By Phillip S. LoSavio, MD
As an otolaryngologist/head and neck surgeon who is head of the Section of Sleep Surgery at Rush, I meet with many sleep apnea patients who have been suffering with obstructive sleep apnea (OSA) for years and sometimes decades.
Obstructive sleep apnea causes people to have intermittent blockage of their throat while sleeping at night. This leads to poor quality sleep and even decreases in nighttime blood oxygen levels in severe cases.
One cannot help but have empathy for these patients. All of us know what it feels like to have a poor night’s sleep from time to time, but it is hard to imagine what it might be like to go through life like that day in and day out.
Some of my patients say they are afraid to go to sleep, concerned they may stop breathing and not wake up. The first thing I explain to my patients is that there are many options available. I’m not going to give up on them, and they shouldn’t give up on themselves.
Wearing a continuous pressure mask (PAP therapy, often referred to as CPAP) is the most common first-line treatment and will very effectively control your sleep apnea when used consistently.
However, many people are either unable to tolerate or unwilling to use this therapy. Unfortunately, many of these patients give up and go on with their lives untreated, elevating their risk of adverse health outcomes.
What causes sleep apnea?
Sleep apnea is a complex disease. When evaluating a patient I begin by asking, “What is causing this patient’s OSA?”
Usually this is a question that has not been asked up to that point or covered only briefly. In order to treat a disease correctly you have to know the cause. You wouldn’t just treat an earache without looking in someone’s ear. Why should sleep apnea be any different?
That’s why all patients I see with sleep apnea receive a thorough upper airway exam. This may include performing a sleep endoscopy, a brief procedure done with some mild sedation that allows me to examine the throat and see where it is getting blocked.
For some patients, I can simply help them with being able to use their CPAP. A blocked nose will make it difficult to use a mask at night. Studies show that treating nasal obstruction will improve a patient’s ability to use a CPAP mask.
But for the large group of people that cannot use a mask, we need to look at other options.
Finding the right solution
A common question I hear is, “Does surgery for sleep apnea work?” The answer depends on which surgery and for which patient. Ideally, the goal of any current therapy is that it is precisely matched to the correct patient.
A sleep endoscopy makes it possible to determine the location of a patient’s obstruction, which in many cases is multi-level, thereby allowing us to match the right sleep surgery to the right patient. So if, for example, you attempt a surgery that targets the palate, and a patient actually has tongue-based obstruction, you can guess how successful (or unsuccessful) that treatment will turn out.
All of my patients go into surgery knowing what is causing their apnea and my plan to approach each of those areas. This could involve various surgical procedures, a dental appliance, weight loss recommendations, or a combination of different approaches. Even for people who have had prior unsuccessful surgery or other therapy, we can offer solutions at Rush.
One exciting option I can now offer is the Inspire therapy system for the treatment of moderate to severe obstructive sleep apnea, which was FDA approved in 2014. The device is based on the concept of upper airway stimulation where the muscles of the throat are stimulated to prevent collapse while sleeping at night. While the therapy is not for everyone, for some it can bring much-needed relief to their sleeping problems.
Getting relief for sleep apnea
If you have not yet found relief from your sleep apnea, consider making an appointment with a sleep surgeon to evaluate your problem. To give you the fullest range of options, look for someone who regularly performs sleep endoscopy procedures as well as contemporary surgical techniques, including upper airway stimulation therapy.
At Rush, we are here to help you get a good night sleep, and we are dedicated to helping you solve your problem. We can be reached at (312) 942-7878 or firstname.lastname@example.org.