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Sleep Apnea
Houston Sleep Apnea Specialist Dr. Shawn Allen is a Board-Certified Otolaryngologist (ENT) and a leader in the diagnosis and treatment of sleep apnea, as well as sinus conditions and nasal breathing disorders.
- What is Sleep Apnea?
- Types of Sleep Apnea
- Symptoms of Sleep Apnea
- Risk Factors for Sleep Apnea
- How is Sleep Apnea Diagnosed?
- Treatments for Sleep Apnea
- CPAP (continuous positive airway pressure)
- Hypoglossal Nerve Stimulator (Inspire implant)
- Surgery for Sleep Apnea
- Frequently Asked Questions About Sleep Apnea
What is Sleep Apnea?
Sleep apnea is a sleep disorder that is characterized by an interruption in airflow while a person is sleeping. These pauses in breathing are either central (when the brain fails to trigger breathing appropriately) or obstructive (when there is effort to breath but obstructions in the airway prevent any or most of the airflow from occurring). Failure to breathe properly disrupts sleep and often causes fatigue, daytime sleepiness, and other potential health complications that will be discussed below.
Types of Sleep Apnea
There are three main types of sleep apnea, and each type is further classified by severity according to the number of disruptive events per hour (<5 normal, 5-14 mild, 15-29 moderate, and 30 or more is severe).
- Obstructive Sleep Apnea, also known as OSA, is by far the most common type of sleep apnea and affects approximately
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Obstructive Sleep Apnea (OSA)
American Sleep Association
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25 million Americans
. It occurs when the upper airway is physically obstructed by narrowing within the nose, enlarged tonsils or adenoids, and/or collapse of the throat including the soft palate, tongue, and walls of the pharynx. - Central Sleep Apnea happens when there is an interruption in the signals from the brain to the muscles that control breathing while you sleep. This type often affects individuals who spend long periods of time in high-altitude environments and patients who use opioid medications.
- Complex (Mixed) Sleep Apnea occurs when a person is diagnosed with both OSA and central sleep apnea during sleep testing.
Symptoms of Sleep Apnea
Sleep apnea causes a wide spectrum of symptoms, making it challenging to recognize in some individuals. Most commonly it presents with daytime fatigue and excessive drowsiness during the daytime despite trying to get adequate sleep. However, a large portion of individuals with sleep apnea do not report significant drowsiness, and it can involve any or all of the following symptoms as well:
- Loud snoring
- Daytime sleepiness
- Dry mouth when you wake up
- Frequent awakenings throughout the night
- Moodiness or irritability
- Morning headaches
- Breathing pauses or gasps (often noticed by a spouse or bed partner)
- Chest pain during the night
- The sense that sleep is not restful
- Weight gain or difficulty losing weight with diet and exercise
- High blood pressure that is less responsive to medications
- Heart arrhythmias that are less responsive to medications
Risk Factors for Sleep Apnea
The likelihood of developing sleep apnea increases with age and men are more commonly diagnosed with sleep apnea than women; obesity is also a
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What is Sleep Apnea?
The American Sleep Apnea Association
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primary risk factor for obstructive sleep apnea.
Other risk factors include:
- Smoking cigarettes
- Chronic sinusitis and/or allergic rhinitis with resulting nasal congestion
- A family history of sleep apnea
- Regular use of alcohol or sedative medications
- Enlarged neck circumference (associated with weight gain)
How is Sleep Apnea Diagnosed?
You may receive an initial diagnosis of sleep apnea based on descriptions of your symptoms from both yourself and someone who has observed you sleeping. However, a sleep study (generally performed as a home sleep test for 1 to 3 nights) will be needed for an accurate diagnosis and to determine the severity and risk level of your condition.
In certain individuals, we may recommend a lab-based sleep study for a more comprehensive polysomnogram, in which special equipment is used to monitor your breathing, movement, blood oxygen levels, and brain activity while you sleep. However, home testing is suitable for most individuals, and in general is accurate and cost effective in measuring patients with suspected obstructive sleep apnea.
Treatments for Sleep Apnea
There are several treatment options available for sleep apnea. Dr. Allen will explain your options and recommend which ones may be best for you based on your individual symptoms and concerns. He may also recommend lifestyle changes such as weight loss or different sleeping positions when appropriate.
CPAP or APAP (continuous or auto-titrating positive airway pressure)
CPAP/APAP therapy involves a small machine that patients use at home while they sleep. This popular non-surgical sleep apnea treatment improves sleep-disordered breathing by delivering pressurized air through a face mask that you wear while you sleep. The continuous and gentle air pressure keeps your airway open. Newer CPAP machines are smaller, quieter, and more comfortable than older models. Auto-titrating machines (APAP) are capable of adjusting pressures with each breath to ensure that only the needed support is provided for adequate breathing, and are appropriate in most cases.
Hypoglossal Nerve Stimulator (Inspire® implant)
The Inspire Upper Airway Stimulation System is an implantable device that treats sleep apnea by sending an electrical signal to the hypoglossal nerve while breathing in to move the tongue forward and open the airway (similar to the pressure support provided by a CPAP machine moving the tongue forward). This newer technology is appropriate for patients with moderate or severe obstructive sleep apnea that cannot tolerate regular use of a CPAP or APAP machine.
The implant is surgically placed within the right upper chest and right neck just below the jawline through two small incisions during an outpatient procedure. Inspire implant surgery is generally tolerated very well and involves a quick recovery. Prior to this procedure, a diagnostic evaluation of the throat is required to assess the nature of collapse and ensure that Inspire therapy is appropriate. This is referred to as Drug-Induced Sleep Endoscopy, or DISE, and is performed under IV sedation to simulate your condition during sleep. When patients are screened appropriately, this procedure is highly successful and achieves a significant reduction in the symptoms and health impact of obstructive sleep apnea without the use of positive airway pressure support.
Surgery for Sleep Apnea
In some cases traditional surgeries are the best options to effectively treat sleep apnea. A comprehensive evaluation to pinpoint the underlying causes of obstructive sleep apnea will determine what type of surgery will be recommended in each individual case. This evaluation generally involves imaging of the nasal airways (CT Sinus) to ensure the nose is adequately open, flexible endoscopy in the clinic to evaluate the throat, and when needed a Drug-Induced Sleep Endoscopy to visualize the obstructions while the patient is sleeping for a more accurate evaluation. Sleep apnea surgeries include:
- Tonsillectomy in which enlarged tonsils are removed
- Adenoidectomy in which enlarged adenoids are removed
- Uvulopalatopharyngoplasty (UPPP) in which the soft palate and/or uvula are shortened and repositioned to avoid obstruction of the airway
- Hyoid Suspension in which the hyoid bone in the neck is repositioned upwards and forwards to move the tongue base forward and expand the upper airway
Frequently Asked Questions About Sleep Apnea
Is sleeping with a CPAP uncomfortable?
Some people have a negative view of CPAP because they may have seen older machines that were large or loud. Newer devices are smaller, quieter, and offer a variety of mouth or nasal masks that many people find comfortable to sleep with. However, if CPAP is not right for you, Dr. Allen will explain all your treatment options to find one that works for you long-term.
What happens if sleep apnea is left untreated?
The short term effects of sleep apnea, such as drowsiness, can have a serious impact on people’s lives, but the long-term effects of untreated sleep apnea can be detrimental to health. Drowsiness and mental fatigue may lead to an increased risk for automobile accidents, decreased productivity, irritability, and more. The prolonged lack of restful sleep can lower your immune system function through elevation of cortisol (the body’s natural steroid) and cause challenging weight gain that is less responsive to diet and exercise. If left untreated, the repeated drops of oxygen levels and stress-induced rapid heart rate caused by sleep apnea can lead to or worsen
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Risks of Sleep Apnea
American Sleep Association
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high blood pressure, heart arrhythmias, heart attack, heart failure, and stroke
. It has been linked with sudden death during sleep as well, which is an increasingly recognized risk of untreated sleep apnea.
Is sleep apnea related to type 2 diabetes?
Sleep apnea and type 2 diabetes are both serious diseases that are more prevalent in people with obesity. One clinical study found that more than
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Obstructive sleep apnea and type 2 diabetes: is there a link?
Pamidi S, Tasali E
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70% of people with type 2 diabetes
also have obstructive sleep apnea. The interruptions in airflow that occur with OSA can have a negative effect on blood sugar levels and exacerbate type 2 diabetes complications.
Can children have sleep apnea?
Children sometimes develop sleep apnea due to enlargement of tonsils and adenoids, which can obstruct the pharynx similar to tongue and palate deformities in adults. In addition to typical sleep apnea symptoms, children with sleep apnea may experience night terrors or prolonged bed wetting, and
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Pediatric Sleep Apnea
Mayo Clinic
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may exhibit behavioral issues during the daytime
other than drowsiness. On a positive note, obstructive sleep apnea in children with large tonsils and adenoids often resolves following a simple outpatient tonsillectomy and adenoidectomy procedure.
Contact Dr. Allen
Dr. Allen is devoted to helping his patients breathe easier so they can have better overall health and an improved quality of life. Sleep is an essential component of good health. Contact us to learn more about sleep apnea diagnosis and treatment.
1 American Sleep Association. Obstructive Sleep Apnea (OSA). Available: https://www.sleepassociation.org/sleep-apnea/obstructive-sleep-apnea/ Accessed August 31, 2022.
2 The American Sleep Apnea Association. What is Sleep Apnea? Available: https://www.sleepapnea.org/what-is-sleep-apnea/ Accessed August 31, 2022.
3 American Sleep Association. Risks of Sleep Apnea. https://www.sleepassociation.org/sleep-apnea/risks/ Accessed August 31, 2022.
4 Pamidi S, Tasali E. Obstructive sleep apnea and type 2 diabetes: is there a link? Front Neurol. 2012 Aug 13;3:126. doi: 10.3389/fneur.2012.00126. PMID: 23015803; PMCID: PMC3449487.
5 Mayo Clinic. Pediatric Sleep Apnea. Available: https://www.mayoclinic.org/diseases-conditions/pediatric-sleep-apnea/symptoms-causes/syc-20376196 Accessed August 31, 2022.