Sleep disordered breathing is very common in the United States. Approximately 1 out of 4 of adults are habitual snorers. In some cases this is a just problem for others in the household. In others, it can be a sign of obstructive sleep apnea. Sleep apnea is where you either stop or significantly slow your breathing while sleeping. Not only does untreated sleep apnea cause daytime sleepiness and fatigue, but it increases the risk of heart attack and stroke. An ear, nose, and throat doctor can help determine the cause of your snoring, if you have sleep apnea, and how to go about treating it.
Below you will find some information on some of the ways we can treat sleep apnea and snoring. Call us today at 501-932-7600 for an appointment to see how we can help you.
The prevalence of obstructive sleep apnea is estimated to be between 5 and 10% in the United States. Sleep Apnea symptoms and diagnosis. The incidence is higher in individuals who are older, overweight, or have other medical conditions. Typical symptoms include snoring, excessive daytime sleepiness, witnessed apneas, poor sleep quality, fatigue, and mood disorders. Individuals with moderate or severe sleep apnea have increased risks of high blood pressure, heart attack, and stroke. The diagnosis of sleep apnea is suggested by patient history and confirmed by a sleep study.
The treatment of sleep apnea depends on the severity. The most common treatment is a CPAP machine and mask worn at night. This blows a steady stream of air through the nose and mouth to keep the airway from collapsing. Common alternative treatments are oral appliance therapy and surgery. Oral appliances are mouthpieces worn at night that pull the lower lower jaw and/or tongue forward to keep the airway open. These are effective for mild to moderate sleep apnea and have the benefit of no machines or painful recovery. Surgery to open the airway is usually reserved for patients who have failed CPAP therapy or have a specfic anatomic obstruction. The obvious benefit is the potential of a one-time fix. The downside it can require a painful recovery with no guarantee that it will resolve the sleep apnea. Surgery can also be used in conjunction with CPAP or oral oral appliances to improve their effectiveness or tolerance.
At the Ear, Nose & Throat Center of Conway, we provide all types of sleep apnea treatment. As surgeons, Dr. Kirsch and Dr. Fraley specialize in surgery for sleep apnea, including Inspire Airway Stimulation Therapy. Depending on the exam findings and severity of the sleep apnea, other surgeries can include tonsillectomy, uvulopalatopharyngoplasty (UPPP), septoplasty, turbinate reduction, and tongue base surgery. As for oral appliances, we offer the Somnoguard AP as an FDA-approved custom fit device that is covered by most insurance companies and offers a non-surgical, non-CPAP alternative.
For patient who are unable to use CPAP, the ENT Center of Conway now offers Inspire therapy. Unlike other sleep apnea surgeries, which require removing excessive tissue in the nose and throat to open the airway, Inspire is a small surgically implanted device. This breakthrough treatment option delivers mild stimulation to the hypoglossal nerve, which controls the movement of your tongue and other key airway muscles. By stimulating these muscles, the airway remains open while you sleep. Once implanted, the device is controlled by a small handheld remote that allows you to turn it on before bed and off when you wake up. The surgery is generally outpatient with significantly less pain and recovery than other sleep apnea surgeries. Most importantly, clinical effectiveness is greater than other sleep surgeries.
To quality for Inspire, you first need to have an evaluation by one of our physicians. General criteria include intolerance of CPAP, a sleep apnea index (AHI) of 15-65, and a BMI of 32 or less. This means the procedure is effective in treating moderate to severe sleep apnea in patients who are not excessively overweight. If you meet these criteria, you will then need what is called a drug-induced sleep endoscopy, or DISE. This is where you are put to sleep with sedation at a hospital or surgery center while your airway is examined with a scope to determine where the obstruction is occuring. If your airway is appropriate for Inspire, we will begin the insurance certification process. Inspire is covered by most major insurers.
If you think that you or a family member would benefit from Inspire Airway Stimulation Therapy, please contact our office at 501-932-7600. Additional information about Inspire can be found on their website or in this patient guide.
In addition to Inspire, our physicians offer traditional sleep surgery. These surgeries involve repositioning or removing excessive tissue in the airway or This includes tonsillectomy, uvulopalatopharyngoplasty (UPPP), tongue base surgery, and nasal surgery (septoplasty, turbinates, etc). These surgeries are often complimentary to each other to address different areas of obstruction contributing to sleep apnea. Unlike Inspire, there are less stringent requirements to qualify. This means that patients with mild OSA (AHI < 15), very severe OSA (AHI > 65), or a BMI over 32 may still qualify. However, with all sleep surgeries, it should be emphasized that a CPAP is almost always the first line of treatment. Outcomes with any sleep surgery can vary.
One of the surgical options we offer to patients is the AIRLIFT hyoid suspension. This minimally invasive procedure repositions and suspends the hyoid bone to expand and stabilize the airway, decreasing resistance while you sleep. It provides immediate and lasting results. It is also adjustible, reversible, and removable. When combined with a uvulopalatopharyngoplasty (UPPP), studies show a mean decrease in AHI of 60%. If you are interested in AIRLIFT, please contact our office at 501-932-7600.
Obstructive sleep apnea is diagnosed with either an in-lab or home sleep study. There are pros and cons to each of these tests, but both are acceptable to diagnose sleep apnea. In-lab testing is done at sleep labs located in or around Conway. This involves an overnight stay at the lab while connected to monitors to measure oxygen levels, snoring, respiratory effort, and sleep brain waves. In-home sleep tests involve wearing a monitor to bed (typically a headpiece) to bed in your own house to measure similar data. While in-lab testing gives more information, in-home testing provides a more natural sleep environment and lower cost. Additionally, some insurances prefer one to the other. To best serve our patients, we offer both in-home testing through our office and in-lab testing at facilities around the area.
Snoring is produced by the vibrations of the soft palate or tongue and indicates some degree of airway resistance. Increased nasal congestion can also make snoring worse. Frequent loud snoring can be problematic for spouses or family members, even placing strain on relationships. It is important to be tested for sleep apnea prior to being treated for primary snoring, as these are treated differently. Unfortunately, snoring without sleep apnea is often seen as "cosmetic" by insurance companies and therefore not covered. This can sometimes limit what treatments are available.
We offer some affordable options to treat primary snoring at the Ear, Nose & Throat Center of Conway. The Somnoguard AP is an oral appliance effected for mild to moderate sleep apnea and snoring. It is custom-fit in our office and when worn at night, pulls the lower jaw forward, reducing vibrations of the tongue and soft palate. We can also perform an injection snoreplasty. This is an office-based procedure where a chemical is injected into the soft palate to scar and stiffen the palate, subsequently reducing any vibrations. Finally, a nasal turbinate reduction or septoplasty can be performed either in the office or operating room to reduce nasal obstruction. These last procedures are typically covered by insurance.
Information adapted from the American Academy of Otolaryngology - Head and Neck Surgery