Best Sleep Apnea Treatments.com

Are you tired all the time, no matter how long you sleep? Do you suffer from unexplained, recurrent or prolonged infections or colds that just won’t go away? Do you continue to get sick despite being on multiple medications and antibiotics? Have you undergone various tests, with no definitive answers? If so, you could have upper airway resistance syndrome (UARS).

UARS was first described by researchers at Stanford University in 1993. They described a group of young women and men who complained of chronic fatigue and excessive daytime somnolence. They all underwent a formal sleep study, and all were found not to meet the official criteria for obstructive sleep apnea. However, by treating them as if they had obstructive sleep apnea, most improved significantly.

This is probably the most common condition that I see in my ear, nose and throat practice. Despite most of my patients coming in to see me for routine, ear, sinus and throat problems, in the vast majority of cases, UARS can cause if not aggravate many of the above medical conditions. In contrast to medical specialists, I as an ENT physician and surgeon have an advantage: I can see the upper airway with a thin fiberoptic camera.

Different From OSA

To understand UARS, you must first understand obstructive sleep apnea. Obstructive sleep apnea is a well-known sleep related breathing problem where you literally stop breathing at night during sleep due to total collapse of your throat tissues in the throat. This can occur anywhere from a few times every hour to over 100 times every hour. By definition, an “apnea” is defined a total stoppage of breathing for 10 seconds or more. “Hypopnea” is restricted breathing with greater than 30% chest wall movement decrease and blood oxygen drop more than 4%, for 10 seconds or more. The total combination of apneas and hypopneas for the entire night, divided by the total number of hours you sleeps, gives you the apnea hypopnea index, or AHI. This is the most commonly used measure to diagnose obstructive sleep apnea. Untreated, OSA can lead to  hypertension,diabetes, obesity, depression, lack of sexual desire, heart disease, heart attack or stroke.

If you have UARS, you have many more than 5-10 obstructions and arousals every hour, but because the period of obstruction lasts less than 10 seconds, these episodes don’t get counted towards the final score the AHI.

Due to repeated arousals at night, especially during the deeper levels of sleep, you may be unable to get the required deep restorative sleep that you’ll need to feel refreshed in the morning. In most cases, the anatomic reason for this collapse is the tongue. There are many reasons for the tongue to obstruct, including a large tongue or being overweight, but once it occurs, the only thing you can do is to wake up.

Features of UARS

People with UARS don’t fit the typical OSA picture: Usually they are thin, with normal or low blood pressure. They can also have cold hands or feet, sinus problem, migraines, TMJ, depression, anxiety, various gastrointestinal problems. In addition to the above, almost invariably, people with UARS prefer not to sleep on their backs. Many people state that if they try, they choke as they fall asleep, or just keep waking up. Over the years, they have trained themselves to sleep on their side or stomach.  Even then, they still obstruct and wake up to a certain degree. Many people also state that they have crazy or vivid dreams, or sometimes no dreams at all. This is because when you wake up while you are dreaming in the REM stage, you will remember your dreams vividly. By definition, all dreams are wild and vivid. Only because you tend to wake up more frequently while you are dreaming do you remember your dreams more vividly. Some people wake up as they begin to enter the dreaming stage, so they never dream at all.

Some others blame their frequent arousals to having to go to the bathroom. One thing to note is that inefficient sleep with increased stress hormones promotes urine production. Another interesting study recently showed that in a large group of people who wake up frequently to go to the bathroom, using very sensitive instruments, they showed that people wake up because they stop breathing, and not because they had a full bladder.

Family history is also very important. This is one way I gauge what the patient may look like in 20-40 years. In many cases, patients with either UARS or OSA have one or both parents that snore severely, with one or many cardiovascular complications, such as obesity, diabetes, hypertension, or heart disease. If one parent is noted to have had a heart attack or stroke in their 40’s or 50’s, then I take the patient’s condition more seriously.

Do You Have UARS?

The natural course of UARS is highly variable, with some patients remaining unchanged for years or decades, or others slowly progressing into OSA. Some older overweight women in their 50’s or 60’s with OSA tell me that they were very thin in their 20’s, and had cold hands, low blood pressure, chronic diarrhea, dizziness, etc., and now do not have any of these conditions, except that now she has normal or high blood pressure, snoring and severe fatigue (classic OSA).

What seems to aggravate UARS symptoms most, however, is a relative change in their lives. Relative weight gain, even 5-10 pounds, can aggravate the symptoms, which gets better once the weight has stabilized, as the body adjusts and accommodates to the new weight. A bad cold or infection can also aggravate these symptoms, since it causes swelling, which narrows the upper airway. UARS people, who are already living on the “edge”, tend to have more prolonged or severe colds, as airway swelling causes more narrowing and anatomic collapse, which aggravates throat acid reflux, causing more swelling, perpetuating the vicious cycle. At a certain point, the body cannot adjust, and the vicious cycle is self-perpetuating. Poor sleep aggravates weight gain (for reasons described here), and weight gain narrows the throat even more, causing more obstruction and arousals. Stress is also a big factor-emotional, psychological, or physical. Whether the stress is internal or external, the body behaves the same way.

As you can see, UARS can potentially explain many symptoms. Typically, patients see multiple doctors for various complaints, without ever finding complete relief. In the end, some even lose faith in Western (allopathic) medicine and look elsewhere in alternative or complementary forms of treatment.

While eupnoea is normal breathing, hypopnea is an abnormal type of breathing when the airflow is labored because of some pathology of the respiratory system. In other words it’s underbreathing. Hypopnea comes from the Greek roots hypo- (meaning low, under, beneath, down, below normal) and pnoe (meaning breathing). Among other abnormal breathing patterns are: bradypnea – rare and slow breath, dyspnea - intense breath with a shortness, sometimes with cyanosis, hyperpnea – the increased amplitude of breathing at the normal rate, tachypnea – quickened and fast breathing, oligopnea – weakening of respiratory movements accompanied with reduction of breath. Hypopnea is often confused with apnea. But while hypopnea is a reduced amplitude of breathing at the normal rate, apnea is a total cessation of breathing.

Hypopnea can occur during sleep. In this case it may turn into a serious sleeping disorder. Sleep hypopnea can be characterized by person’s repetitive stops of breathing or low breathing for short periods of time during sleep. Speaking in anatomical terms, there is intermittent collapse of the upper airway and reductions in blood oxygen levels during sleep. Thus, a sleeping person becomes incapable to breathe normally and awakens with each collapse. Quantity and quality of sleep is lowered, what results in sleep deprivation and excessive daytime sleepiness. The most usual physiological consequences of hypopnea are cognitive disfunction, coronary artery disease, myocardial infarction, hypertension, memory loss, heart attack, stroke, impotence, psychiatric problems. People suffering from sleep hypopnea increase considerably the overall number of traffic accidents. Their productivity is diminished and they have constant emotional problems and strains.

The most common hypopnea symptoms are: loss of energy, forgetfulness, excessive sleepiness, snoring, lack of concentration, depression, rapid changes in mood and behavior, morning headaches, nervousness.

There is the so called hypopnea index that can be calculated by dividing the number of hypopneas by the number of hours of sleep. But as far as hypopnea is closely related to apnea most often we speak of the apnea-hypopnea index (AHI). AHI is an index of severity that combines apneas and hypopneas. It is calculated by dividing the number of apneas and hypopneas by the number of hours of sleep correspondingly. When AHI is positive we usually speak of sleep-disordered breathing or SDB.

Although hypopnea itself is not a mortal disease, if it is not treated properly it may shorten a person’s life considerably by aggravating other diseases. CPAP, or continuous positive airway pressure, is considered to be the most effective treatment of hypopnea. It is usually used in case of heavy hypopnea. A patient puts up a mask over his nose or mouth while an air blower forces air through the upper airway. The air pressure is adjusted in a way to avoid the upper airway tissues from collapsing during sleep. Mild hypopnea is treated more conservatively. In the majority of cases hypopnea treatment presupposes refusing from alcohol and smoking before sleep, strengthening gullet muscles by doing certain excercises, avoiding sleeping on the back. Also there is a straight relation between weight loss and improvement of breathing while sleeping. It is established that abnormal breathing patterns during sleep such as sleep apnea and hypopnea, obesity hyperventilation syndrome, etc. usually improve when eating disorders causing overweight and obesity are properly treated.

Bariatric surgery may significantly reduce breathing interruptions during sleep, according to two recent studies. Sleep apnea is one of the risk factors for cardiovascular disease and also causes snoring.In case of obese people, during sleep, the throat muscles relax and the fatty tissue around the neck temporarily narrow the airway. When the muscles are entirely relaxed, the airway sector may be completely obstructed.Both studies showed that bariatric surgery may have other benefits besides weight loss and patients also improve their sleep quality. The first study, conducted in Spain, involved thirty-one subjects who had an initial BMI averaged forty-seven and suffered from sleep apnea.Almost half of the participants had an apnea/hypo apnea index (AHI) higher than fifteen, meaning they stop breathing for more than ten seconds for more than fifteen times per hour. This may seem unimportant, but during an eight-hour night, the participants may reach up to forty minutes without breathing per night.After the bariatric surgery, the subjects had a BMI of up to thirty, and noticed improvements of their sleep quality. The results also showed that participants no longer need treatment for their sleep disturbances.The second study with the same subject was conducted by a team of American researchers in Salt Lake City and also proved that the bariatric surgery may normalize breathing and keep the blood oxygen levels to an optimum level during sleep.Plus, the American study showed that obese subject who suffered a bariatric surgery may decrease their risk of metabolic syndrome by reducing the levels of insulin resistance.

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Finding the right surgeon for you can be a challenge in any situation, but finding the right sleep apnea surgeon can be even more challenging since there are so many different procedures and there are no standard operations. I’m asked quite often by people in other states or other countries who they should go see to treat their sleep apnea condition, and over the years, I’ve come up with the following 10 thoughts and tips. These are suggestions that I would offer to a friend or relative in a remote state if they asked for my advice.

In most cases, an ENT surgeon will be the most appropriate person to see, as they are most qualified to perform surgical procedures of the upper airway. By definition, ENTs (otolaryngologists) are trained in plastic and reconstructive surgery of the soft tissues of the head and neck region. They are the specialists that other doctors call to manage complications of the upper airway. However, there are situations where oro-maxillo-facial surgeons and general plastic surgeons may also play a role.

1. Did you exhaust every other possible option for sleep apnea? Did you try CPAP? How much effort did you put into making sure you gave CPAP a chance to work? Did you consider dental appliances? A good surgeon doesn’t rush into surgery without trying conservative options first.

2. Can you breathe through your nose? Having a stuffy nose can definitely prevent you from benefitting from either CPAP or dental devices. Often, after optimizing nasal breathing via medical or surgical means, people are able to use CPAP or dental devices more effectively.

3. Make sure the surgeon is confident to a reasonable degree where your obstruction is happening. Performing major surgery to “see what happens” is not a reason to do surgery. There are three major areas: the nose, the soft palate and the tongue. The surgeon must be comfortable operating in all three areas. How thoroughly do they examine your upper airway? Do they look with the fiberoptic camera with you sitting up and lying flat? Do they look for movement of the space behind the tongue by having you thrust your lower jaw forward?

4. Can they give you their success rates and complication rates? What is their definition of success? What are their long-term success rates? Compare this with current success rates for uvulopalatopharyngoplasty (UPPP), which has published success rates around 40%. Multilevel surgery approaches around 75 to 80%.

Can they honestly give you their complication rates? If they have no complications whatsoever, I’d be suspicious. Are they prepared to handle anything that may arise? Ask what his or her last complication was and how it was managed. It may seem counterintuitive, but if they don’t have any experience managing complications, you don’t want to be the first one.

5. Do they have a plan in case the surgery doesn’t work as planned? If the post-op sleep study shows less than a significant drop in the AHI score, what are your options? This should be discussed before your initial surgery. Do you stop there, or do you go back and do more (if there’s an obvious area to address), or do you go back to CPAP? Is a referral to an oro-maxillofacial surgeon an option?

6. Don’t focus too much on volume of cases. What’s important is how well it’s done and the appropriate location of the procedure, rather than total number of cases performed. Thousands of UPPPs alone are performed every year by surgeons with only a 40% success rate. If this is the only operation that’s offered, without a plan to address the tongue either simultaneously or at a later point, then your chances of success is no better than 40%.

7. Do they use the Friedman staging system? This is a simple screening tool where by looking at the size of your tonsils and your tongue position, you can predict whether or not a UPPP alone can have an 80% chance of success. Most people will fall into the “unfavorable” category, but if you meet the “favorable” criteria, a UPPP alone may be a good option, as long as you understand that there’s still about a 20% chance of failure.

8. How comfortable are they performing tongue base procedures? Do they have experience with multiple procedures or are they very good at just one? Are they able to perform any of the minimally invasive tongue base procedures in addition to the standard techniques?

9. How well do they work with your sleep doctor and/or dentist to coordinate your care? Is he or she willing to combine multiple treatment options if necessary? Sometimes dental devices or surgery can make CPAP more tolerable by lowering the necessary pressure.

10. Do you trust your surgeon? You must be comfortable and have a good rapport before you undergo any invasive procedure. Get second or third opinions. No matter how technically skilled the surgeon is, if there’s no bedside manner or if the staff is rude, it will eventually show in the quality of your care. As with any doctor, the focus must be on you as a whole person, rather than an isolated surgical procedure.

As you can see there’s no one best solution for treating sleep apnea. There are general recommended guidelines and conservative options must be tried before surgery, but even with surgery, many different paths can be taken, since every patient is different with individual needs. If you’re considering surgery, find someone that you’re comfortable with, and develop a good relationship with that surgeon.

Sleep apnea surgery is one of the most controversial subjects in sleep medicine. There are heated debates within the sleep community as well as in online forums and support groups. Sleep apnea surgery is definitely not for everyone, for some, it can be a life-changing experience. Here are 5 important issues that you must be aware of before considering any form of sleep apnea surgery:1. Does sleep apnea surgery work?Yes, but only when done properly. Just like with CPAP or dental devices, if you don’t use it properly or use it at all, it won’t work. One of the most common misconceptions about sleep apnea surgery is the relatively low success rate of the uvulopalatopharyngoplasty (UPPP) procedure, which is often quoted at 40%. But performing this operation is like bypassing only one blocked heart vessel when you have 3 other vessels that are blocked. For some strange reason, ENTs are overly obsessed with the soft palate, since this is where snoring usually comes from and we have the most research and procedures for the soft palate.We now know that if you address the entire upper airway together (nose, soft palate, tongue), then your success rates are much better, approaching 80%. Why only 80%? There’s only so much you can do with the soft tissues within the small space within smaller jaws (which is the main anatomic reason for sleep apnea). The more aggressive you are, the higher the success rate, but the more chance of pain and complications. If you go to the next level and enlarge your jaws (upper and lower), then success rates can reach 90 to 95%. To put things into perspective, if you bypassed everything with a tracheotomy (placing a breathing tube below your voice box), then you’ll have a 100% “cure”, but obviously, this is not a very practical option.One question you must ask then, is, what’s the meaning of success? In surgery, one common definition is that the final AHI (apnea hypopnea index) on a formal sleep study drops greater than 50% of the original and the final number has to be less than 20. One of the main criticisms of sleep apnea surgery is that even if “successful”, you may still have mild sleep apnea. Surgeons will argue that it’s better than not using CPAP at all. 2. Not All Surgeries Are The SameThere are probably dozens of procedures for sleep apnea from various nasal, soft palate and tongue operations to skeletal framework procedures. These can range from minimally invasive to major surgery. The problem is that by definition, they’ll all work to a certain degree. For example, procedures for a stuffy nose have been shown to “cure” sleep apnea in 10% of patients. But for the most part, none of these options by themselves have very good success rates.The key is to examine the upper airway for each individual and figure out where the obstruction is and take care of it simultaneously. Most people have more than one area of obstruction. Surgeons at Stanford have about a 75 to 80% success rate with soft palate and tongue base procedures. This is called multi-level surgery for sleep apnea. You have to look at the airway from the tip of the nose all the way to the voice box.3. There’s No Cure for Sleep ApneaUnless we all undergo tracheotomies, there’s no way to prevent breathing pauses at night. Modern humans’ upper airway anatomy is thought to be predisposed to breathing problems at night, which only gets worse as we age. I talk about why this problem has gotten much worse in recent years in my book, Sleep, Interrupted. All of us are on a continuum, where various factors (anatomy, age, weight, inflammation, etc.) contribute to forces that make our tongues and palates to collapse. The older we get, we’ll either gain weight, which narrows our breathing passageways, or our throat tissues will sag and collapse easier.Surgery will shift the line of this continuum downwards, but it won’t bring it down completely. This is why it’s important to incorporate a healthy diet and lifestyle and exercise regimen into any sleep apnea treatment regimen. For most people, lowering the numbers significantly will make you feel much better. But sometimes, the numbers will go down dramatically, but you may not feel any better. This just goes to show that there may be other issues besides sleep apnea that have to be addressed. You’ve had sleep apnea for years or decades. Just by fixing your sleep apnea won’t immediately fix problems that can arise from sleep apnea, such as hormonal problems, weight gain, or memory problems and brain fog.4. Surgery is the Last Resort, But Don’t Rule It OutAdmittedly, there are many people who rush to surgery prematurely, but there are also many others that aren’t even offered surgery due to misconceptions by physicians. There are also many patients that are turned off by all the conflicting information that’s available on the internet. Before you even think about surgery, make sure you’ve tried or considered all the other options thoroughly. Most people who fail CPAP do so because of poor counseling, support and followup by the medical system. Just like everything else with life, your chances of success depends on which doctors you see. The follow-up and support offered by  your CPAP equipment vendor can also play an important role in whether or not you’ll benefit from CPAP. The same issues also apply with dental devices for sleep apnea. This is why it’s important to educate yourself about all the treatment options, and not to give up too easily. Too many people give up at this point, and don’t consider any further treatments. Surround yourself with a group of trusted doctors and professionals that forms a team. Use their expertise and guidance to find a way to make things work. If nothing works for you, don’t rule out surgery just for the sake of avoiding surgery. Learn and educate yourself about surgery before rejecting it.5. How to Find the Right SurgeonFinding the right surgeon for your sleep apnea condition can be challenging. Everyone claims to specialize in snoring and sleep apnea surgery. Who are you to believe?First of all, find someone who’s comfortable performing a wide range of procedures in all the three areas of the upper airway (nose, soft palate and tongue). Are they familiar with the minimally invasive procedures as well as the standard options? No everyone will be an expert at all the procedures, but it’s important to know about all the other options as well as well as to make appropriate referrals when necessary.There are a variety of “minimally invasive” procedures out there, especially for the soft palate, but these procedures have to be offered very selectively. Even if successful initially, is your surgeon prepared for relapsed that are likely years later? Is the goal of surgery only to cover up the snoring, or will it treat the underlying anatomic causes? If your surgeon recommends palatal surgery “just to see,” without addressing the entire upper airway from the nose to the tongue, go for a second opinion. If you do decide to undergo a palatal procedure (with or without tonsillectomy), be prepared for a 60% failure rate, which means that the tongue needed to be addressed as well. Sometimes, more needs to be done to the soft palate or the nose has to be addressed. Everyone is different, and the treatment recommendations have to be tailored to the individual.

If you suffer from obstructive sleep apnea, and you’re frustrated with conventional treatment options, you may feel an urge to look at alternative options. If you spend enough time researching this, you’ll find a number of strange, interesting and sometimes bizarre ways of treating sleep apnea. To save you some time, I’ve listed 7 unusual ways below, along with my personal opinions for why it may or may not work:

1. Singing for snorers. There are various programs that teach snorers ways of singing to tighten throat and tongue muscles which in theory can lessen the severity of snoring. I haven’t see any scientific studies validating this method, but I can imagine that singing in general can make you feel good. Singing or speaking is activated by the vagus nerve, which is a part of the parasympathetic nervous system, which is the relaxation half of the involuntary nervous system. Yoga-based deep breathing exercises also teach that exhalation should be longer than inhalation. Interestingly, exhalation, like when you sing, also stimulates the parasympathetic nervous system. When you spend a longer time exhaling than inhaling, you’ll definitely feel better.

2. Tongue exercises. Various programs are available over the internet to teach snorers tongue, mouth and throat exercises, presumably to keep the tongue’s resting position at the roof of the mouth, keeping the mouth closed and breathing more through the nose. By toning the tongue and throat muscles, it probably also causes less obstructions during non-REM deep sleep, when muscles are only partially relaxed.

3. Playing the didgeridoo. This Australian Aborigine wind instrument has been shown in a research study to significant lower sleepiness and apnea-hypopnea scores. The AHI dropped about 6 points (from an average of 21). Similar to singing, profound throat and tongue muscle control is thought to provide extra stimulation to the muscles, leading to less collapse.

4. Playing and oboe, bassoon, or English horn. These double-reeded instruments require much more intense lip and mouth motor control. Musicians playing these instruments were found to be significantly less susceptible to obstructive sleep apnea, as compared with regular wind instruments.

5. Acupuncture. A placebo controlled study showed that acupuncture lowered the AHI on average by about 50%. It probably somehow realigns the imbalance that’s seen of the two halves of the involuntary nervous system.

Warning: Don’t try these last two options on your own. These are investigational medical options and as far as I know, are not available to the general public.

6. Mirtazapine. This is an antidepressant that in clinical trials was found to lower the average AHI by about 50%. It probably somehow increases neuromuscular tone in non-REM deep sleep, or suppresses REM sleep so that you spend more time in non-REM deep sleep.

7. Glossopharyngeal nerve stimulator. A nerve stimulator is implanted onto the nerve that stimulates the tongue on one side. This is paced with the diaphragm. So when you inhale, it stimulates the tongue, tensing it and preventing collapse.

Here’s a bonus:

8. Provent nasal plugs. These are adhesive plugs that cover up each nostril, with a two-way hole: As you inhale, air flows smoothly, but when you exhale, there’s a little bit of resistance, building up pressure in your throat at the end of your breathing out cycle, preventing your throat from collapsing. It’s FDA approved for obstructive sleep apnea. It does seem to work to various degrees in different people. You need a prescription from a doctor to try it out.

Notice a common theme? Many of these options involve exercising the tongue and throat muscles, ultimately changing neuromuscular properties of the musculature. None of these work as well as the three conventional options for treatment (CPAP, dental devices and surgery), but worth looking into if nothing works.

Sleep Apnea Syndrome refers to transient cessation of respiration during sleep. The most common kind of sleep apnea is called Obstructive Sleep Apnea Syndrome (OSA) which is defined as the cessation of airflow during sleep preventing air from entering the lungs caused by an obstruction. It is characterized by repetitive episodes of upper airway obstruction that occur during sleep, usually associated with a reduction in blood oxygen saturation. Another site of obstruction can be the nasal passages.

These periods of ’stopped breathing’ only become clinically significant if the cessation lasts for more than 10 seconds each time and occur more than 10 times every hour. OSA only happens during sleep, as it is a lack of muscle tone in your upper airway that causes the airway to collapse. The airway becomes obstructed at several possible sites which can be due to obstruction caused by excess tissue in the airway, large tonsils, and a large tongue and usually includes the airway muscles relaxing and collapsing when asleep.Various Symptoms

Some of the symptoms of Obstructive Sleep Apnea Syndrome include, but are not limited to excessive daytime sleepiness, frequent episodes of obstructed breathing during sleep, loud snoring, morning headaches, reflecting sleep, a dry mouth upon awakening, high blood pressure, being overweight, irritability, change in personality, depression, difficulty in concentrating, excessive perspiration during sleep, heartburn, reduced libido, insomnia, frequent nocturnal urination (nocturia), restless sleep, nocturnal snorting, gasping, choking (may wake self up), and rapid weight gain etc.Sleep disorder can range from very mild to very severe. The severity is often established using the apnoea/hypopnoea index (AHI), which is the number of apnoeas plus the number of hypopnoeas per hour of sleep - (hypopnoea being reduction in airflow).

Obstructive Sleep Apnea Syndrome is a potentially life-threatening condition that requires immediate medical attention. The risks of undiagnosed obstructive sleep apnea include heart attacks, strokes, impotence, irregular heartbeat, high blood pressure and heart disease. In addition, obstructive sleep apnea causes daytime sleepiness that can result in accidents, lost productivity and interpersonal relationship problems. The severity of the symptoms may be mild, moderate or severe.Treatment:

Mild Sleep Apnea is usually treated by some behavioral changes. Losing weight, sleeping on your side are often recommended. There are oral mouth devices (that help keep the airway open) in the market that may help to reduce snoring in three different ways. Some devices may (1) bring the jaw forward or (2) elevate the soft palate or (3) retain the tongue (from falling back in the airway and blocking breathing). Sleep Apnea is a progessive condition (gets worse as you age) and should not be taken lightly.