Sleep Apnea Therapy

Sleep apnea therapy can be done in various ways, generally divided into two major namely non-surgical and surgical therapies. This therapy aims to free up the airways in patients, since generally the main cause of sleep apnea is a narrowing / blockage of the airways. The following will be explained briefly about sleep apnea therapy commonly used in the medical world.

Non-Surgical Therapy

·         Continuous positive airway pressure (CPAP)

Is a tool commonly used by people with sleep apnea, which serves to provide air pressure through a mask placed over the nose during sleep. The compressed air aimed at preventing the collapse of the airway in the throat. This prevents apnea and snoring. Most people feel awkward and uncomfortable when first use this mask, sometimes it takes a while to be familiar with.

·         Mouthpiece (oral device) or Inter-oral devices (IODs)

Another option is to use an oral device that is designed to keep the throat open. Oral appliances are a successful alternative for a handful of patients. Some devices are designed to open the throat by bringing the jaw forward. Sometimes this can eliminate snoring and mild OSA.

·         Stimulants

If the symptom of daytime sleepiness is very severe, short-term dosage of drugs known as stimulants may be advisable. Stimulants work by increasing the activity of the nervous system so that patients feel more alert and awake. A drug called modafinil may be advisable, while the side effects can include dizziness and blurred vision. But the long-term use of stimulants is not recommended since people can become addicted to it.

·         Positional therapy

Most people benefit from sleeping position at 30 degrees elevation of the upper body. This helps prevent the gravitational collapse of the airway. A 30 degree elevation of the upper body can be achieved with the bedroom set, or wedge placed under the bed mattress. This approach can easily be used in combination with other treatments and are very effective for people who are obese. Lateral sleeping positions (sleeping on the side) is also recommended.

Surgical Therapy

The goal of surgery is to remove the excess tissue from the nose or throat that can vibrate and causing snoring. The excess tissue may block the upper portion of respiratory tract and lead to sleep apnea. Several surgical approaches commonly used include:

·         Uvulopalatopharyngoplasty (UPPP)

UPPP is a procedure of removing tissue from the back of the mouth and upper throat, as well as the tonsils and adenoids. UPPP usually performed in a hospital and requires general anesthesia. The success rate of this method is only at 30 to 50 percent.

·         Jaw Correction

This procedure is usually called as Maxillomandibular Advancement (MMA). The purpose of this action is to enlarge the space behind the tongue and soft palate. Such surgical treatment is considered as one of the most effective way to treat sleep apnea due to a very high success rate. Generally, MMA is often performed along with Genioglossus Advancement (tongue advancement).

·         Implants

Implant procedure is a minimally invasive treatment. It involves the placement of three small polyester rods in the ceiling soft to prevent the collapse of soft palate. This treatment is only recommended for mild to moderate degrees of sleep apnea.

·         Laser Assisted Uvulopalatoplasty (LAUP)

LUPP is an activity removing tissue at the back of the throat with a laser with radiofrequency. LAUP is indeed one of the cheaper types of surgery, but it goes straight to the condition where it can only reduce snoring and does not eliminate the sleep apnea itself.

Sleep apnea therapy is proven to alleviate sleep apnea at a certain level, but since it is difficult to cure sleep disorders, it is better for people with severe disorders to reduce their bad habits such as consuming alcoholic beverages.

Sleep Apnea In Children

The experts stated that sleep apnea in children can indicate the likelihood of children at risk for several serious health problems.

When children experience sleep deprivation, of course, can disrupt the child's daily routines, and so did with excess sleep. Sleep apnea is a form of disruption that often occurs in children. This disorder is characterized by the loss of a child breathing momentarily during sleep. While not everyone who snores has sleep disorder, but snoring is a sign that most often occur, and for those who suffer from sleep apnea also had difficulty breathing.

American Academy of Family Physicians (AAFP) informed that parents need to be concerned when they hear their kids snore during their sleep. Occasionally, upper respiratory tract infection can cause enlargement of the tonsils, thus blocking the smooth movement of air passing from mouth and nose to the lungs. Excessive weight can also cause or increase the risk of children for having OSA (Obstructive Sleep Apnea).

Sleep apnea in children is generally characterized with signs or symptoms such as:

·         Daytime excessive sleepiness.

·         The reduced of weight gain or very little improvement, if any.

·         Breathing through the mouth.

·         Enlarged tonsils.

·         Sleep disorders (do not sleep soundly).

·         Cognitive and behavioral disorders during the day, such as poor concentration, become aggressive and hyperactive.

If you suspect your child has the OSA symptoms, then you need to consult the ENT specialist who has Otolaryngology subspecialist. If the symptoms persist until the end of childhood, his condition can cause increased blood pressure and the decline of academic values ​​in schools. 

How to handle it?

A doctor will examine if and how a child has sleep apnea. When the cause is being overweight or allergies, then the doctor will first address the main cause. Sometimes, the diagnosis of OSA is quite difficult to make and children also need to undergo some tests to see the cause of snoring. Generally this is done with Polysomnography (PSG), which monitors brain waves, muscle tension, eye movement, respiration / breathing, oxygen levels in the blood and audio monitoring (snoring, etc.) during sleep.

OSA or sleep apnea in children is often treated with surgical removal of tonsils. The other method is somnoplasty, namely lifting excessive throat tissue, by using radio frequency waves to remove the tissue. Another method is laser-Assisted Uvulopalatoplasty (LAUP).

If sleep apnea in children is still present after surgery, then the child needs help with a mask during sleep, so as to accelerate the intake of air through the nasal passages. This therapy is commonly referred to as nasal continuous positive airway pressure (CPAP).

Obstructive Sleep Apnea (OSA): Symptoms, Causes, and Treatments

Obstructive sleep apnea (OSA) is a condition of cessation of breathing for a few seconds during sleep. OSA can occur when the upper airway is closed while efforts to breathe continue. In general, when we sleep, all in a state of relaxation / rest, here included respiratory muscles from the tongue, palate especially the soft palate (soft palate) so that the upper respiratory tract is relatively narrow.

Extreme narrowing of the airways due to various reasons will result in disruption of the air flow during sleep, degrees ranging from the mildest to severe. Generally, narrowing of mild upper respiratory tract is characterized by snoring during sleep, up to severe narrowing of the cessation of breathing during sleep (OSA).

After a few moments sleep without breathing (generally 10 seconds up to 2 minutes), the brain responds to conditions of oxygen deficiency in the body with awake / choking reflex which sometimes OSA sufferer himself did not realize it. These disorders can occur in such a weight (waking many times in one night) thus resulting in poor sleep quality.

OSA Symptoms

Symptoms are often experienced by patients with OSA is generally attributable to poor sleep quality, such as:

·         Excessive drowsiness during the day

·         Snore / snoring during sleep

·         Stop breathing during sleep

·         frequent waking during sleep due to choking

Other symptoms which are also associated with OSA include:

·         Memory loss / forgetfulness

·         Decline in intellectual abilities (cognitive)

·         Decreased sexual desire

·         Depression

·         Headaches in the morning (after waking up)

The Cause of OSA

Most cases of OSA are believed to be caused by:

·         Old age (natural or premature),

·         Brain injury (temporary or permanent),

·         Decreased muscle tone,

·         Increased soft tissue around the airway (sometimes due to obesity), and

·         Structural features that cause airway narrowing.

Diseases allegedly caused by OSA:

·         Hypertension

·         Coronary heart disease

·         Stroke

·         Metabolic syndrome (metabolic syndrome)

·         Depression

Management of OSA

The purpose of handling / treatment of OSA would prevent the symptoms of OSA and the impact of OSA such as snoring itself, excessive daytime sleepiness and prevent the continued impact of the body such as the risk of high blood pressure and other diseases. Management of OSA covers:

·         Lifestyle changes including weight loss, exercises, sleep modification techniques (sleep facing side, raises a pillow), avoid smoking, alcohol, sleeping drugs and stress.

·         CPAP (continuous positive airway presure), is a device worn during sleep where the function is to provide positive air pressure into the airway during sleep, so there is no airway obstruction.

·         Dental devices/oral breathing devices, which aims to keep the airway open during sleep by realignment the positions of your tongue and chin.

·         Drugs which help to keep awake during the day.

·         Surgery

In general, doctors will perform the treatment depends on how severe the OSA is. Normally be advised in advance to start with lifestyle changes and the use of CPAP. Before directly addressing the OSA, the doctor usually treat other health problems associated with OSA. For example if you suffer from inflammation of the nose (rhinitis) which causes blockage in the nasal airway, the doctor will add a treatment with a nasal spray (nasal spray) to overcome the disorder, or people with thyroid hormone deficiency (hypothyroidism) then it will be given medications to increase the metabolism of these hormones.

Please note in general, that the management of obstructive sleep apnea in children and adults is no different. However in general the choice of tonsillectomy (tonsillectomy) with or without adenoidectomy becomes the primary choice in children as enlargement of the gland tonsil (palatine tonsila) is the major cause of obstructive sleep apnea in children. The use of CPAP in children performed if the choice of surgery is not possible.