Sleep Apnea

Without treatment, sleep apnea can lead to high blood pressure, heart attack or stroke. If the sleep apnea is severe and has gone on for a long time, it can lead to heart failure.

Many things can cause or contribute to sleep apnea including:

•  A greater than normal relaxation of the throat muscles and tongue
• The structure of the head and neck. This can cause the airway of the mouth and throat to be unusually small. Sometimes the structure of the head and neck contribute to the throat being blocked during sleep.
• Large tonsils and adenoids
• Being overweight

Treatment options offered at the Cedars-Sinai Pain Center include:

• Positive airway pressure devices
• Counseling on lifestyle changes that can help reduce sleep apnea
• Mouth guards and mandibular advancement splints to shift the position of the tongue and jaw to keep the airways open
• Surgical procedure

People who have certain conditions have a greater risk of developing sleep apnea. These conditions include:

• Amyotrophic lateral sclerosis (Lou Gehrig's disease)
• Atrial fibrillation
• Brain tumors
• Heart failure
• Muscular dystrophy
• Spinal cord injuries
• Strokes

People who live with someone who has these conditions should be on alert for signs of sleep apnea. The physicians at the Pain Center at Cedars-Sinai are always available to work with other physicians and specialists in addressing sleep apnea issues in patients with risk factors for sleep apnea

Mouth guards and mandibular advancement splints work by repositioning the tongue or jaw to keep the airway of the throat open. They can be helpful to some people with mild or moderate sleep apnea.

These are custom-fitted plastic mouthpieces made by a dentist or orthodontist. They fit around the teeth and over the tongue. For people with mild sleep apnea or who snored loudly but don't have sleep apnea, they can be helpful.

They work by adjusting the lower jaw and tongue to keep the airway open.

Like a mouthguard, these are custom-made devices that around the teeth and over the tongue. The device holds the lower jaw slightly down and forward. This pulls the tongue slightly forward away from the opening of the airway.

Mandibular advancement splints are helpful to people who have mild or moderate sleep apnea.

One of the most common treatments for sleep apnea is a machine that keeps pressured air flowing through the airways of the throat. The person wears a face mask attached to a tube and a machine that blows pressurized air through the mask into the airway to keep it open. The air acts like a balloon holding the relaxed muscles of the throat open.

There are several forms of this device:

• Continuous positive airway pressure (CPAP). Most positive airway pressure devices blow a constant stream of pressurized air into the airway.
• Variable positive airway pressure (VPAP) or bilevel positive airway pressure (BiPAP). This is a newer type of machine that lowers the amount of pressure when a person breathes out. The device uses an electronic circuit to monitor the person's breathing. Having less pressure in the moment when a person is exhaling may make it more comfortable for the person with sleep apnea. This type of machine is mostly used for people who have other breathing problems or who can't sleep if they have to breath out against a stream of air. 
• Automatic positive airway pressure (APAP). This type of device constantly monitors a person's breathing and makes adjustments. These devices us pressure sensors and a computer to do the monitoring.
  If your doctor recommends a positive airway pressure device, a technician will come to your home with the equipment. He or she will set it up and make adjustments as your doctor orders.

Some people have side effects such as a dry or stuffy nose, a bloating of the stomach or headaches. If any of these occur, the doctor can recommend a number of things to reduce the side effects. Some solutions include adjusting the settings of the machine, adjusting the size or fit of the facemask or adding moisture to the air as it flows through the mask.

People with severe sleep apnea usually feel much better after using a continuous positive airway pressure machine. It is important to continue to have followup appointments with your doctor so he or she can monitor your progress.

Positive airway pressure devices don't cure sleep apnea. If a person stops using one of these devices or fails to use it correctly, the sleep apnea will return.

Sometimes the structure of the mouth and throat is such that the only treatment for sleep apnea is surgery. The type of surgery needed depends on the cause of the sleep apnea. Some of the surgical procedures that may help a person with sleep apnea include:

• Advancing the lower jaw (genioglossus advancement). This moves the part of the lower jaw that attaches to the tongue forward. After the surgery, the tongue is further away from the back of the airway.
• Moving the hyoid suspension. This is a small bone in the neck where some of the muscles of the tongue are attached. In this procedure, the hyoid suspension is moved forward in front of the larynx.
• Placing supports for the soft palate at the back and roof of the mouth (pillar procedure). Three small inserts are injected into the soft palate. This reduces snoring for people with mild to moderate sleep apnea.
• Reducing the base of the tongue either using lasers or radiofrequency ablation. 
• Removing the tonsils and adenoids if they block the airway. This can be especially helpful for children who have sleep apnea.
• Repositioning of the lower jaw (maxillomandibular advancement). In difficult cases where the cause of the sleep apnea is believed to be an abnormal facial structure, this surgery may be used. In this procedure, the upper and lower jaws are detached from the skull, pulled forward and reattached with pins, plates or both.
• Surgery on the nose. This type of surgery includes getting rid of blockages, straightening the septum, which divides the left and right nostrils or eliminating congestion that might reduce airflow.
• Surgery to put a small hole and tube in the windpipe (a tracheostomy). Air flows through the tube into the lungs. This is only done in cases where someone has severe sleep apnea and all other treatments have failed.
• Surgery to rebuild the lower jaw. 
• Surgery to remove the tonsils, uvula (the tissue that hangs down in the middle of the back of the throat), part of the roof of the mouth at the back of the throat. This is only effective for some people with sleep apnea.

Among the factors that contribute to sleep apnea are ones that can be controlled by lifestyle choices. Following the guidelines below may help reduce the effects of sleep apnea for some people.

• Maintain a healthy weight. People who are overweight—especially those who carry weight around the jaw and neck—are more likely to get sleep apnea than people who maintain a healthy weight. The extra fat and tissue around the neck can put pressure on the airway or tongue.
• Avoid alcohol or drugs that relax the central nervous system. Alcohol relaxes the central nervous system. When a person drinks too much alcohol or takes drugs that relax the central nervous system, it can cause the muscles of the throat to relax. This can cause a form of central sleep apnea.
• Quit smoking. Smoking causes many harmful effects to the lungs and blood vessels. Quitting smoking will almost immediately make it easier for a person to breath better.