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Sleep Apnea

In central sleep apnea your brain simply fails to signal your body to breathe

Reasons for Sleep Apnea

Sleep apnea is a common sleep disorder in which breathing may be interrupted during sleep causing repetitive pauses or disruptions known as apneic events. These events prevent you from getting well-rested sleep, as the start-stop rhythm of your breathing causes you to become partially awake during these episodes. There are several varieties of sleep apnea including obstructive sleep apnea (OSA) and central sleep apnea (CSA).

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Wife next to husband in bed with Obstructive Sleep Apnea that can be treated

What Happens in OSA & CSA Sleep Apnea?

In obstructive sleep apnea (OSA), the muscles in your throat relax causing your tongue to obstruct the throat. This will either narrow or completely block the upper airway making it difficult for you to breathe. When this happens, your chest muscles and diaphragm work harder to open the blocked airway, causing partial awakening. The most common and effective treatment plan for OSA is a CPAP machine. A CPAP machine blows pressurized air into and through your airway keeping it open so that you can breathe.

Normal Airway after Obstructive Sleep Apnea Treatment

Image: Normal Airways

Obstructive Sleep Apnea can be treated

Image: Obstructive Sleep Apnea

In central sleep apnea (CSA) your brain simply fails to signal your body to breathe. You are physically capable of breathing during sleep, but your brain does not signal you to cause your oxygen levels to dip and carbon dioxide to build up in your body. The most common treatment plan for this type of sleep apnea is a CPAP or an adaptive servo-ventilation (ASV) machine. An ASV machine is similar to a CPAP but adjusts the pressure levels of the outgoing air to match your breathing patterns.

The Downside to CPAP and ASV – Why Some May Choose Surgery Instead

Some may not tolerate CPAP and ASV machines as these require you to place a mask over your face. Mask discomfort and high pressures from the machine may be overwhelming and too uncomfortable for some.

Do you tolerate CPAP and ASV machines like this?

Available Surgical Procedures for Sleep Apnea

Couple feeling free and relaxed after obstructive sleep apnea surgery

There are several different types of surgery for sleep apnea, some of which are minimally invasive and target the soft palate and uvula or tonsils, while some are much more intensive and target the upper and lower jaw.

  • Weight Loss Surgery.

    This is usually recommended as losing weight can help open up the airways as less weight places less compression upon the airways.

  • Uvulopalatopharyngoplasty (UPPP).

    A UPPP surgery will either reposition or remove excess tissue that sits at the back of your throat and mouth. Common tissues affected are the soft palate, uvula, tonsils, and the muscles within the soft palate. By repositioning your muscles, and removing the excess tissue, your airway becomes wider.

  • Upper Airway Stimulation Therapy (Hypoglossal nerve stimulator).

    This procedure involves using an implanted device (similar to a pacemaker) to monitor your breathing. While you sleep, the implant will stimulate the hypoglossal nerve which controls your tongue thereby pushing your tongue out of the way to reduce obstruction.

  • Radiofrequency Volumetric Tissue Reduction (RFVTR).

    With this surgery, radiofrequency energy is used to shrink or remove tissues at the back of your throat, thus opening up the airways. RFVTR is most commonly used on the tonsils, tongue, and soft palate.

  • Septoplasty and Turbinate Reduction.

    These are surgical options that will improve air flow through your nasal passageways. The septoplasty will straighten up a crooked or deviated septum, while a turbinate reduction will reduce or remove the vascular humidifying structures that are in the nasal cavity.

  • Genioglossus Advancement.

    If you are suffering from sleep apnea because your tongue is falling backwards and blocking your airways, a genioglossus advancement may be recommended. This moves the major tongue attachment forward, opening up the space behind the tongue for more breathing.

  • Hyoid Suspension.

    This is a more complex surgical option for those who have sleep apnea that is caused by a blockage near the bottom portion of the tongue. A hyoid suspension simply moves the hyoid bone and the nearby muscles forward in your neck to open your airways up more.

  • Maxillomandibular Osteotomy (MMO) and Advancement (MMA).

    If you are a sleep apnea patient that has a smaller lower jaw (mandibular hypoplasia or retrognathia), your upper and/or lower jaw can be moved forward to enlarge the mouth space. The increase in space allows you to breathe better. This is an extensive procedure, so it is likely to be recommended at much later stages in treatment.

  • Palatal Implants.

    This type of surgical treatment places small, fiber rods into the soft palate to stiffen it up and prevent the airway from blockage. It is commonly used in those who have mild sleep apnea or in those who suffer from snoring.

  • Midline Glossectomy & Base Tongue Reduction.

    This surgical procedure removes a posterior bulky portion of your tongue, enlarging the airway.

  • Lingual Tonsillectomy.

    By removing the tonsillar tissue near the back of your tongue, as well as your tonsils, the lower part of your throat will be opened for easier breathing.

Which Surgery Option is Right for Me?

The best way to determine which surgical procedure is right for you is to have a consultation with an ear, nose, and throat specialist (ENT), as a thorough exam of your throat, tongue, and nasal passageways will reveal the reasons for obstruction of your sleep apnea. If you have any questions regarding any of the procedures listed above, please get into contact with us here at Florida Otolaryngology Group. Our licensed and board certified ENT specialists are happy to help and are committed to providing you with the highest quality of care. Give us a call at 407-677-0099.

Patient consulting with a doctor to see if sleep apnea surgery right for him

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