Obstructive sleep apnea is a potentially serious disorder that causes periods of interrupted breathing while you are asleep. One of the reasons this happens while sleeping is that all of the muscles in your body relax during this period, including those that help keep your throat open to allow air to flow into the lungs, explains Stanley H. Chia, MD, FACS, associate chair of Otolaryngology at MedStar Washington Hospital Center. New sleep apnea treatment options do exist and one, called Upper Airway Stimulation (UAS), is making a difference for some patients for whom standard therapy was not effective.
Sleep Apnea: The Health Effects
With sleep apnea, the airway becomes narrowed or partially blocked when the muscles in the upper throat relax. The tissues then close in, block the airway and cause you to stop breathing. This is called apnea.
One of the most common symptoms of sleep apnea is snoring, which happens when the air is squeezed through this narrowed airway. Another symptom is constant exhaustion from a chronic lack of sleep.
The consequence of sleep deprivation isn’t simply exhaustion, however. “This disorder can cause or worsen some serious disorders, such as high blood pressure, stroke and heart disease,” says Dr. Chia. “In very severe cases of sleep apnea, patients may stop breathing over 100 times an hour. They try to get air in their lungs, but the airway collapses, blocked by tissue in the back of their throat. Their oxygen levels drop, and they awake repeatedly during the night. Often they aren’t even aware of waking, until a partner complains about the snoring and gasping for air—the most common symptoms.”
What are sleep apnea treatment options?
CPAP (Continuous Positive Airway Pressure) is the gold standard treatment for sleep apnea. The CPAP mask is worn over the mouth and/or nose, and is connected to a pump by a hose that pushes air into the wearer’s throat and keeps the airway open.
“It’s effective for many people,” Dr. Chia says. “But nearly half of patients prescribed CPAP cannot wear the mask through the night, so they are not treated adequately. Until recently, the only other surgical treatments available have had mixed results, and recovery is painful.”
Today, there is another option called Upper Airway Stimulation (UAS) therapy —the first new treatment option for obstructive sleep apnea in more than a decade. “This new technology, which was recently approved by the FDA, offers a subset of patients an effective therapy,” says Dr. Chia.
The Upper Airway Stimulation Option
For one 33-year-old Washingtonian, sleep was treacherous—and a good night’s rest had eluded him since childhood. He had suffered with obstructive sleep apnea for decades—gasping for breath dozens of times during the night. Sleep-deprived and literally tired of feeling that way, he sought help from Dr. Chia. A thorough evaluation found that he was an excellent candidate for UAS therapy.
“The Upper Airway Stimulation procedure isn’t for everyone,” Dr. Chia explains. “But it is one of the sleep apnea treatment options proving effective for people with moderate to severe sleep apnea who don’t respond to other treatments.”
Candidates for the UAS sleep apnea treatment option must meet some criteria. “They need to have a body mass index of less than 32, and a sleep apnea score of between 20 and 65, determined by a sleep study,” he says. During the surgery, a small generator device similar to a pacemaker is implanted under the skin below the collarbone. Another incision is made on the side of the patient’s chest where a wire sensor is tunneled under the skin and attached to the generator and senses the individual’s breathing.
Another incision is made in the neck and a lead is connected to the hypoglossal nerve, which stimulates tongue movement. With every breath the patient takes, a signal is sent to the nerve to stimulate the tongue, which moves forward in the mouth and opens the upper airway.
Sweet, Sleep Relief
After a month to allow tissues to heal, the device is calibrated. Then patients simply turn it on at bedtime, using a remote control.
“Like more than 70 percent of those who have had the UAS procedure, my patient’s sleep apnea has improved dramatically,” says Dr. Chia. “In fact, he told me that he is sleeping deeply enough to have dreams for the first time that he can remember—and getting a good night’s sleep for the first time in years.”
Obstructive Sleep Apnea Fast Facts
- Having small upper airway, or large tongue, tonsils or uvula
- Having recessed chin, small jaw or large overbite, large neck size
- Smoking and alcohol use
- Being age 40+ and/or overweight
- Being African-American, Pacific-Islander or Hispanic
- Having a family member with the disorder
- Chronic snoring
- Feeling sleep deprived
- Difficulty concentrating, depression
- Falling asleep at work or driving
- High blood pressure or morning headaches