Sleep Apnea: Types and Treatment Options (with video)
The word apnea comes from the Greek, meaning “without breath.” In essence, sleep apnea means to stop breathing while asleep. From the scientific perspective, this disorder is "characterized by periods of an absence of attempts to breath because the individual is momentarily unable to move respiratory muscles or maintain air flow through the nose or mouth."
According to the National Institute of Health, an estimated twelve million Americans (1 out of 25) are affected with sleep apnea (sometimes called sleep apnea syndrome). Of two major kinds, “obstructive” sleep apnea (the more common), and “central” sleep apnea, this condition can be quite frightening for both the person who wakes up gasping for air, as well as for loved ones who may be near
“Obstructive” Sleep Apnea occurs when something blocks the trachea (the “windpipe” allowing air to be taken into the lungs). Typical blockages include: dry throat tissue, fatty tissue in the throat, relaxed throat muscles, the tongue, tonsils/adenoids, or the uvula (the orb hanging in the back of the throat). Deviated septums, broken noses, exceptionally large breasts, and obesity are also known contributors. Use of alcohol and sedative drugs typically worsen existing blockages, while smoking and sinus infections can cause swelling in the throat which exacerbate the condition. Hypothyroidism (decreased activity in the thyroid gland) is also a risk factor for some. Similar in manifestation, “central” sleep apnea occurs when the brain fails to send a clear expand and contract message to the diaphragm. This variety is more of a central nervous system weakness related to the medulla oblongata (located where the brainstem attaches to the spinal column) than to a physical abnormality.
For mild cases of sleep apnea, experts suggest an examination of lifestyle and behavior first. For some individuals, the answer could be as simple as sleeping on one’s side (or changing sides), which can prevent the tongue and palate from falling backwards in the throat and blocking the airway. Another option is to take calcium and magnesium tablets to tone the uvula and the area around the larynx (voice box), which in many cases will alleviate the problem. Another thing experts suggest is to consider the intake of coffee, tea, soda, or milk products, as these beverages have been known to create a pH imbalance which encourages the body to rob sodium out of the mucosal lining in the throat, which inhibits its ability to retain proper throat lining moisture. Avoiding these products for a period of seven days while drinking a slippery elm concoction four times a day will not only tell you if your choice of beverages is the culprit, it will help re-moisturize the lining of the throat. (You can do this by putting 4 tablespoons of slippery elm into a one-quart Mason jar filled with hot water, put on lid and let steep for 30 minutes. Drink 4 oz four times a day--hot or cold.)
For moderately severe cases, many medical professionals suggest the use of a CPAP machine (Continuous Positive Airway Pressure), a respiratory ventilation machine also used for neonates and patients who’ve suffered respiratory failure. This, however, requires the wearing of a mask which an estimated 60% of users never adjust to, and only deals with the symptoms, not the cause. A second option is the use of an OAT appliance (Oral Appliance Therapy), a custom-made mouthpiece that shifts the lower jaw forward, opening up the airway. Although OAT is a relatively new treatment option for sleep apnea in the United States, it is quite common in Canada and Europe.
During central sleep apnea, a condition more common among infants and those in otherwise poor health, the signal from the medulla oblongata to the diaphragm is apparently lost in transmission. While the transfer of signals from the brain to various parts of the body is a complex systems involving many variables, some neurologists suggest that by increasing the amount of healthy fatty acids in the body, the conductivity of messages throughout the nervous system may be improved. Herbalists advocate Evening Primrose oil for this purpose, as well as an infusion of mullein herb. In severe cases, it would of course be best to rely on what has thus far worked for you (including use of PCAP) while you find natural curatives for this condition.
Some people with sleep apnea develop a combination of both “obstructive“ and “central.” When obstructive sleep apnea is severe and longstanding, episodes of central sleep apnea sometimes develop. While there are several theories as to why this jump or transfer in source develops, the exact mechanism of the loss of central respiratory drive during sleep is most commonly related to acid-base and CO2 feedback malfunctions stemming from heart failure, with a whole host of symptoms relating to body mass, cardiovascular, respiratory, and occasionally, neurological dysfunction that have a synergistic effect in sleep-disordered breathing. Generally, treatment would begin with those used for “obstructive,” progress through those used for “central,” then if severe enough, progress to surgical options.
Treatment Options II
For patients who do not respond to natural or nonsurgical measures, surgical treatment is the next option. Several areas of potential obstruction may be addressed including the nasal passage, pharynx (throat), base of tongue, and facial skeleton. In these types of surgeries, treatments are individualized in order to address all the associated anatomical areas of obstruction. Often, correction of the nasal passages needs to be performed in addition to correction of the pharynx passage (area behind the oral cavity). Methods known as septoplasty and turbinate surgery may improve the nasal airway, while tonsillectomy and uvulopalatopharyngoplasty are options to address pharyngeal obstruction. Other surgical options include “base-of-tongue advancement,” hyoid bone myotomy and suspension, and various radiofrequency technologies. For patients who fail these operations, the facial skeletal structure may be physically altered by means of major surgical reconstruction if the symptoms warrant it.
Mosby’s Dictionary of Medicine, Nursing, and Allied Health
PCAP image: http://www.healthbeginsinhim.org/images/Sleep%20Apnea.jpg
illustration via: http://www.sleepapnea.org/
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