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Obstructive Sleep Apnoea - Surgical Treatment or CPAP Machine?

Updated on May 7, 2011

What is Obstructive Sleep Apnoea?

Obstructive Sleep Apnoea is a condition where an individual stops breathing for a period of time during their sleep. This cycle repeats many times during the night interrupting a person's sleep. The obstruction may be complete or partial but is usually sufficient to waken the sleeper for just a few seconds so that they resume breathing again. This interruption prevents a person from achieving the restful states of sleep, such as REM (rapid eye movement - the dream phase) sleep.

The Cause of Sleep Apnoea

Although the exact causes is unclear, the site of obstruction is usually involves the soft tissues at the back of the mouth and nasal cavity. During the day, the muscles in this area help keeps the airway intact. At night, the muscles relax to a point where the airway collapses and breathing is obstructed.

Who is at Risk?

The people at risk for developing Obstructive Sleep Apnoea are those who have:

Common Signs and Symptoms

Common symptoms are:

  • excessive sleepiness during the day
  • personality changes
  • depression
  • decreased memory
  • erectile dysfunction
  • morning headaches
  • frequent need to urinate

People who suffer from Obstructive Sleep Apnoea are rarely aware that they wake up frequently during the night. The physical signs that suggest a person may have Obstructive Sleep Apnoea are:

  • obeisity
  • loud snoring
  • a witnessed episode of apnoea by a sleep partner (e.g. the spouse)

People with Obstructive Sleep Apnoea also often suffer from high blood pressure and tachycardia (rapid heart beat).

How Do You Know if You Have Sleep Apnoea?

Five simple questions may be used to identify a person with sleep apnoea:

1. Do you fall asleep easily during the day (e.g. while driving) despite having an adequate amount of sleep?

2. Do you wake up with dry mouth?

3. Do you wake up frequently during the night to urinate?

4. Do you have high blood pressure?

5. Do you get tachycardia (rapid heart beat)?

If a person says "yes" to three or more of the above questions, they are most likely to have Obstructive Sleep Apnoea. It has also been found that some 80-90% of cardiac patients suffer from Obstructive Sleep Apnoea. A sleep study may be required to properly diagnose the condition. Untreated Obstructive Sleep Apnoea increases the risk of developing heart disease and stroke.

Treatment Options

There are several treatment options available for people with Sleep Apnoea:

  • Surgical (The Pillar Procedure is one new surgical treatment option that has received considerable media attention in recent times)
  • CPAP Machine

The Pillar Procedure is a relatively simple surgical procedure for treating Obstructive Sleep Apnoea. It involves implanted three pins into the soft palate to maintain the airway during sleep. The procedure was first introduced in 2003, and has been hailed as somewhat of a breakthrough in the management of Obstructive Sleep Apnoea.

The studies so far are somewhat limited and the longevity of this procedure has only been tested up to 15 months. Success rate is about 50-60% in a study of about 20 odd. Although risk of infection from this procedure is low, irritation to the tissues and protruding implants are two post-operative issues cited.

Recommended by a cardiologist who has had quite a bit of experience in this area is the CPAP machine. He feels a CPAP machine is a far safer option than undergoing surgery. Some of the reasons why he disagrees with surgery and the Pillar Procedure:

1. Airway obstruction occurs only at night when the muscles are relaxed and not during the day which suggests that there is nothing overtly wrong with the soft tissues in the airway. Surgery seems rather aggressive.

2. What are the long term effects of surgery? Long term is defined as 10 years. The Pillar procedure has only been around for a couple of years - insufficient to determine the long term effects.

3. What are the effects of implants in the palate on eating and speech? The oral environment is a very dynamic environment, constantly undergoing change.

4. The Pillar Procedure only addresses the soft palate. Obstructive Sleep Apnoea involves other soft tissues as well (e.g. the tongue).

What is a CPAP machine and how does it work?

CPAP is the abbreviation of Continuous Positive Airway Pressure. A person with Obstructive Sleep Apnoea wears a mask which is hooked up to a machine that monitors the person's breathing throughout the night. When the machine detects that breathing has stopped, it will send a pulse of air to open the airway so breathing may resume.

Pictures of the CPAP Machine

What the mask looks like when worn
What the mask looks like when worn
Side profile
Side profile
The tubing rotates easily when the sleeper turns in bed
The tubing rotates easily when the sleeper turns in bed
CPAP units are now very compact and easy to take along when traveling
CPAP units are now very compact and easy to take along when traveling

Companies that Manufacture CPAP Machines

There are many different models of CPAP machines that are now available.

There are basically three types of masks - a full face mask that covers the whole face, one that covers only the nose and mouth, and one that covers only the nose (although this is only suitable for people who are not mouth breathers).

The newer CPAP machine models are now so compact (even smaller than the unit shown in the picture below) that it can even be used on an aeroplane on overnight flights.

Some companies that manufacture CPAP machines:

DeVilbiss

Fisher & Paykel Invacare Puritan Bennett ResMed Respironics

A Couple of Notes About CPAP Machines

It is advisable to get a thorough check up with your ENT specialist before using a CPAP machine to ensure that blockage of the airway are not due to other physical obstructions, e.g. nasopharyngeal carcinoma (cancerous growth blocking the airway), enlarged adenoids/tongue, etc.

CPAP machine are not advised for people who have suffered a pneumothorax previously. Encasing your lungs is a sack containing fluid. A pneumothorax is a condition where there is a communication between the lungs and that sack and air becomes trapped inside that sack.

Comments

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    • profile image

      jimtheauthor 

      7 years ago

      my doctor told me if you have surgical treatment done, your throat will learn how to close again in about a year. just use the cpap,

    • profile image

      kimh039 

      8 years ago

      Thanks for the info. Very informative article and easy to understand and read.

    • figur8 profile imageAUTHOR

      figur8 

      10 years ago

      Thanks for sharing your experience. I forgot to mention the learning curve... My FIL, my Dad and my uncle all have OSA and they all use the CPAP machine.

    • G-Ma Johnson profile image

      Merle Ann Johnson 

      10 years ago from NW in the land of the Free

      You've got right..I use the CPAP machine very successfully..Actually hadn't heard of the surgery but wouldn't want that anyway. At first it is a bit hard to get used to the mask covering your face ,,but they make it ramp up to the correct pressure and also at first I froze but learned there is a dial to set the temp. It felt like a refrigerator. they just had a big re-call on all the machines..and handled it very well. I advise anyone with this problem to seek help I sleep like a baby now. Well most of the time G-Ma :o)

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