The question “Is it normal for me to stop breathing while I’m asleep?” can be answered with one word: “No!” If you regularly stop breathing during sleep you may be suffering from a condition known as sleep apnea. This condition can be much more dangerous to your health than you might realize because it can increase your risk of developing heart disease, high blood pressure, or even suffering a stroke.
Apnea which occurs during sleep is generally divided into three categories based on the disease process that is ultimately responsible for its presence. These categories are central, obstructive, and mixed.
Central apnea occurs when the brain fails to send messages to the muscles that are responsible for respiration. The disease processes responsible for such failures can include previous head trauma, a previous stroke, high blood pressure, and heart disease.
Obstructive sleep apnea, or OSA, is the most common type of apnea and occurs when there is a physical reason for either a partial or complete airway blockage. These blockages are usually associated with either a relaxation of the throat muscles that causes the tongue to fall backward toward the throat and block the upper airway or in the structure of the jawbone, This form of apnea is most commonly due to obesity, particularly if the neck circumference is greater than 17 inches in males and greater than 15 inches in females.
Mixed apnea is due, as might be expected, to multiple factors that encompass both obstructive and central features.
Regardless of the underlying cause, such episodes of apnea are usually first suspected because a spouse or partner has noticed an increase in the frequency of restless sleep episodes, an increase in snoring, or even difficulty arousing their partner from sleep. Such observations should prompt at least the consideration of a sleep apnea evaluation.
The diagnosis of apnea occurring during sleep requires conducting an overnight sleep study. This study is practically always sufficient to distinguish between the three subtypes of apnea when based on a combination of the sleep technologist’s observations that are made during the test and the results obtained from the various monitors that are attached during the study.
If obstructive apnea is present, and the patient is overweight or obese, a weight loss regimen is usually tried first. Weight loss programs are frequently accompanied by a trial of continuous positive airway pressure (CPAP), which requires that the patient wear a special mask that is attached to a breathing machine at administers a mixture of air and oxygen. If that program is successful, as documented by a repeat sleep study, no further treatment is usually necessary provided that regaining of lost weight does not occur. If weight loss alone is not corrective, or if obviously obstructive features are also present, other treatment options will need to be explored.
Surgical Treatment of Obstructive Apnea
The are a number of surgical options available for treatment OSA, with the most commonly-performed procedures being uvulo-palato-pharyngo-plasty (UPPP), laser assisted uvulo-palato-plasty (LAUPP), and orthognathic surgery.
Uvulo-palato-pharyngo-plasty (UPPP) is the most commonly-performed surgical procedure performed for treatment of OSA. This procedure involves surgical reshaping of the soft tissues of the mouth and throat areas of the upper airway and is performed under general anesthesia although it may, depending on the operating surgeon’s preferences, be done on an outpatient or overnight admission basis.
Laser Assisted Uvulo-Palato-Plasty
Laser assisted uvulo-palato-plasty (LAUPP) is considered to be both a modification of, and an alternative to, traditional UPPP. LAUPP is usually performed using local anesthesia in the operating physician’s office or in an outpatient surgical facility. Since the procedure is less extensive than UPPP, patients will usually tolerate it well with minimal recovery time.
Orthognathic surgery, or jaw correction surgery, is an option when other corrective procedures or interventions are not considered to offer the best chances for correction of jaw and jaw muscle problems that are the cause of, or major contributing factors to, OSA. Since there are several surgical procedures that may be used to correct the anatomical factors that can lead to OSA, these procedures will not be discussed here since they are best understood when discussed with a maxillofacial surgeon.
Which Procedure is Best for Me?
Those with a confirmed diagnosis of OSA should be aware that this condition is potentially very serious and can lead to a number of health conditions that could result in long term lifestyle changes or disability, particularly if more a conservative therapy has been tried and judged impractical or ineffective. In these cases it is advisable to seek the opinion of a physician experienced in the surgical management of OSA and the various options that may be available.
Dr. Majid Jamali, whose practice at Oral and Maxillofacial Surgery of New York deals with surgical solutions to conditions leading to the development of OSA, will use his years of experience in all aspects of maxillofacial surgery to assist you, by working with both you and your referring health care provider, in deciding which procedure will likely yield the best results. Dr. Jamali and his staff may be contacted at the address and phone numbers below and are ready to answer your questions about the surgical treatment of OSA or any other aspects of maxillofacial plastic surgery.
Oral & Maxillofacial Surgery of New York 42 Broadway, Suite 1501 New York, NY 10004 Phone: 212-480-2777 | Fax: 212-480-3777.