patients with large palates and large tongues are at risk. LAUP can lead to fatal sleep apnea. People who believe that surgery will fix it are at risk. Sleep apnea goes beyond snoring. According to the American Academy of Sleep Medicine’s guidelines of practice for LAUP, patients should be evaluated by a specialist before they have LAUP. To determine if sleep apnea is gone, patients with sleep disorders should undergo a second sleep study.

Somnoplasty

Another new technique is somnoplasty. Radio-frequency energy is used to shrink the soft tissue. The U.S. Food and Drug Administration approved Somnoplasty for the treatment of sleep apnea in 1998. It can be used on the upper airway (soft palate and base of the tongue). Somnoplasty, like LAUP, is being promoted to the public as a simple treatment for the annoying, but the common problem of snoring. Patients run the risk of not being diagnosed with sleep apnea, just like LAUP.

Somnoplasty is not an effective treatment for severe to moderate sleep apnea, as LAUP has shown. In milder cases, it may be beneficial, possibly in combination with weight loss or CPAP. There haven’t been any definitive controlled studies done on Somnoplasty. How does Somnoplasty work? Somnoplasty uses radio waves at high frequencies to heat cells and cause scarring. The scar shrinks the tissue and reduces its bulk. This technology is used in surgery for many years to treat small tumors and cut out bleeding capillaries. Somnoplasty uses a lower level of energy. The procedure takes place in the doctor’s chair.

After anesthesia, the operator inserts a thin electrode in the tissue. The radio-frequency energy created by the electrode causes a lesion. It basically “cooks” small areas of tissue. It takes between 3 and 6 minutes to create a lesson. Usually, several lesions are created in one session.

After the surgery, swelling occurs within days. Scar tissue replaces lesions in a matter of weeks. Scarring reduces the size of the affected area and decreases its bulk. The extent of scarring is a factor in how much tissue shrinkage occurs. For best results, it is recommended that you have at least four sessions. Between sessions, there will be an 8-week healing period. What are the risks of somnoplasty surgery? Somnoplasty is less risky than scalpel surgery because it uses a local anesthetic. After 1 year of Somnoplasty experience, there have been no reports of any significant side effects. The long-term effects of Somnoplasty are still unknown.

After surgery, swelling can occur. This can pose a risk to patients with sleep apnea who have trouble keeping their airways open. After surgery, patients should be able to sleep at 45 degrees. Somnoplasty has a risk in common with LAUP. It can silence the main warning sign of sleep disorder by eliminating snoring. Patients could be unaware of the long-term effects of a potentially dangerous, undiagnosed condition. The experience and training of the surgeon performing Somnoplasty is another potential risk. It is a good idea to inquire about the qualifications of the person performing Somnoplasty. Can Palate Somnoplasty be used to treat sleep apnea? A series of lesions are created in the soft palate during Somnoplasty palate surgery. The goal is to shrink and tighten the palate.

Somnoplasty is approved by the FDA for use in the treatment of sleep apnea. Because it affects the same tissues, however, it is unlikely that it will be more effective than UPPP or LAUP for apnea. Unfortunately, long-term results have not been established. Reputable Somnoplasty practitioners will assess you and advise you on the possible dangers of sleep apnea. If you do not have these symptoms, or if you suspect that you may have sleep apnea underlying, don’t expect Somnoplasty to cure your problem. To determine if your sleep apnea is gone, it is important that you return to your specialist for a sleep study after Somnoplasty. Can Palate Somnoplasty eliminate Snoring?

According to reports, it may be able to reduce or eliminate snoring as well as LAUP. Unfortunately, long-term results are still not available. Tongue Reduction using Somnoplasty. Tongue reduction with Somnoplasty is a procedure that reduces the volume of the tongue to not block the throat. A scalpel or laser was used in the past to remove the notch at the back of your tongue. Sometimes, this was combined with tonsillar tissue located at the base. Since somnoplasty is a relatively new procedure, it is difficult to predict whether it will be more effective than the laser method. It is also difficult to predict the success rate of tongue reduction surgery for treating apnea.

Two surgeons presented the results of laser surgery on 24 patients who had previously had unsuccessful UPPP surgery. Laser tongue surgery was not considered successful in less than half of patients. Patients with an RDI of 10 or more and blood oxygen levels of below 90 still showed signs of success. Many of these patients would need CPAP. Although still experimental, Tongue Somnoplasty has some promise for treating obstructive sleep apnea.

What is the difference between somnoplasty and conventional UPPP? Somnoplasty is safer than UPPP because it involves less bleeding, requires less hospitalization, and does not require general anesthesia. One published study shows that Somnoplasty recovery is less painful than LAUP. Somnoplasty costs between $1,600 and $2,000 currently. Insurance usually does not cover it if it is done for primary snoring.

The Pillar procedure

Pillar is a new surgery that uses plastic implants to strengthen the soft palate. It seems to be moderately effective in decreasing snoring. This surgery is currently only available to a small number of sleep apnea sufferers. Early results indicate a slight improvement of the Apnea-Hypopnea Index. Long-term results are not available. We will wait to see if more patients have the Pillar procedure. Then, we can make a decision on whether it is effective in treating sleep apnea.

Jaw Surgery and Other Maxillofacial Surgery

Maxillofacial Surgery is the surgery of the mandible (lower) and maxilla (upper) as well as the bone and tissue of the faces. Head and neck surgery is performed by otolaryngologists or ENTs. It involves other parts of the head and face as well as the airway. Although surgery has been used for the treatment of sleep apnea for over 20 years, it is difficult to predict which patients will benefit from this type of surgery. These surgeries can be performed individually or together.

• Mandibular advancement – Moves the lower jaw forward
• Midface advancement – Moves the maxilla (upper) forward
• Hyoid surgery – Repositions the base of the tongue

There are many options for jaw surgery and maxillofacial surgery to treat sleep apnea. All of them are designed to eliminate obstructions in the lower jaw’s airway. To move the tongue forward, there are several surgical options available for the lower jaw. These procedures can be as simple as moving a small portion of bone forward at one end of the jaw or moving the entire jaw forward by cutting through both sides of it and sliding it forward. Another surgical procedure is to reposition the hypoid bone at the base of the tongue. This surgery was pioneered by the Stanford University Medical Center surgical team. It involves two stages: tongue advancement, tongue suspension, and hyoid suspension. Then, there is upper/lower jaw advancement.

Jaw surgery can help anyone.

These surgeries are not yet able to be predicted. The outcome of these surgeries can be affected by many factors, including the skull structure and soft tissue, as well as obesity and neuromuscular control of the airway.

The simplest and most effective procedure, mandibular advancement, is becoming more popular in the United States. However, its utility is still not fully understood. This procedure has only been used in a small number of patients suffering from complicated apnea. One patient with a small jaw and small airway opening was an example. Neither UPPP nor medication had been able to help him. Although surgery didn’t completely remove his apnea, it did reduce it by about half. Like many other cases of sleep apnea surgeries, success depends on whether you consider the total elimination of the apnea a success or if you accept the elimination of half the apnea while still using CPAP to treat any remaining apnea.

One sleep center found that 6 percent of people with obstructive breathing had a malformed lower jaw. Another 32 percent had a slightly shorter lower jaw. These people are the most likely candidates for mandibular enhancement surgery. Their apnea may be due to structural problems in their lower pharynx. This means that their jaw and tongue are positioned farther back than normal, and have a smaller lower airway opening. This complicated surgery for sleep apnea must be done as a team effort. The team should include the ENT specialist, the sleep specialist, and the maxillofacial doctor who will perform the actual mandibular operation. If teeth need to be repositioned, an orthodontist is needed. If the surgeon is experienced, the surgery is relatively safe. However, it is performed under general anesthesia which is particularly dangerous for those with breathing problems.

What are the disadvantages?

The lack of blood supply to the jawbone can cause problems in the healing process. The jaw can be closed for up to 6 weeks if the jaw is cut on both ends and moved forward (sliding Osteotomy). This causes significant discomfort for the patient. Orthodontics may be necessary to realign the bite and reposition teeth. This entire process is costly and takes a lot of time. This surgery has one major drawback. The jawbone can reposition itself to its original position after mandibular surgeries. This is due to the strong pull of the tongue muscles on the jawbone over many years. While some surgeons may disagree with this statement, other physicians are skeptical about the longevity of this type of surgery.

Tracheostomy

Tracheostomy was once a common treatment for sleep apnea. However, it is now much less common due to CPAP. It is now performed on two types: patients who are extremely sick due to sleep apnea, who require immediate (sometimes emergency), treatment to save their life, and those who have failed other treatments. The treatment of last resort is tracheostomy. If all else fails, it can be used to end sleep apnea. It is an optimistic form of surgery in that sense. Although it is very simple, there are some serious drawbacks. A tracheostomy is a small incision made into the trachea, or windpipe, at the front of your neck just below the voice box (larynx).

If a tracheostomy is the only permanent treatment for the patient’s sleep apnea, this opening can be made permanent. If the patient chooses to switch to CPAP or another therapy, the opening can be closed surgically. A tracheostomy allows air to flow through the opening to the upper airway. During the day, the tracheostomy is closed with a plug and the person can breathe normally through his nose or mouth. The tracheostomy opening is kept open at night and the person breathes through his neck. The tracheostomy is usually accessed through the tracheostomy. It is a small, curving tube with a flange on the top. It is inserted through a tracheotomy hole and extends several inches into the windpipe. The tracheostomy tube is usually worn continuously. The tube is held in place by the flange at its top. It also protects the throat opening.

Although tracheostomy surgery isn’t particularly dangerous, it is usually performed under general anesthesia. This can be potentially risky. There are two types of complications that can arise from tracheostomy. The first is the opening of the tracheostomy. Sometimes, the opening will attempt to close itself again. If the tissue surrounding the opening is not properly healed or becomes damaged, infected, or eroded, it can lead to other problems. To avoid these problems, there are many surgical options. A respiratory infection such as pneumonia is another problem with a tracheostomy. A tracheostomy allows a person to inhale air directly into their lungs. This bypasses all-natural germ-filtering systems found in the nose or upper airway.

Therefore, bacteria, viruses, or other foreign objects can easily get into the lungs. This must be prevented. After tracheostomy surgery, there may be some discomfort, swelling, and difficulty swallowing. The tube is worn until the incision heals. It is custom-made to fit each individual and is comfortable to wear. The patient must follow a strict, 24-hour program to care for the tracheostomy after a tracheotomy.

This includes cleaning, suctioning, and misting as well as applying salt solution or antibiotics. A suction machine should be used immediately after surgery to remove any mucous secretions from the tracheostomy tube. This will prevent obstruction of the airway and hinder breathing. Although mucus production is decreasing over time, a suction device will still be required indefinitely to clean the tube and prevent any further buildup. To avoid bacteria entering the tracheostomy, it is essential to maintain cleanliness. Both patients and their families should be taught these procedures by nurses and respiratory therapists.

A tracheostomy can help anyone.

A tracheostomy can help anyone suffering from obstructive or mixed sleep apnea. People who are selected for tracheostomy are often suffering from severe sleep apnea, which can lead to severe complications. You may have tried different treatments but failed. They could have severe sleep apnea-related heart problems or serious cardiac arrhythmias. They might have very low blood oxygen levels.

Tracheostomy reduces snoring and improves sleep quality. It is almost impossible to cure daytime drowsiness or apnea for anyone who has had the operation. It can reduce fatigue and prevent headaches in the morning.

What are the disadvantages of tracheostomy surgery?

The impact it has on a person’s day is one of the major drawbacks to tracheostomy.

Many people take several weeks or months to learn how to manage the frustrations associated with tracheostomy hygiene. They also need to adapt to the new appearance of their tracheostomy opening. This adjustment period is often accompanied by a bout of depression. Individuals are responsible for their own depression. They also need to be prepared for the procedure and have support from family members. Counseling should be given to the patient, their spouse, and any other family members about the procedure and the possible effects of temporary depression. People can adjust easier by talking with others who have had tracheostomies or are attending sleep apnea support group meetings.

Many people who have had tracheostomies report they are able to return to their normal lives after the adjustment period. They live a normal, active life and don’t seem to be bothered at all by their tracheostomies. They will need to be very careful around the tracheostomy entrance. They must also ensure that no air enters the windpipe through their tracheostomy. People with tracheostomies, for example, may not be able to swim. People with tracheostomies, which have an opening in their throat that leads directly to the lungs, are at great risk of drowning. They should avoid swimming and all water-related activities, such as water skiing, sailing, rafting, or fishing from a boat.

Another drawback is the cosmetics involved in covering the tracheostomy open. The opening is covered with a small shield or plate that is secured by a cord around its neck. Although it is not inherently objectionable, many choose to cover their tracheostomy plates with a turtleneck or scarf. The daytime sealing of the opening can also be a problem. If there is air leakage, it can make it difficult to talk. Sometimes, air leakage can be caused by coughing or sneezing. This can cause temporary embarrassment.

Poor healing and erosion can also cause problems. It is important to choose the best surgeon possible (a plastic surgeon) and to carefully follow the post-operative instructions. Ask your doctor any questions and continue to ask for assistance in dealing with any follow-up issues. Bariatric (Weight Loss Surgery). Because it surgically forces a change in eating habits that the individual is unable to achieve by any other means, weight loss surgery is also known as “behavioral” surgery. A person’s eating habits should be changed to lessen the amount they eat at a time. This can be done surgically by making your stomach smaller.

SURGICAL RISKS. Over the past two decades, there have been many types of bariatric surgeries. Because bariatric surgery is performed on obese patients, it carries particular risks. Obese people are at risk of dying from the procedure two to three times more than those of normal weight. It is therefore important to consider the potential risks and the benefits that can be reasonably expected after surgery. Gastric bypass patients are often considered obese. In one group, 17 patients weighed twice the recommended body weight. These patients were not having “cosmetic surgery” in order to lose weight. They were people whose lives were at risk due to their excessive weight and other complications.

Patients who are selected for gastric bypass are usually screened to ensure that they only include those who have successfully lost weight using carefully monitored weight-loss programs. Often, the screening includes a psychological assessment of the patient. For bypass surgery to be successful, patients need to understand the risks and behavioral changes required. Over the past 40-years, many types of weight loss surgery have been created. Gastric bypass and laparoscopic adjusted gastric banding are the most popular surgical weight-loss methods.

Gastric bypass

This is the most commonly performed bariatric procedure. Gastric bypass reduces the size of the stomach by placing staples across it. This divides the stomach into two pouches, one larger and one smaller. The “new” stomach is the upper pouch. It takes food from the stomach and then empties into the branch of the intestines attached to it. Food intake will be limited to twice the volume of the new stomach after surgery. This is usually around 30 mL. This means that you can only eat about one-quarter cup of food at a given time.

Major surgery is gastric bypass. It affects major organs, including the stomach and intestines. There are also large arteries involved. You can either open the abdominal cavity or perform laparoscopy (operating through small holes). Both methods have similar risks. Anesthesia, other medications, and surgical errors all pose risks. The placement of several tubes during and after surgery will increase the degree of the incision. These include a nasogastric tube for fluid removal, intravenous hookups, and possibly an endotracheal tube to support a ventilator. There are many complications that can occur after bypass surgery.

These complications can include infection, bowel obstruction, the collapse of the lungs, blood clots, and other side effects following abdominal surgery. Excessive vomiting is the most common side effect of gastric bypass. A gastric bypass performed by open abdominal surgery usually requires a one-week stay in the hospital, significant postoperative pain, and discomfort, as well as a prolonged recovery period of 4 to 5 weeks.

What is the effectiveness of gastric bypass?

Average weight loss following gastric bypass is between 65 and 70 percent of excess weight (not total weight), which can be achieved in a period of 1 to 2 years. According to one study, most patients who had undergone surgery for sleep apnea experienced significant improvement within 6 months. Some patients experienced complete relief. Patients reported no sleepiness during the day or loud snoring. There were also changes in personality: greater responsiveness, less emotional problems, and more difficulty at work.

For complete results, a full year is required. Patients in the study group may expect additional weight loss or improvement in their apnea symptoms over the six months that follow. Some people who have had gastric bypass surgery may return to their presurgery weight in the long term. Gastric bypass surgery has a failure rate of between 30 and 50 percent. Laparoscopic Adjustable Gastric banding. Although “Lap-Band surgery” has been used in Europe and other countries, it was only approved by the Food and Drug Administration (USA) in 1991. As the name implies, this surgery is typically performed laparoscopically. If done by an experienced surgeon, it isn’t particularly risky. The procedure involves placing an inflatable band around your stomach’s upper portion. The stomach is confined to a small pouch and drainage opening by inflating the band. To adjust the inflation of your band, a tube is connected to the band via a port located outside of your abdominal wall. This must be done multiple times per year.

What is the effectiveness of lap-band surgery for treating apnea?

This surgery is not as effective as a gastric bypass in terms of weight loss. It only achieves about 50 percent weight loss. Only three of nine patients with sleep apnea who underwent lap-band surgery had their condition completely eliminated within 18 months. Six others did not experience any improvement. Lap-band surgery has potential risks, including those for other bariatric procedures, stomach damage, infection or malfunction, as well as problems with the access port.

Who can benefit from bariatric surgery

For severely obese patients suffering from apnea, bariatric surgery can be a permanent and effective solution. This is if they are motivated to change their eating habits and if their doctors consider them suitable candidates for this type of surgery. It is important to weigh the potential benefits against the risks.

Oral Devices to Treat Sleep Apnea

Many oral devices are available among several sleep apnea treatment options. They can hold the lower jaw, tongue, or both forward during sleep to prevent the upper airway from collapsing. These devices work best for those who have obstructive sleep apnea that is primarily located in the lower pharynx.

Jaw Retainers (or Mandibular Advancement Devices, or MADs) Jaw retainers hold the lower jaw forward. They are sometimes called MADs (mandibular advance devices), but they can also be called anterior mandibular positioning devices (AMPs), mandibular rearrangement devices (MRDs), and oral airway dilators (OADs).

MADs are similar to retainers or bite plates that can sometimes be prescribed by orthodontists. They can be made from dental acrylic with metal loops that are placed over many teeth to keep the device in place.

Different manufacturers have created their own MAD versions. Some models can be adjusted to allow for the most comfortable forward position for your lower jaw. MADs are usually custom-made. There haven’t been any definitive studies that can pinpoint which patients will benefit from jaw retainers or which devices are most effective.

Mandibular appliances have been studied in sleep apnea patients. However, the studies used small numbers of patients with different success criteria. Based on the few clinical trials that have been conducted, they appear to be approximately 50% effective.

This means that about half of those who have tried them still suffer from sleep apnea symptoms. Modular models that can be adjusted may prove more useful than those that cannot. It is unlikely that any design will be equally effective for all patients.

People who are interested in an oral appliance for sleep apnea should seek out a dentist who has experience in fitting these devices and who also works with a sleep specialist. After the dentist has fitted the patient, the sleep specialist (not the dentist) should diagnose obstructive sleep apnea.

The dentist should also measure the effectiveness of the device. Contact them to find a dentist in your area who has been trained.

The Academy of Dental Sleep Medicine A MAD can be beneficial to anyone. MAD manufacturers and experimenters have reported positive results in the study of patients with mild to moderate apnea.

MADs concentrate their sleep apnea treatment options on the lower jaw or tongue. This means that people with a smaller lower jaw than average (orthodontists call it a “class II occlusion”) will likely have the best results.

MADs have also been successfully used in children with irregularly formed jaws and obstructive sleep apnea. Three-quarters of sleep apnea sufferers have airway obstructions in more than one location. Patients with obstructive sleep apnea that is primarily caused by nasal problems or problems in the upper pharynx (large tonsils, adenoids, and uvula) are unlikely to be treated with a MAD.

They will require further treatment, or even surgery for sleep apnea. To use the retainer, you need to be able to blow through your nose. A person suffering from a blocked nose or an allergy will not be able to wear it. Many people, even those who appear to be good candidates for MADs, still have sleep apnea.

This can be evident by their heavy snoring. It is important to have sufficient teeth to hold the appliance in place. A MAD may be a good option for those who are unable to use CPAP despite their best efforts. If your nasal obstruction prevents you from using CPAP successfully, then you won’t be able to use an oral appliance unless the obstruction can be removed by surgery or medication.

Even if it’s only partially effective, there may still be some use for a MAD.

1. If CPAP is not available (backpacking, primitive traveling),
2. If the device allows patients to use a lower CPAP pressure,
3. Screening patients for mandibular advancement surgery (to simulate possible outcomes of surgery)

These situations do not have objective studies that can prove their benefit. How to get used to wearing a MAD. Getting used to wearing a MAD may take several nights or several weeks. The most common side effect is excess saliva.

Excessive saliva is a side effect of any foreign object, such as a retainer. However, this usually subsides after a few nights. It may take up to 2 to 3 weeks for the jaw muscles and the other muscles to get used to the MAD. It may take you at least three weeks to get used to it and determine if it is worth it.

The MAD has a disadvantage: you can’t rent one to test it out. You can adapt one “do it yourself” brand by heating it in hot water. Although it does provide some indication of effectiveness, it is not very long-lasting.

If you don’t pay to have one made, you won’t know if a MAD is effective. You will be thrilled if it works. MADs are less restrictive than breathing devices, smaller and easier to use, and also cost less. There are other options if it doesn’t work.

What Is The Cost Of MADs?

Although MADs are more affordable than CPAP units, they can still be quite expensive. Do-it-yourself brands cost about $25. There are trained technicians at some sleep centers who can fit an adjustable model for $300 to $400.

A custom-fitted appliance can cost as much as $600 and may even be more expensive due to the markup by dentists. This is about twice the price of an ordinary orthodontic retainer. It does not include the cost of having your dentist or orthodontist take jaw impressions or additional visits to adjust or check the fit of the appliance.

These extra costs can add several hundred dollars to your total cost. To find out if your insurance will cover these costs, check with them in advance. Do you think a MAD is worth your consideration? Here are some questions you should ask your sleep specialist if you think you could be a candidate for MAD success.

1. A sleep study was done to determine the baseline of your sleep disorder before you started your sleep apnea treatment option.
2. Is your sleep apnea mild?
3. Have you considered CPAP (a more efficient sleep apnea treatment option) if your sleep apnea symptoms are moderate to severe?
4. Do you experience nasal obstructions that prevent you from breathing through your nose?
5. Are you suffering from temporomandibular (TMJ) syndrome? Or are there any other dental issues that a MAD could exacerbate?
6. Can your sleep specialist refer you to a dentist who has experience fitting sleep apnea oral appliances if you have TMJ problems or other dental issues?
7. Have you been scheduled by your sleep specialist to have a follow-up study of the effectiveness of the oral appliance while you are wearing it?
8. Have you compared the cost of an oral device with your insurance agent? This includes fabrication, fitting, and follow-up sleep tests. Is this an affordable sleep apnea treatment option?

These questions are partly based on the American Academy of Sleep Medicine’s guidelines for oral appliances. Does your MAD really work? Once you have become comfortable with the MAD, it is a good idea to return to your sleep center to get a sleep study to confirm that the appliance is effective in eliminating your apnea.

The MAD must be tested in a sleep study to determine if it works when you’re sleeping on your back or on your side. MADs’ effectiveness tends to decrease over time. To ensure that your MAD is still effective in eliminating sleep apnea, consult your sleep specialist.

Other oral appliances

The tongue-retaining device (TRD), made from soft plastic, consists of a tongue-sized suction cup. It is designed to pull the tongue forward while holding it in place. It is held in place by the teeth and gripped by the tongue. The TRD has been moderately uncomfortable for many people who have tried it.

In some experiments, the TRD was only worn for half the night. The TRD is able to reduce the frequency of apnea events by approximately 50%, despite its limitations. This means that the TRD could be about as effective as uvulopalatopharyngoplasty (UPPP), a type of surgery described later. TRD is not a popular choice in sleep research and has not been widely adopted or made available. The TRD is only useful for a select group of patients with obstructive sleep apnea.

People who aren’t obese, don’t have nasal obstructions, and have mild-to-moderate apnea are more likely to benefit from a TRD. This means that the severity of apnea when they sleep on their backs is greater than when they sleep on their sides.

This group may have apnea that strongly affects their tongue position. Therefore, it might be a good idea to hold the TRD forward while they are speaking. TRDs can be used to control severe cases of apnea.

The Oral Positive Airway Pressure Apparatus

The oral positive airway pressure appliance (OPAP) treats obstructive sleep apnea using a mouthpiece rather than a nasal mask. The small mouthpiece can be worn by itself or attached to CPAP tubing and a CPAP machine.

The OPAP appliance is designed to be worn alone. If desired, it can also be used as a jaw retention device to keep the lower jaw forward. It attaches to a CPAP device and holds the airway open using air pressure.

Who Can Benefit From An OPAP Appliance?

The OPAP appliance could be an option for those with mild or severe obstructive sleep apnea. The OPAP appliance can be worn alone and may be used as an alternative to a dental appliance for obstructive sleep apnea.

The advantage of the OPAP device is that it does not require a nasal mask. Many people suffer from nasal obstructions, making CPAP difficult to use. The OPAP appliance also eliminates the problems of CPAP mask fitting and skin irritation caused by wearing the CPAP mask on the face. The OPAP appliance doesn’t require headgear, so it is more comfortable. It also eliminates the “bad hair days” that can occur after wearing CPAP headgear for too long.

What Are The Drawbacks To OPAP?

OPAP is still relatively new. Very few people have tried it. The most significant drawback is the excessive production of saliva. The long-term effects of OPAP are still unknown. There are still questions about the effects of OPAP on the teeth and the temporomandibular (TMJ) joint. Patients with TMJ issues should talk to their dentist about an OPAP appliance.

What is the cost of an OPAP appliance? Currently, an OPAP appliance can only be fitted as a custom-fitted appliance, like a dental device. This can prove costly. It will likely cost around $600. In the future, an off-the-shelf version may be offered at a lower price. You should check with your insurance company to see if they will pay for an OPAP appliance.

How can you get an OPAP appliance? Ask your sleep specialist if an OPAP device would suit you. If she is able to answer your questions, she will be able to refer you to a dentist who has been trained to fit an OPAP device. For a list of dentists who are trained in treating sleep disorders and are familiar with OPAP appliances, please contact the Academy of Dental Sleep Medicine (see appendix).

Orthodontic Treatment to Redesign the Jaw

Orthodontists play an increasingly important role in treating obstructive sleep apnea. Patients with sleep apnea who have a small jaw (class II malocclusion) will have an easily blocked airway.

Orthodontic sleep apnea treatment option can be used to modify the jaw by removing teeth and placing implants to fill in the gaps. This can be done alone or in combination with jaw surgery (see below) to enlarge the jaw enough to remove or reduce obstructions to the airway.

Orthodontists are now recognizing the dangers of obstructive sleep apnea. They remove childhood teeth to “make space” in the jaw. This practice can lead to jawbone changes over time due to chewing and tongue movement.

The jaw will become smaller due to fewer teeth taking up space. This can lead to crowded teeth, an overbite, and a narrower airway. Obstructive sleep apnea may result. The future may see a simpler solution to a child’s crowded jaw: preservation of the size, architecture, and function of the jaw.

Drugs for Treating Obstructive Sleep Apnea

Obstructive sleep apnea is generally not treated with drugs. Many of the drugs used to treat central apnea have had mixed results. Some people with Pickwickian Syndrome have found the hormone medroxyprogesterone to be effective. It is believed to improve the patient’s breathing, decrease the frequency of apnea episodes, and improve their symptoms.

Some researchers report no improvement in apneas. Therefore, the results of this drug are mixed. Medroxyprogesterone can have undesirable side effects. Some people may experience fluid retention, nausea, or depression.

It is a sex hormone, so it can cause breast tenderness and extra hair growth. People with liver disease or blood-clotting problems, pregnant women, and people suspected or known to have genital carcinoma should not use it.

Protriptyline, an antidepressant, is effective in mild cases. If the individual’s life is not at immediate risk from sleep apnea, it is not recommended as a treatment.

Protriptyline has some drawbacks. It decreases rapid eye movement (REM) and can cause dry mouth, constipation (mild or intolerable), difficulty starting urine flow, and impotence. Protriptyline can cause confusion in the elderly.

People with high blood pressure, arrhythmias, or prostate disease may not find it appropriate. Obstructive sleep apnea can be treated with oxygen alone. In fact, oxygen can actually make it worse.

Sources:

• Protriptyline In Obstructive Sleep Apnea — A Double-Blind Trial | NEJM. (n.d.). Protriptyline in Obstructive Sleep Apnea — A Double-Blind Trial | NEJM. https://www.nejm.org/doi/full/10.1056/nejm198210213071701.
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• A. (2020, June 5). Bad Breath Causes In Kids | Dentist In Harrisburg NC. Best Dentist Harrisburg, NC | 704-659-5036 | Family Dentistry in Harrisburg. https://icardandstreinfamilydentistry.com/benefits-and-drawbacks-of-oral-appliance-therapy/.
• Efficacy Of Positive Airway Pressure And Oral Appliance In Mild To Moderate Obstructive Sleep Apnea – PubMed. (2004, September 15). PubMed. https://pubmed.ncbi.nlm.nih.gov/15201136/.
• Stick Out the Tongue: Using a Mouthpiece To Treat Snoring And Apnea. (2020, May 15). Verywell Health. https://www.verywellhealth.com/tongue-stabilizing-device-for-treating-sleep-apnea-3015243.
• Mandibular Advancement Device | American Sleep Association. (2021, June 23). American Sleep Association. https://www.sleepassociation.org/sleep-treatments/snoring-mouthpieces/mandibular-advancement-device/.
• An Update On Mandibular Advancement Devices for the Treatment Of Obstructive Sleep Apnoea Hypopnoea Syndrome. (2018, January 1). PubMed Central (PMC). https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5803051/.