By Jason I. Kass, MD, PhD
Division of Otolaryngology – Head and Neck Surgery

Getting a good night’s sleep is something we all want. Unfortunately, for the 50-70 million U.S. adults who suffer from obstructive sleep apnea (OSA), getting a restful night of sleep can be more of a dream than a reality.

OSA occurs when your airway is blocked while you are sleeping. The blocked airway leads to drops in blood oxygen levels, which causes your body to undergo significant stressors to wake you up, only to repeat the cycle over and over again.  Someone with moderate sleep apnea will usually stop or slow their breathing 15 times or more an hour.

People with untreated OSA have major disturbances in their quality of life. These include morning headaches, irritability, chronic fatigue with fuzzy thinking and difficulty keeping up with the demands of the day. Untreated OSA is also associated with many health risks including stroke, high blood pressure, type 2 diabetes, complications from surgery and even difficulty driving. Daytime sleepiness can contribute to or cause thousands of deaths a year, often from auto accidents, according to the American Association of Sleep Technologists (AAST).

Treatment of OSA include both non-surgical and surgical approaches.

Non-surgical treatment includes:

1. Weight loss – The tongue has fat pads that get smaller when you lose 15% of your weight.
2. Continuous Positive Airway Pressure (CPAP) – A machine, which helps to keep your airway open. This is one of the best options, if you can tolerate wearing the mask.
3. Oral Appliance – A dental appliance that pulls your lower jaw forward will also pull your tongue forward. This can be very effective when implemented by a sleep dentist (a dentist who specializes in sleep disorders)
4. Excite OSA – A new FDA approved device specifically approved for those that have isolated snoring or mild OSA. This device is initially used for 20 minutes a day and stimulates the tongue and throat to be stiffer and less likely to vibrate causing snoring.
5. Positional Pillow – Many people suffer worse OSA when they are lying on their back. These pillows force people to sleep on their side, which can help.

Surgical Treatments:

1. Procedures that address the area of obstruction including tonsillectomy and various surgeries that shorten an elongated soft palate or open up the throat which is narrowed by redundant tissue. Even the back of the tongue can be reduced in bulk.
2. Inspire Procedure – Hypoglossal nerve stimulation (see below)

One of the most innovative solutions for those that struggle with CPAP is the Inspire procedure. Eligible patients can have a battery pack implanted in their upper chest with a sensor to measure breathing and a stimulator that activates the nerve that controls the tongue (hypoglossal nerve). The sensor and stimulator work together to protrude the tongue and open the airway.

The sensor and battery pack, which is implanted through an outpatient surgical procedure much like a pacemaker, has electronic leads that monitor breathing and sends impulses to the tongue while sleeping. The stimulation helps clear the airway so you can breathe more effectively. Users control the device using a remote. They can turn it on at bedtime and off when they are ready to get out of bed.

Interested patients must meet the following criteria:

1. Moderate to Severe Sleep Apnea
2. Intolerance of CPAP (you should always try this first)
3. Body Mass Index less than or equal to 32
4. A favorable pattern of obstruction determined by a sleep endoscopy

If your sleep partner tells you that you are pausing or stopping your breathing at night, or you have significant daytime fatigue, talk with your medical provider as soon as possible about getting evaluated. A sleep study is usually the first step.  These are done at home and can diagnose OSA. You will also learn important information about the quality of your sleep, if it is being disrupted, and how your body responds (changes in heart rate and blood oxygen). With so many effective treatments for OSA, there’s no reason not to get a good night’s sleep!