Frequent snoring can be loud, irritating, and exhausting for spouses and partners who may feel like they’re sharing a bed with a chainsaw. But if it’s a symptom of sleep apnea – when a sleeping person actually stops breathing over and over due to airway blockage – snoring can be far more than just an annoyance.
Over time, sleep apnea leads to a higher risk of death from heart attacks, heart failure, heart rhythm problems and stroke. The frequent waking that patients experience also can cause excessive daytime sleepiness, raising their risk for car accidents and other injuries. That’s why it’s important to seek treatment for sleep apnea from a qualified sleep specialist.
“I think a lot of people are afraid to come into the sleep doctor’s office because they’ve heard horror stories, especially about CPAP … but they often don’t realize that there are now so many different treatment options available for sleep apnea,” said Dr. Shalini Paruthi, who is board-certified in Sleep Medicine and Internal Medicine and serves as medical co-director of St. Luke’s Hospital’s Sleep Medicine and Research Center.
Continuous positive airway pressure [CPAP] remains the most common first-line therapy chosen for sleep apnea. CPAP devices include a face mask, hose and small motor that delivers filtered, pressurized air throughout the night to hold the airway open. Although they’re effective, however, using a CPAP is difficult for many patients who find the devices uncomfortable and hard to maintain.
Another effective therapy involves holding the airway open during sleep with a small oral appliance worn nightly, which is custom-fitted by a sleep dentist. “We’re very lucky in the St. Louis area because we have seven board-certified sleep dentists here,” Paruthi pointed out.
A third option is positional therapy or “bumper belt” devices which are very helpful for patients who experience apnea while sleeping on their backs, but not on their sides. These consist of belts or cushions that help patients stay in the correct position and prevent them from rolling onto their backs during the night.
A number of surgical options also exist for treating sleep apnea. Ear, nose and throat surgeons can either shorten the uvula, which can “flop” backward and block the airway, or cut back the soft palate to improve airway space. Success rates for these surgeries vary, but average about 30% overall, Paruthi said. A different oral surgery procedure involves breaking the jaw and moving it forward to open the airway; although effective, however, this procedure carries more substantial risks and longer recovery times.
In August 2018, St. Luke’s also became the first St. Louis area hospital to offer a newer sleep apnea treatment called Inspire, an implantable neurostimulator which functions like a pacemaker does for the heart. Approved by the FDA in 2014, Inspire devices have been implanted in about 5,000 patients nationwide to date, Paruthi said.
During an outpatient procedure using light anesthesia, the Inspire device is inserted under the patient’s chest muscle on the right side. Two small wires extend from the device: One goes to the rib muscle to sense breathing, and the other extends to the specific motor component of the hypoglossal nerve, which controls the tongue muscle.
The device treats sleep apnea simply by moving the patient’s tongue forward with every breath while he or she is asleep. “By doing that, it keeps the tongue muscle out of the airway so the space is kept open and the apnea is prevented,” Paruthi explained.
Patients receive a small remote control to activate the Inspire device when they go to bed. It can either be programmed to turn off after a certain number of hours or patients can control it manually. “They can tell when it’s on, but it isn’t uncomfortable in any way,” she added.
She said Inspire is intended for patients for whom CPAP or other sleep apnea therapies haven’t provided the desired results.
For those who suspect that their snoring – or that of a loved one – may be due to sleep apnea, the first step is to visit a sleep specialist to find out, and then work with their doctor to find the therapy that’s best for them. “Whatever treatment we use, our goal is to ensure the best possible outcomes for patients,” Paruthi said.