Treatment of Sleep Apnea

What is Sleep Apnea?

Sleep apnea is defined as a pause in breathing lasting 10 seconds or more during sleep due to narrowed airways. Men over 45, menopausal women, those with obesity, short and thick necks, alcohol and tobacco users, sedative users, and individuals with upper airway obstructions are at risk. Genetic factors can also contribute to sleep apnea.

What Causes Sleep Apnea?

Sleep apnea occurs when the muscles at the back of the throat relax more than normal, causing the airways to gradually narrow and eventually close completely as the person breathes in and out. When the person cannot get enough air, their oxygen levels drop, sending signals to the brain to wake the person up, which reopens the airways. This process repeats throughout the night, preventing the person from getting deep, restful sleep.

Most Important Symptoms of Sleep Apnea

The most important symptoms of sleep apnea include:

• Snoring
• Breathing pauses during sleep
• Excessive daytime sleepiness

A person might report waking up choking or their bed partner may notice that the person holds their breath or stops breathing while asleep. Other symptoms include night sweats, frequent urination at night, waking up very tired, morning headaches, attention deficits, and lack of concentration during the day.

How is Sleep Apnea Diagnosed?

Sleep apnea is diagnosed by having the patient stay overnight at a sleep center for a test called “Polysomnography.” Electrodes are attached to the scalp, around the eyes, and chin to monitor brain waves, eye movements, and whether the person stops breathing during sleep.

A cannula is placed in the nose to measure airflow. Electrodes are also attached to monitor heart rhythm and leg movements. A belt is placed around the abdomen to observe abdominal movements, and a probe is placed on the fingertip to measure blood oxygen levels. The patient sleeps at the sleep center with these devices for one night. The recorded data is analyzed by a specialist in sleep disorders.

Degrees of Sleep Apnea

There are three degrees of sleep apnea. Mild sleep apnea is characterized by 5-15 apnea episodes per hour, moderate sleep apnea by 15-30 episodes, and severe sleep apnea by more than 30 episodes per hour.

Treatment of Sleep Apnea

The treatment of sleep apnea is planned according to the severity of the condition. In mild sleep apnea, if the patient has no chronic conditions (such as hypertension, heart failure, diabetes, stroke, etc.),lifestyle changes form the basis of treatment. Patients are advised to lose weight, avoid alcohol, tobacco, and sedative medications.

If the person only has positional sleep apnea (apnea only occurs on back sleep position),they are given recommendations to avoid sleeping on their back. One common recommendation is to sew a cloth pocket, insert a ping-pong or tennis ball into it, and sew a strap to both sides of the pocket, which the patient ties around their back while sleeping. The ball in the pocket prevents the patient from sleeping on their back.

Every patient diagnosed with sleep apnea is referred to an ear, nose and throat specialist for examination. In cases where upper airway obstructions are found, such as nasal bone deformities, swollen nasal tissues, or enlarged tonsils, surgery may be performed to treat sleep apnea successfully.

Additionally, dentists can prepare a custom device that advances the jaw forward and is worn in the mouth before sleep, which can treat sleep apnea. However, if a patient with mild sleep apnea also has a chronic condition, these measures may not be sufficient. In such cases, a device called CPAP (Continuous Positive Airway Pressure) that provides positive pressure to open the upper airways should be used. This device, with the help of a mask covering the mouth and nose, applies pressure to keep the airways open throughout the night and treats sleep apnea.

In moderate and severe sleep apnea, the definitive treatment is with CPAP. Lifestyle changes alone are not sufficient. Again, if there is a pathology blocking the upper airways, surgery can be performed, but in these cases, surgery only provides temporary relief. After a while, apnea returns, and the person faces the same complaints. Therefore, in patients with moderate and severe sleep apnea, the only definitive solution is the application of pressure using a CPAP device while sleeping with a mask covering the mouth and nose.

Of course, patients may initially struggle to sleep with a machine. However, as they see improvements in their sleep quality and wake up feeling more rested, most patients describe themselves as "reborn."

New Developments in Sleep Apnea Treatment

Recent developments in sleep apnea treatment have brought new hope to those struggling with this condition by offering promising options beyond traditional CPAP machines. These include:

Medication Treatments: Researchers have shown that the drug Tirzepatide, used for diabetes and obesity treatment, is effective in reducing sleep apnea, particularly in obese patients, by reducing airway obstruction. Another drug, AD109, has shown promising results in clinical trials by targeting upper airway muscle relaxation, reducing apnea events, and improving both nighttime and daytime symptoms.

Oral Devices: The first oral device for severe sleep apnea, called Complete Airway Repositioning and Expansion (CARE),has been approved by the FDA. These devices keep the airway open during sleep by expanding the palate and repositioning the lower jaw, offering a less invasive alternative to CPAP treatment, and showing significant improvements in many patients.

Continuous Negative External Pressure (cNEP): This new treatment involves a device that applies negative pressure externally to the neck to prevent airway collapse, offering a less invasive option compared to CPAP. Initial studies suggest that it could be a viable alternative for those who cannot tolerate CPAP.

These treatments are not yet available in Turkey.