Sleep Apnoea


What is Sleep Apnoea ?

While we sleep all of the body’s muscle-tone relaxes. In most parts of the body this does not matter and indeed helps one to relax and sleep comfortably. When the muscles that help hold open the throat behind the tongue relax, this leads to partial collapse and narrowing in this area. Even in normal people this increases the resistance to the flow of air when breathing in, but this is usually of no significance. When this narrowing that occurs is excessive, there can be obstruction to breathing.  This obstruction can mild, causing snoring and then, when the collapse is complete, it causes apnoea. Apnoea is cessation of breathing.

Fortunately, the body is able to sense this increased obstruction to breathing and forces the sufferer to wake up briefly to draw in a few breaths of air and then return to sleep. This obstruction and waking often becomes a continuous cycle, every minute or so, that can go on hundreds of times a night, every night.  Usually though, the individual does not remember all these episodes of waking.  This of course can lead to the person feeling constantly tired and run down. This can affect work, concentration and mood. It can also have significant health implications raising blood pressure and is associated with heart disease.

Causes

In general terms causes are three-fold: general, nasal obstruction, throat obstruction.  General features are alcohol and smoking, age over 40, being male and being overweight. The last of these is the most important general feature, and if patients are significantly overweight surgical success is limited.  Nasal obstruction is most commonly due to a deviated septum and/or allergic rhinitis (hay fever) although any of the many causes of nasal obstruction can be implicated.  Throat obstruction is usually due to a long palate and the presence of residual tonsil tissue, (although other features such as a recessive jaw, or excessively large tongue can be implicated).

Assessment

Patients need a thorough medical assessment in our clinic to assess the cause of obstruction.  Your assessment will include full upper airway assessment including a fibre-optic examination. It is a good idea to bring your partner along as he/she can often give a more accurate picture of your degree of snoring and obstruction. We may decide to investigate further with CT examination or even a sleep study. This is where the patient sleeps overnight in a specialised clinic and all perameters of sleep function are assessed. Sometimes treatment may be as simple as a nose spray at night or even just weight loss, but often we suggest a surgical treatment.

The Surgical Procedure

Surgery usually involves nasal and or palate surgery. The details of septoplasty (correcting a deviated septum) are discussed elsewhere in this website. Surgery on the palate is called uvulopalatopharygoplasty. It's quite a mouthful of a term so we call it a UPPP.  UPPP involves careful surgical removal of excess tissue from your soft palate and uvula. If your tonsils are still present they may be removed as well. The operation makes your airway larger, so vibrations are decreased. The procedure is performed under a general anaesthetic and can be performed at the same time as nasal surgery if the latter is needed.  

What to Expect After Surgery

While making lifestyle changes should be the first step in treating your snoring, these measures are not always effective. If they are not, then surgery is often indicated. The surgery is usually on the nose (septoplasty and turbinate reduction) to improve nasal airway, and often simultaneously on the throat (UPPP). More severe apnoea may only respond to more advanced procedures or wearing a CPAP or pressure mask at night.

These operations are safe and the results are very good. Snoring isn’t always eradicated, but it is most often reduced enough to allow the patient and partner to sleep well. Recovery can be a little difficult as the throat surgery is uncomfortable post operatively. That is primarily because it is difficult to rest the throat - patients have to eat, drink, breathe and communicate through an ‘operative field’. That said, we provide adequate analgesia, the week passes fast, and patients are invariably thrilled with the results.

Please take the time to make an appointment if you are concerned about your snoring and breathing with Dr Mooney on (02) 9389 4497 or use our Online Inquiry Form to speak with out Patient Coordinator for further information.

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