Sleep apnea occurs when a person stops breathing while they’re sleeping, recurring in episodes lasting at least 10 seconds. It’s estimated that nearly 30 million Americans experience some form of sleep apnea, and that most of them don’t even know it. That’s nearly 1 in every 10 Americans experiencing breathing difficulties during the night—and the daytime effects and symptoms that come with those difficulties—with no awareness of the cause or the potential relief.
Healthe-Matters spoke with Peter Vosler, MD, a board-certified head and neck surgeon, about what sleep apnea is, how to recognize it, and how the latest treatment is a lifesaver for some.
Types of sleep apnea
There are two types of sleep apnea: central sleep apnea and obstructive sleep apnea.
- Obstructive sleep apnea is the most common and occurs when the throat muscles relax during sleep and air physically cannot pass through the throat. This can happen multiple times throughout the night. Obstructive sleep apnea can be mild, moderate, or severe.
- Central sleep apnea occurs when, during sleep, the brain does not send the necessary signal to the breathing muscles, instructing them to take a breath.
Symptoms of sleep apnea
Initial symptoms of sleep apnea will look much like one would expect from critical lack of sleep, and include:
- Excessive tiredness and fatigue during the day
- Loud snoring
- Waking up choking or gasping
- Difficulty concentrating
- Irritability
- Depression
For some, the effects on quality sleep can be such that they’re falling asleep at their desk or even when stopped at a stoplight.
Still, Dr. Vosler says, “The long-term effects of sleep apnea are much more concerning.”
When left untreated, sleep apnea can contribute to a wide range of very serious conditions, including several cardiovascular problems, such as coronary artery disease, increased risk of heart attack and different arrhythmias, like atrial fibrillation. Untreated sleep apnea can also increase risk of diabetes, memory loss, and dementia, as well as a lower life expectancy, overall.
How is sleep apnea traditionally treated?
The most common treatment for sleep apnea is called a CPAP, meaning Continuous Positive Airway Pressure. A CPAP is a machine that uses gentle pressure to deliver air through a mask to keep the throat open while the person is sleeping. The mask is worn throughout the night and removed in the morning.
There are also lifestyle changes which can help and are often recommended before starting any sort of advanced therapy or treatment. These include maintaining a healthy weight, increasing exercise, eating a healthy diet and practicing good sleep hygiene. All of these have the ability to alleviate sleep apnea symptoms.
What is Sleep Hygiene?
Sleep hygiene means following best practices to achieve healthy sleep on a regular basis. This means going to bed at the same time every night, waking up at the same time every morning, not eating before bed, moderating alcohol consumption, no smoking and no looking at screens before bed, including the phone.
How does Inspire therapy alleviate sleep apnea without a CPAP?
One of the newest treatments for sleep apnea at Sarasota Memorial, the Inspire system is a small device implanted near the collarbone that can monitor a person’s breathing at night and stimulate the muscles necessary to keep the airway open. Used to treat moderate to severe sleep apnea, the device can be controlled via remote, so patients can turn it on when they go to sleep, turn it off when they wake up, and adjust stimulation strength as necessary.
“It’s called a hypoglossal nerve stimulator,” says Dr. Vosler. “The theory behind it is that when the airway in your throat collapses, it's because of lack of tone, or your muscles relaxing. This device stimulates the tongue muscles to open up your throat so you can breathe.”
Patients need to have a sleep study done within the past two years that shows moderate to severe sleep apnea. The degree of sleep apnea is measured by the apnea-hypopnea index, or AHI. If a patient has an AHI of 15-65 and their body-mass index is below 35 kg/m2, then they qualify for Inspire. Dr. Vosler will then discuss the next steps involved, including a drug-induced sleep endoscopy to see if the device will work for them. Once the patient is asleep and obstructing, a small camera is used to see how the throat collapses, and if the Inspire can help. It is an essential part of the workup to avoid putting in an implant that won’t help with a patient’s sleep apnea. However, most patients qualify for the implant after the sleep endoscopy and can be scheduled for outpatient surgery.
The procedure takes less than an hour to perform. Pain in recovery is mild and controlled with Tylenol and Ibuprofen. Risks are minimal but can include nerve damage to the tongue. “But this is incredibly rare,” says Dr. Vosler. “I have not seen that in the literature, and I have not seen that in my practice.”
A month following the surgery, the Inspire is activated and the patient will work with their sleep doctor to fine-tune the device to their needs.
How effective is Inspire therapy?
“The vast majority of patients that I've done this for have seen success,” says Dr. Vosler, with postoperative discomfort resolving by the two-week mark and follow-up sleep studies showing sleep apnea symptoms either greatly alleviated or completely resolved. It’s an advance in the field he welcomes.
“It's very important to have options,” Dr. Vosler says. “Before Inspire, there wasn't another option besides CPAP, and some people just cannot tolerate it. They put it on every night and it's on the floor every morning. And there are long-term side effects of sleep apnea that accumulate over time and that you don’t want. Inspire gives these patients an option.”
Hear more from Dr. Vosler on surgical treatment for sleep apnea with this episode of HealthCasts.
Surgical Treatment for Sleep Apnea | HealthCasts Season 6, Episode 7 from SMHCS on Vimeo.
Learn More
To learn more about Respiratory Care Services at Sarasota Memorial, click here.
To request an appointment with Dr. Vosler, click here.
Written by Sarasota Memorial copywriter Philip Lederer, MA, who crafts a variety of external communications for the healthcare system. SMH’s in-house wordsmith, Lederer earned his Master’s degree in Public Administration and Political Philosophy from Morehead State University, KY, and snores like a rusty chainsaw.