sleep tx

Snoring: treatment alternatives that make sense

by Barry Bittman, MD

If snoring kept you awake last night and you’re exhausted today, the information I’m about to share just might save your life or someone you love.

In last week’s column, I discussed snoring and a condition known as Obstructive Sleep Apnea (OSA) in terms of self-recognition and eventual diagnosis in a sleep lab. Today, we’ll focus on rational treatment options and preventive measures.

To review what’s been discussed, consider the fact that OSA affects millions of individuals in our nation. It’s typically caused by the collapse or sagging of tissues at the back of the throat that interferes with air flow. The obvious result is snoring. Yet, what’s really occurring behind the scenes is a condition that can result in diminished memory, headaches, impotence, high blood pressure, worsening of diabetes and even heart disease.

A correct diagnosis is established in a sleep lab where a technician with the aid of a computer performs continuous measurements and analysis of heart rate, breathing patterns, brain waves, eye movements and muscle activity during sleep. Once the diagnosis is known, a variety of treatment options can be considered.

While there’s a tendency in our society to rely on medications, I’ll begin by setting the record straight. There’s no drug that has ever been shown to be effective for this condition. On the other hand, it has been well-established that certain drugs used to treat insomnia such as sleeping pills can substantially worsen sleep apnea.

Sedative or calming medications are often used in an attempt to help a person achieve a better night’s sleep. Sometimes they are prescribed without realizing the individual’s real problem is OSA. Remember, the majority of people suffering from this condition are not aware of it in the first place. Therefore, the drug prescribed to promote sleep actually worsens the condition and accelerates the often devastating problems described above.

And drugs aren’t the only culprits that add to this problem. Alcohol and tobacco have been implicated as important factors in the development of OSA. I cringe at the thought of someone removing an oxygen mask to smoke a cigarette. In a similar manner, it’s disheartening to imagine a person consuming alcohol at bedtime to help them sleep, when such a practice actually suppresses the activity of brain centers needed to trigger breathing responses necessary for survival. Remember, what seems to be working on the surface may actually be worsening the condition.

Another issue to consider is weight loss. While obesity is rapidly becoming more prevalent in our society, few people realize the true extent of health consequences that result from this condition. For many sufferers, being overweight is actually the principal cause of OSA. Unfortunately, few people with OSA consider weight reduction at all. If you’re diagnosed with OSA and you’re overweight, you’ll never have a better reason to visit a registered dietician for a healthy weight management program. Forget the fad diets¾ they simply don’t work. Insist on a medically-supervised weight loss program.

Two other procedures that have gained wide acceptance for the treatment of this condition, are worthy of consideration. They are the use of CPAP, or continuous positive airway pressure and specialized surgical procedures to remove tissues blocking airway passages in the back of the throat.

CPAP requires the use of a mask that is held over the subject’s face with adjustable straps. Air pressure is adjusted to keep the airways in the back of the throat unobstructed. Often, testing is required and sometimes another night in the sleep lab is needed to determine optimal settings. With some coaxing, many people get used to wearing the device during sleep.

When all else fails, a surgical procedure called UPPP or uvulo-palato-pharyngoplasty is sometimes considered. While it has a complex name, it’s no more than surgically cutting away the excess tissue in the back of the throat. The procedure, which is sometimes performed with a laser, has few complications in the hands of an experienced ear nose and throat surgeon. Yet without weight reduction or elimination of other factors described above, it may only be effective in 30-50% of OSA sufferers.

You’re probably asking yourself how to choose an effective treatment strategy. The answer is simple. Consider these basic steps: Avoid cigarettes and alcohol. If overweight, enroll in a rational weight management program under the guidance of a registered dietician. Do not take sleeping pills of any kind without bringing up the issue of OSA with your doctor first. Rest assured, your steps to initiate treatment of OSA can save your life or the one of someone who keeps you up all night¾ Mind Over Matter!