Dr. Brualla, a specialist in Neurophysiology, explains in this article what sleep apneas are and what treatments are currently available to combat this pathology.
Sleep apneas are breathing pauses lasting more than 10 seconds that occur during sleep. These pauses, initially detected by the bed partner, often end with snoring that is louder than usual. They are associated with micro-awakenings (usually not conscious) that will lead to a superficial, fragmented and unrefreshing sleep and, consequently, to an increase in tiredness and sleepiness during the day, with greater irritability, memory lapses, etc.
Prevention of sleep apneas
We can take some measures to prevent sleep apnea; among them, the most important are: losing weight, avoiding alcohol, not taking hypnotics (especially benzodiazepines) and sleeping on your side.
Treatment for sleep apnea
Treatment will depend on both the type and degree of apnea and the characteristics or preferences of each patient (and their better adaptation or tolerance to one or other treatments). For the treatment of sleep apnea there are different options:
- CPAP or Bi-PAP devices: continuous positive pressure air is administered through a mask (usually nasal and in other cases facial) connected to an air compressor tube that creates a continuous positive pressure. This will help keep the airway open during sleep. Bi-PAP devices (with a different pressure for inspiration -IPAP- and for expiration -EPAP-), very useful in patients with central sleep apneas and in patients where SAHS is associated with chronic obstructive pulmonary disease (COPD) or sleep-related hypoventilation disorders. Another form of therapy is ALS or Adaptive Servoventilation which constantly assesses the patient’s ventilation by compensating with variable inspiratory and expiratory pressures in order to maintain constant minute ventilation. Very useful in patients with instability of ventilatory control, in patients with central apneas, in complex apneas, in central apneas associated with narcotic intake and in central apneas of unknown cause that do not show improvement with CPAP.
- DAM (Mandibular Advancement Devices): intraoral orthopedic appliances or mandibular advancement devices (DAM prostheses). Recommended for the treatment of snoring and mild to moderate apneas. These prostheses usually keep the jaw in its normal or slightly advanced position during nighttime sleep, thus preventing the jaw and tongue from falling backwards during sleep, facilitating the passage of air. Other types of oral appliances, less commonly used, are tongue retaining devices.
- Positional Apnea Devices (NighBalance): recommended for positional apneas, that is, when apneas appear only or mostly during the supine position (face up). It is a small device that is adjusted by means of a belt to the patient’s thorax or abdomen and has a position sensor that detects when the patient is asleep on his or her back. It then initiates a small vibration “inviting” a change of posture.
- Hypoglossal nerve stimulator: useful for obstructive apneas when airway collapse is due to tongue retrodecay. The hypoglossal nerve neurostimulator is a device that is placed as if it were a pacemaker. When it detects an apnea, it stimulates the hypoglossal nerve, which produces a contraction of the tongue, thus helping to keep the airway open.
- Oropharyngeal and mandibular surgery: only in selected patients, especially when there is a craniomandibular malformation or anatomical obstruction.
At present, the treatment of choice for sleep apnea is usually, in most cases, either the CPAP device or the use of a DAM prosthesis.