The 3 types of sleep apnea and how to treat them

There is nothing like a good night’s sleep. It helps keep the body refreshed, memory sharp and our concentration focused. Unfortunately, a full night’s rest doesn’t come easily for everyone.

Snoring and sleep apnea disrupt sleep patterns, leading to daytime sleepiness, trouble concentrating, memory loss and even dozing off during important times, such as driving. And that’s just the beginning. Snoring also can lead to high blood pressure, cardiac arrhythmia and problems with neurocognitive functions.

“Sleep apnea is when an individual’s breathing is interrupted several times a night,” said Scott Kay, MD, board-certified ear, nose and throat (ENT) specialist and founder of Princeton Otolaryngology Associates in Monroe and Plainsboro. “When the breathing stops, the brain may not receive the right amount of oxygen. When oxygenation drops, blood vessels in the lungs begin to contract in order to contain the blood in the heart. This can lead to pulmonary hypertension and high blood pressure.”

Signs of sleep apnea include a gasping or choking while sleeping, the individual wakes himself or herself up, a frequent need to urinate at night, sweating, daytime sleepiness and feeling fatigued. Dr. Kay, who also suffers from sleep apnea, said treatment varies based on the type of sleep apnea or degree of snoring an individual experiences

At Princeton Otolaryngology Associates, patients are evaluated by an ear, nose and throat (ENT)  physician starting with a fiberoptic exam of the upper airway to determine if there is a nasal obstruction, an obstruction of the palate or at the base of the tongue. The next step is to conduct a sleep study, the most common being a home study.

“The materials are mailed to you. You put something around your wrist, finger or chest and then you go to sleep,” Dr. Kay said. “The next morning, you send back the equipment, and I get the results about two weeks later. With this information, we can determine what the best treatment would be.”

There are three types of sleep apnea: obstructive, central and mixed. Obstructive sleep apnea is the most common and occurs whenever there is an obstruction of the upper airway. With central sleep apnea, the brain does not signal the body to breathe while sleeping. Mixed sleep apnea is the presence of both central and obstructive sleep apnea.

“When sleep is interrupted, you’re never going to achieve a deep REM sleep, and never going to get a good night’s sleep,” Dr. Kay said. “This happened to me. My wife took a video of me sleeping and I could see that I wasn’t breathing well at night, and after I saw that video, I knew I had to do something.”

Obstructive sleep apnea is often treated with the use of a Continuous Positive Airway Pressure (CPAP) machine, which consists of a mask worn over the face to deliver a continuous flow of air. Dr. Kay himself has had a good experience using a CPAP to treat his own apnea. “It’s a pretty good solution because if you can adapt to wearing a mask and using the machine, it works 100% of the time.”

The second option is a dental appliance that is worn at night and moves the tongue or jaw forward, moving the obstruction out of the airway at the base of the tongue. The third option is surgical, where a correction of the airway can be made by straightening the septum, removing tissue from the nose or removing the tonsils and/or tissue from the palate.  Procedures are also available to remove tissue from the tongue or protrude the tongue forward.

Princeton Otolaryngology Associates’ patients are closely monitored following a procedure. Those who use a CPAP are evaluated again after a month, then yearly. Surgical and dental appliance patients also are followed carefully, and all patients receive follow-up sleep studies to determine if the treatments have been a success.

“We’re also fully comprehensive. We do the evaluations and sleep studies all in our office, so patients don’t have to go to a separate specialist.” Dr. Kay said. “Having firsthand knowledge of how to use the CPAP, I feel I am more able to help patients overcome the hurdles they face as they get used to it. Secondly, I get very good results with the surgery. I can expect that at least three-quarters of patients are going to do well after surgery, depending on the anatomy.”