Each night, around 22 million Americans go to sleep — and stop breathing. They start breathing again, but those with sleep apnea can experience stoppages of breathing several times an hour. Depending on the severity of their sleep apnea, these stoppages can occur anywhere from five to 100 times an hour. This makes getting a good night's sleep difficult while also putting those with sleep apnea at a higher risk for cardiovascular disease, heart attack, stroke, depression, and motor vehicle accidents.
Obstructive sleep apnea is the most common type of sleep apnea and involves the collapse of muscle tissues in the airway while in a relaxed sleep state. The best way to treat this is with the use of a continuous positive airway pressure (CPAP) machine. This pushes air into the airway to keep it open and keep the person breathing. But it only works if the person wears it consistently.
"Over half of people who have CPAPs are not using them," said Kelly Baron PhD, MPH, DBSM, a behavioral sleep medicine specialist with University of Utah Health. "And then some of those only use them a couple hours a night and say they don't feel much better. The recommended use for CPAP is all night, every night, including naps. The more you wear it, the more improvement you'll have in how you feel."
Many patients discontinue use of the CPAP machine due to the discomfort of using it. Air is delivered via a face mask, which many find strange or cumbersome. Some even say it makes them feel claustrophobic. But there are ways to make it work. "There are multiple types of masks available," Baron said. "Also, adjustments can be made to the fit of the mask and the pressure of the air being pushed through it."
For those who can't tolerate the CPAP machine, there are other options for treating sleep apnea. Losing weight is one: a majority of sleep apnea patients are overweight or obese. That extra weight causes their airway to collapse and their breathing to be interrupted.
Of course, losing weight can be difficult, but it can be done. "Sleep apnea can be the motivation some people need to lose that 30 pounds," Baron said. "However, if you're having severe apnea, weight loss alone probably is not sufficient."
Mandibular advancement devices (dental appliances) that move the jaw forward during sleep can also be helpful for some patients with sleep apnea. Currently there are more than 100 FDA-approved devices on the market. You just need to find the one that's right for you.
Most of them are worn like a mouth guard and help protrude your jaw so your airway stays open. "These devices pull the lower jaw forward to open up more space in the back of your throat," said Krishna Sundar, MD, Medical Director of the University of Utah Health Sleep-Wake Center. "So even when the throat relaxes and narrows at night, the protrusion of the lower jaw by the dental appliance prevents the throat collapse during sleep from occurring completely." These devices are fitted by dentists who are trained in their application.
Surgical options are also available for certain sleep apnea patients. Previously, they involved removing the tonsils, the uvula, and throat tissue to open the airway and decrease the likelihood of airway closure during sleep. However, these patients relapsed with an occurrence of throat collapse at a different level of the upper airway, so these surgeries are not done as frequently.
Several years ago, the hypoglossal nerve stimulator implant was introduced as another option. This involves placing a wire around the nerve that stimulates a muscle, the genioglossus, in the tongue and causes it to protrude at the time of inhalation. "By stimulating the genioglossus muscle at the right time, we can breathe and help keep your upper airway open at night," Sundar said. "Patients have to meet certain criteria on how their airway collapses in order to qualify for this therapy."
With all of these options, one thing is clear: sleep apnea doesn't have to keep you up at night.