INTRO TO SLEEP APNEA – PART 2

Last week I discussed what sleep apnea is. This week I will discuss diagnosis and treatment.

Specialists who diagnose and treat sleep apnea express varying opinions about the cause and best treatment of the breathing disorder. Ask a lot of questions of each specialist to determine the most appropriate procedure or combination of procedures for your particular case. Here are the specialists who may be involved in diagnosing your sleep apnea and the ways they might assist you:

An ear, nose and throat doctor (ENT) may recommend surgery to clear blockages caused by a genetic abnormality in the nose or throat. The uvulopalatopharyngoplasty (UPPP) procedure eliminates tissue from the back portion of the mouth near the top of the throat. The adenoids and tonsils may be removed as well. Should your airflow blockage be life-threatening, the ENT may find it necessary to build an opening in the windpipe through a procedure called a tracheotomy. This would be an extreme case. Also, an operation on your nose might be necessary to improve a deviated septum or to remove polyps that are blocking your airflow.

A pulmonologist (a doctor who deals with diseases of the respiratory system) may recommend a sleep evaluation based on an analysis of your breathing muscle capacity. Pulmonologists may also recommend the use of oxygen should blood-oxygen levels fall to dangerous levels during sleep.

A neurologist (a doctor who deals with nervous system disorders) will evaluate brain functionality and may recommend a medication such as acetazolamide to improve the brain’s ability to trigger the breathing muscles.

A cardiologist (a doctor who deals with diseases and disorders of the heart) may recommend a sleep test as well.

A sleep specialist may perform a sleep test that measures oxygen blood level (among other anatomical factors) during sleep. Sleep specialists may recommend the use of a continuous positive airway pressure (CPAP) machine. The machine delivers a continuous flow of oxygen through a mask that you wear over your nose during sleep.

An alternative is a bi-level positive airway pressure (bi-level PAP) machine, which increases the oxygen level upon inhalation and decreases it upon exhalation. An adaptive servo-ventilation (ASV) machine is a third choice. This equipment measures your level of breathing and records the data so that oxygen delivery can be matched to your specific needs. A CPAP machine is usually considered the best way to treat sleep apnea if the patient can tolerate it.

Certain dentists and oral surgeons are skilled in evaluating the tongue for its ability to move freely and its tendency to block airflow during sleep. The tongue can become restricted as the mouth and gum tissue shrinks with age. In this case, a laser may be used to eliminate the tissue causing the tongue restriction.

Another dental approach is to position the jaw so that airflow is not blocked. If the upper and lower jaws are responsible for sleep apnea, then an oral surgeon and an orthodontist may work together to relocate them.

Finally, many patients with sleep apnea can be successfully treated with a dental appliance made by a dentist with experience in treating this sleep disorder. The appliance is worn while sleeping to hold the lower jaw in an appropriate position to keep the airway opening. This is becoming more and more of an accepted and effective treatment.

Dr. St. Clair maintains a private dental practice in Rowley and Newburyport dedicated to health-centered family dentistry. If there are certain topics you would like to see written about or questions you have please email them to him at jpstclair@stclairdmd.com. You can view all previously written columns at www.jpeterstclairdentistry.com/blog.