Troubled by sleep apnea? This can occur due to an obstruction in the airway. Dr. Jamali is giving information on sleep apnea symptoms, Surgery, medical and non medical treatments with Sleep apnea overview.
Snoring may seem like a relatively innocuous annoyance, but the consequences can be deadly. People with sleep apnea are at triple the risk of sudden death during sleep when compared to the general population. While there are devices that can help lower this risk, they are generally uncomfortable and inconvenient to use. For this reason, a lot of people seek a more permanent, surgical alternative.
What is sleep apnea?
“Apnea” comes from the Ancient Greek words for “the absence of” and “breathing.” It refers to periods where a person stops breathing. In sleep apnea, this occurs during sleep, when the person may be completely unaware that they’re experiencing breathing problems unless a spouse or someone else points out snoring or other irregularities.
What causes sleep apnea?
Central sleep apnea occurs when the brain stops telling the muscles responsible for breathing to do their job for brief periods of time. People with this type of apnea may wake up gasping for air and have problems falling or staying asleep. Obstructive sleep apnea, which is far more common, occurs when muscles at the back of the throat relax and allow the airway to partially close. People with this type of apnea may wake up with headaches or feel tired during the day. Physical factors like neck circumference, narrow airways, or obesity are generally the primary culprits. Some medications, like sedatives, can trigger obstructive sleep apnea.
How is sleep apnea treated?
People with obstructive sleep apnea may need a device called a CPAP machine. This machine maintains positive air pressure in the airway all night, to prevent it from collapsing. A surgical procedure called a UPPP (short for uvulopalatopharyngoplasty) can help some patients by removing excess tissue around the airway to keep it from blocking breathing, but many patients still require a CPAP afterward. In a lot of cases, surgery to reposition the jaw (orthognathic surgery) and increase the size of the airway is the best option.
Can liposuction of the neck help?
Obesity is a contributing factor to sleep apnea, and fatty deposits around the neck can sometimes make proper breathing difficult while sleeping. That said, liposuction doesn’t touch the soft tissues that are actually responsible for obstructing the airway during sleep. For this reason, liposuction of the neck is unlikely to stop a patient’s snoring.
Who is a candidate for orthognathic surgery?
Jaw surgery involves general anesthesia and a pretty significant recovery time when compared to other treatments, including UPPP. For this reason it is often reserved for either people who have tried other measures to correct their sleep apnea and not experienced any improvement, or those who have jaw deformities that can also be corrected during surgery.
What does orthognathic surgery involve?
When being assessed for sleep apnea, patients generally have x-rays taken of the skull to determine if its conformation is a contributing factor to their breathing problems. In orthognathic surgery to correct breathing problems, the upper and lower jaws are moved forward to increase the size of the airway. This procedure is performed under general anesthesia, and takes about three to four hours to complete. All incisions are made inside of the mouth, so there are no external scars, and allow surgeons to free the upper and lower jaws and bring them forward. They are held in place with titanium plates and bone screws, while the patient’s bite is kept stable with the use of braces and other dental appliances. The jaw does not have to be wired shut afterwards.
What are the healing process and aftercare like?
It’s important for patients to avoid chewing while they heal, typically for up to six weeks. Most patients are able to return to work after four weeks. In some cases, a temporary tracheostomy may be placed to help prevent breathing problems due to swelling. It’s necessary to follow a liquid diet for the period immediately following surgery, then gradually transition to a diet of soft foods for the six week recovery period. Patients will also need to sleep with the head elevated to reduce swelling and assist breathing for the first week after surgery.
What risks are involved?
As with any surgery, orthognathic procedures carry some risks. Swelling may cause problems with breathing or swallowing, patients may experience bleeding, incisions can become infected if they are not properly cared for, and some areas of the face may feel numb or tingly for up to a year following surgery. Many patients notice minor changes in their appearance, but these are generally positive.
There’s no need to struggle through the daily exhaustion and headaches of untreated sleep apnea. If you are currently suffering, don’t put off relief. What may seem like a little bit of snoring may actually become deadly, and orthognathic surgery can end up saving your life. Dr. Jamali is an award-winning surgeon with decades of medical experience and a passion for facial reconstructive surgery. Contact him at Oral & Maxillofacial Surgery of New York today for a consultation, and see how orthognathic surgery can help improve your life.
Obstructive sleep apnea (OSA) is a condition where a person’s sleep is disrupted by obstruction at the back of their throat. When OSA occurs, the tongue is sucked against the back of the throat. The tongue blocks the upper airway and airflow is impeded. As the oxygen level in the brain decreases, the sleeper gets woken up. The tongue assumes its normal position, and the flow of air returns. This many times happens with a loud gasp.
When OSA occurs repeatedly, there is decreased oxygenation in the person’s system. This can cause serious cardiovascular issues, daytime sleepiness, depression, and problems with concentration. A less severe form of the condition is called Upper Airway Resistance Syndrome (UARS). The symptoms of this condition are very similar to those of OSA.
How Is OSA Diagnosed?
Diagnosis of sleep apnea is based upon the confirmation of the doctor of the trademark symptoms. The doctor will take a detailed history of the patient and assess the anatomic relationships in the maxillofacial region. By taking a skull x-ray, the doctor can determine the extent of the obstruction. Sometimes, the doctor will conduct a naso-pharyngeal exam with a fiber-optic camera. The doctor might also order a sleep study to determine the patient’s oxygen levels during their sleep.
How Is OSA Treated Non-Surgically?
Obesity can many times increase the severity of sleep apnea. It is found that losing weight can many times reduce the severity of the condition or eliminate it altogether. Weight loss should be a priority for all people have sleep apnea. Eating a better diet and exercising are not only important for overall health. They will also help you get better sleep. For extremely obese people, weight loss surgery may be an option. This technique is used when a patient has failed to lose weight by other methods.
Positive Airway Pressure
Positive airway pressure is a treatment where the patient places a small mask or nose tubes over the nose or the nose and mouth, and compressed air is delivered to the lungs. The air pressure helps keep the airway from collapsing. PAP therapy is considered to be highly successful in treating the condition. It is also the most common treatment for the condition. However, a person must use the device whenever they sleep. Some people are unable to go through with this treatment because the device makes them feel uncomfortable or claustrophobic.
Dental devices can relieve sleep apnea by positioning the lower jaw forward. This in turn moves the tongue forward, preventing it from blocking the back of the throat. There are dentists who are expert in treating sleep apnea, and they should be consulted for this treatment. Oral appliances are most helpful for people who have mild or moderate sleep apnea. If you wear dentures or your teeth are in poor condition, then this treatment may be unavailable to you. Problems with these appliances include increased salivation, jaw pain, and tooth shifting.
Some people will suffer from sleep apnea more when they sleep on their back. For such people, it may help them to lie on their side when sleeping.
Oxygen can help increase oxygen levels in the blood. However, this does not relieve sleep apnea itself. A doctor might supplement PAP therapy with oxygen if low blood oxygen levels persist.
What Are the Surgical Treatments for OSA?
While positive airway pressure therapy can be helpful in treating sleep apnea, it is not easy for everyone to comply with it. Studies have shown that the actual usage of PAP only constitutes about 50 percent of sleep time. Patients many times find that they are unable to wear the mask throughout the night. They may also be uncomfortable with the high pressure of the air blown into their system. Surgery for sleep apnea is a feasible solution to the problem.
There are many surgical options for the treatment of sleep apnea. Here, orthognathic surgery will be discussed.
A person’s airway is confined by the upper and lower jaws. If you move the upper jaw and lower jaw forward, the airway can be made bigger. This procedure is considered to be the most effective surgical treatment for OSA. It is used on patients as the sole treatment for the condition. It is also used on patients who have significant jaw deformity that causes sleep apnea. The procedure is done in the hospital under anesthesia. The surgery takes about three to four hours to complete.
Dr. Jamali is a board certified oral and maxillofacial surgeon. He holds a doctorate degree from Tufts University and has a lot of experience in dealing with the administration of anesthesia. You can set up a consultation with Dr. Jamali to discuss the unique set of issues that are affecting you. We are located at 42 Broadway, New York, NY 10004. Our phone number is 212-480-2777.
If you suspect that you might be suffering from a sleep disorder of some sort, your doctor may suggest that you undergo a sleep study. If you have reservations about undergoing a sleep study, understanding more about what this study can show you will go a long ways towards easing any concerns.
What is a Sleep Study?
It’s estimated that nearly 70 million Americans are affected by both sleep disorders and similar issues on an intermittent basis. If these disorders are left untreated, they can lead to the development of much more severe conditions. A sleep study is a non-invasive examination that’s administered overnight. Throughout the duration of this study, doctors will monitor your brain and body as you sleep.
Premium EEG monitors are utilized as a means of identifying if there are any disruptions in normal sleep patterns. This study measures a variety of metrics, from oxygen levels and eye movements to breathing rates. All of this is done through a sensor, so there are absolutely zero needles involved with the study. The room that you stay in throughout the study is made to be as comfortable and dark as possible to ensure that you sleep the same way you usually do.
You’ll need to arrive a couple of hours before your normal sleep schedule in order for everything to be properly set up. Before you go to sleep, sensors will be placed around your body and head. After the study has been administered and the data collected, you will go home while the doctor evaluates the results of the examination. This evaluation can take up to a couple of weeks.
What Can a Sleep Study Show Me?
A sleep study can show you a wide range of things about both your mind and your body. Given that this study takes a look at your heart rate, breathing rate, body movements, eye movements, snoring, and oxygen levels, it’s clear that a determination can be made if you are indeed suffering from either a full-blown sleep disorder or an intermittent sleeping issue. As these disorders and problems occur when you’re asleep, it can be very difficult to actually identify whether or not you’re suffering from one by yourself. However, if you’re feeling fatigue or tiredness throughout the day, this may be due to the onset of a sleep disorder.
Sleep disorders come with their own set of risks, especially if left untreated. These risks commonly include stress, obesity, heart disease, high blood pressure, fatigue, diabetes, a heart attack, and headaches. There are a number of additional risks to your mental health, such as depression, anxiety, mood swings, and cognitive impairment, among others. Because of these risks, you should definitely consider a sleep study.
This type of study can help doctors diagnose a wide range of sleep disorders. The most common of these is obstructive sleep apnea, which can be easily identified in a sleep study due to the irregular breathing patterns caused by the issue. This condition tends to cause people to snore loudly. These periods of interrupted breathing can last for quite some time, which can be very dangerous to your health. This type of study can also show if you’re suffering from restless leg syndrome. This is a disorder that occurs when a person is continuously moving their legs in bed. These movements can happen just before sleep due to “uncomfortable” feelings on the body or during sleep. If you’re asleep when it happens, this is classified as a periodic limb movement disorder. Either way, a sleep study will allow the condition to be identified and a treatment to be readied.
Bruxism is another sleep disorder that’s easy to catch with a sleep study. This condition results due to the grinding of your teeth as you sleep. Bruxism occurs due to an abnormal clenching of the jaw. It can be very damaging to your teeth, which is why treatment is necessary right away upon detection. There are a number of additional parasomnias that can be identified through the administering of a sleep study. This includes everything from REM sleep behavior disorder and sleep walking to night terrors and sleep talking.
Who Should Take a Sleep Study?
Basically, anyone that believes they will benefit from a sleep study should at least inquire about it. To know more about whether or not you would benefit from it, ask yourself a few questions. Some of these questions include:
Do you often snore? Has your partner mentioned gasps or pauses with your breathing when asleep?
Do you have difficulties with sleeping consistently throughout the night?
Do you suffer from a substantial amount of fatigue and sleepiness throughout the day?
Do you move your legs often when attempting to sleep in order to get comfortable?
If you answer yes to several or even one of these questions, you may want to look into a sleep study.
What is the Best Solution for Sleep Apnea?
If you’ve been administered with a sleep study and have been diagnosed with sleep apnea, the most common sleep disorder, you may be wondering about the treatments open to you. The best solution for this disorder is known as orthognathic surgery, which is a relatively simple plastic surgery procedure. This procedure is completed in a hospital with general anesthesia and usually involves an overnight stay at the hospital. The bones in your upper and low jaw will be re-positioned in an attempt to increase the size of your airways, thereby eliminating the obstruction that caused your sleep apnea in the first place.
If you’re interested in this procedure, contact Dr. Jamali at 212-480-2777 today. His offices are located at 42 Broadway, Suite 1501 in New York City. Dr. Jamali is a board certified oral and maxillofacial surgeon and has obtained many years of experience in dealing with sleep apnea, so you can be confident that you will be well taken care of.
Sleep apnea is a condition that causes people to experience pauses in their breathing or have abnormally shallow breathing while they sleep. The pauses in breathing may happen as often as every other minute while the person is sleeping. Sleep apnea has side effects that can negatively impact one’s lifestyle because it likely results in poor sleep and therefore leads to daytime fatigue. An average of 15 million U.S. adults suffers from sleep apnea. Here are some ways that sleep apnea may hinder one’s lifestyle.
Causes of Obstructive Sleep Apnea
While there are two different types of sleep apnea, obstructive sleep apnea is the most common. Obstructive sleep apnea is diagnosed when one’s airway becomes blocked while they are asleep. This may be a partial or a full block. One reason this can happen is that the throat and tongue muscles relax too much while someone is asleep, which creates a barrier for the air flow that is trying to reach the lungs. Other factors that may come into play include having excessively large tonsils, and obesity, which can narrow the windpipe.
Experiencing a blocked airway may result in lowered blood oxygen levels, prompting the brain to wake up and re-open the airway. This brief awakening may be short enough that the person has no memory of it, but it often results in loud snoring when normal breathing is resumed.
Signs and Symptoms of Obstructive Sleep Apnea
The most common sign of this type of sleep apnea is snoring, as when the airways are opened, the person suffering from sleep apnea is likely gasping for air. However, not everyone who snores in their sleep suffers from sleep apnea. A different sign of obstructive sleep apnea is when people have pauses in their snoring, shortly followed by a period of choking or gasping for air. Sleep apnea often results in daytime sleepiness due to the disruptions in deep sleep. Other symptoms include:
Waking up with a dry mouth or a sore throat
Waking up with a headache
Difficulty concentrating while awake
Mood changes, depression, irritability
High blood pressure
How Obstructive Sleep Apnea May Hinder Your Lifestyle
Avoid sleeping on your back is one way to prevent your tongue and throat muscles from relaxing and falling into your airway, resulting in a blockage. For people who are suffering from mild sleep apnea, changing sleeping positions may be a simple way to relieve some of the symptoms.
You can also sleep in a slanted, upright position to increase the body’s ability to correctly keep air flowing. This keeps the throat from naturally narrowing when lying flat.
Diet and Exercise
If excess weight is an issue, weight loss is an important factor in decreasing the fatty tissue that is built up in the throat. This helps the air flow naturally during sleep. With a proper diet and regular exercise, the resulting weight loss will reduce apnea episodes. A well-balanced diet and regular exercise will result in a positive impact on sleep quality and a significant reduction in daytime fatigue.
Smoking and Alcohol
Quitting smoking and drinking alcohol can help to relieve some sleep apnea issues. Smoke irritates the lungs and causes inflammation of the sensitive tissues in the airways. Smoking increases swelling of the tissues, which therefore increases airway obstructions.
Alcohol can cause the throat muscles to collapse into the airways because it relaxes them – this may contribute to an obstruction. Do not drink alcohol for at least 3 hours prior to going to sleep. While alcohol may result in drowsiness, it can also interrupt deep and restorative sleep cycles.
Excessive daytime drowsiness due to sleep apnea may cause episodes of dozing off during the day at inappropriate times. This may happen at work, while watching TV, and even while driving.
When to Consult a Physician
People who suffer from sleep apnea are often unaware that it is occurring. For this reason, a spouse or someone else who lives and sleeps close to the patient is often the one to notice there is a problem and urge the person to see a doctor. One should see a doctor if they experience the symptoms of sleep apnea in order to have a sleep test done to confirm the diagnosis.
Having jaw surgery to correct sleep apnea can vary depending on the patient. The most successful orthognathic surgery for patients suffering from obstructive sleep apnea is called maxillomandibular advancement surgery. This jaw surgery removes bone from both jaws and the chin and moving the jaws forward.
This movement opens and widens the airway, which is an important part of preventing the airway from collapsing. Jaw surgery of any type may be seen as a major surgery, however, there are no reported deaths following orthognathic surgery, and major complications are extremely rare.
While numbness may occur in the lips, cheeks, and chin of the patient, it is temporary and not incapacitating for the patient. The numbness is actually found to be advantageous to the patient, as it decreases the pain following the surgery.
The ideal candidate for this type of surgery has failed to benefit from more conservative treatments such as a CPAP machine or a splint. Some ideal candidates may also have a craniofacial deformity, have a BMI of over 30, is under the age of 50, and has moderate or severe sleep apnea. Orthognathic surgery is considered to be one of the safest and most effective upper airway surgeries to treat this disorder.
In order to receive more information on this type of surgery or treatment for obstructive sleep apnea, contact Dr. Jamali in New York. Dr. Jamali is a board certified oral and maxillofacial surgeon who is also an active member of the American Association of Oral and Maxillofacial Surgeon, the American Dental Association, the American Dental Society of Anesthesiology, and the New York State Dental Association. Contact his office at 212-480-2777.
Did you know that many sleep apnea sufferers around the world may be waking up as many as a hundred times per night or more without knowing it?
With worldwide estimates as high as 24 percent of men and 9 percent of women who may be living with sleep apnea, it is not surprising the American Sleep Apnea Association considers it a major worldwide health issue today.
If you think you may have sleep apnea or suspect a loved one (child or adult) may be a sufferer, this blog will offer the foundational information you need to begin the diagnostic and treatment process with Dr. Jamali.
Sleep Apnea Explained
There are two main categories of sleep apnea. The first, central sleep apnea is far less common and less well known. This type of sleep apnea occurs when the brain signals for respiration are interrupted and night time breathing cessation occurs as a result.
The second, obstructive sleep apnea is by far the most common and best known sleep apnea disorder. This type of sleep apnea occurs when there is an obstruction of some kind that blocks the airway at the back of the throat during the night. This obstruction, which often stems from excess soft tissue in the soft palate, can block respiration during the night, often as frequently as hundreds of times per sleep cycle.
The first step to deciding on the best treatment is confirming which type of sleep apnea you have developed, central or obstructive.
Risk Factors & Symptoms for Sleep Apnea
More is continually being learned about the full range of risk factors for and symptoms of sleep apnea.
These are considered to be the most common risk factors and symptoms:
Morning headaches, dry mouth or sore throat.
Sudden waking in the night, often with a gasp for air.
Daytime sleepiness, irritability, fogginess or inability to concentrate.
Sleeping but never feeling rested.
Loud snoring (obstructive type ONLY).
Waking many times in the night to use the bathroom.
Being overweight or obese (however, thinner people can also develop sleep apnea).
Having a thicker neck, smaller jaw, larger tongue and more soft tissue at the back of the mouth (soft palate area).
Being male and over the age of 40 (however, women and children can also develop sleep apnea).
Having a family medical history that includes a diagnosis of sleep apnea in close relatives.
A personal history of acid reflux, deviated septum, allergies or narrow sinus passages.
Diagnosing Sleep Apnea
Diagnosing sleep apnea typically begins with a visit to a family doctor with a complaint of fatigue or allergies.
After taking a list of symptoms and doing an exam, this will generate a referral to a specialist like Dr. Jamali who can order a sleep test to diagnose whether sleep apnea may be the cause of the symptoms.
The sleep test, which can be performed in a sleep center or at home, can determine whether breathing cessation is occurring in the night and if so, how often and for how long. From here, the treatment phase can begin.
Gastric Bypass Surgery & Sleep Apnea
Because there is a known correlation between individuals struggling with issues of overweight or obesity and obstructive sleep apnea, gastric bypass for weight loss is of interest to the medical community as a possible treatment option.
However, it is important to understand the risks of undergoing gastric bypass surgery without first treating the sleep apnea in other ways. These risks include proper management of anesthesia and breathing monitoring during surgery.
But the more significant risks occur with the decision to put off more immediately impactful sleep apnea treatments to have gastric bypass surgery go through the recovery process and wait for the weight loss to occur in the hopes that it will ease or eliminate the symptoms.
For very mild cases of obstructive sleep apnea, it may be deemed medically low-risk to proceed with gastric bypass surgery before looking at other more immediately impactful options such as use of a CPAP machine, correction of sinus or deviated septum issues or having reconstructive jaw surgery.
But for moderate to severe sleep apnea cases, it is best to treat the primary symptoms right away to reduce the risk of brain damage and death that can result from ongoing or extended airway obstruction at night.
Treating Sleep Apnea
The prescription of breathing devices for the management of sleep apnea (such as CPAP, VPAP, Nasal EPAP, etc.) can make a measurable difference in the reduction of sleep apnea symptoms.
However, for moderate to severe cases of obstructive sleep apnea, an increasingly preferred route with more permanent and widespread positive results is orthognathic (jaw) surgery. Sometimes jaw surgery is also combined with other necessary corrections, such as surgical correction of a deviated septum, widening of nasal/sinus passages, removal of excess soft palate tissue or correction of bite issues.
Because jaw surgery can potentially eliminate the need for ongoing uses of a breathing device at night, it is increasingly becoming a preferred choice for obstructive sleep apnea patients and their loved ones as well.
Contact Dr. Jamali for Help
Dr. Jamali’s busy oral and maxillofacial surgical practice is located in New York City, NY. Dr. Jamali is a Real Self Top Doctor and has been named to the Real Self Top 100 (2014).
His passion for facial reconstructive surgery and jaw surgery was preceded by a deep interest in general dentistry, dental and oral trauma, internal medicine, issues of anesthesia, general surgery and otolaryngology (ear, nose and throat specialization). As modern medicine continues to advance, Dr. Jamali continues to devote a significant portion of his time towards continuing education to better serve his patients and their loved ones.
To learn more and schedule a consultation with Dr. Jamali, you are invited to contact us at 212-480-2777 or visit us online at www.omsofny.com.
Even though the phrase “sleep apnea” is now relatively widely recognized by the general public, much confusion still exists about exactly what sleep apnea is, who is at risk, whether it only affects people who are overweight or obese and how it is treated.
If you have been diagnosed with sleep apnea or you suspect a loved one may be showing signs of the disorder, this article will equip you with sufficient basic information to seek appropriate medical consultation and care with Dr. Jamali.
What Is Sleep Apnea?
Sleep apnea is not just one single disorder, but actually encompasses a range of symptoms that can extend from mild to severe. At its mildest level, sleep apnea may go undetected for many years. At its most severe, sleep apnea is a known killer.
What Are the Types of Sleep Apnea?
Sleep apnea takes on two main forms: obstructive and central.
This type of sleep apnea is the most common type and basically is caused when the airway gets blocked. Often, this is caused when the soft tissue at the back of the soft palate and throat collapses and blocks the airway.
This type of sleep apnea is less common and occurs when the signals from the brain to the autonomic (automatic) respiratory muscles don’t transmit and breathing ceases.
What Are the Symptoms of Sleep Apnea?
The most common sleep apnea symptoms include the following:
Snoring loudly at night.
Waking suddenly but not knowing why.
Not feeling rested even after a full night’s sleep.
Having a sore throat or dry mouth in the morning.
Feeling drowsy, irritable or foggy during the day.
Headaches in the morning.
Other symptoms may be present as well, and with central sleep apnea, usually there is no snoring, so it can be harder to detect.
Who Is At Risk for Sleep Apnea?
There are some known risk factors that make some people more prone to developing sleep apnea. However, no list of risk factors can fully encompass every person who may develop sleep apnea, which is important to keep in mind when seeking medical care with Dr. Jamali for suspected sleep apnea.
The best known risk factors that may predispose someone to develop sleep apnea include these:
A family history of sleep apnea.
Issues with overweight or obesity.
Being over age 40.
Having a wider neck circumference.
Having large tonsils or a lot of soft tissue in the soft palate area.
Having a smaller jaw and larger tongue.
A prior diagnosis of GERD (gastroesophageal reflux).
A prior diagnosis of a deviated septum or other sinus issues.
Continual struggles with respiratory allergy symptoms.
What Does Weight Have To Do With Sleep Apnea?
As it turns out, being overweight or obese is not as significant a predictor of who may develop sleep apnea as was previously believed. The National Institutes of Health (NIH) state that, of the millions of people who currently suffer from sleep apnea, as many as 90 percent of these may be unaware of their condition.
Part of this is because many people who are otherwise thin don’t think they could possible develop sleep apnea. As well, since the disorder is more common in men, thin women are less likely to consider they may possibly have sleep apnea, even if symptoms are a match.
Children can also develop sleep apnea, regardless of their body weight. For this reason, the best approach is always to seek medical consultation with Dr. Jamali for a medical diagnosis rather than trying to self-diagnose based on common symptoms of sleep apnea alone.
What Treatments Are Available For Sleep Apnea?
The available treatments for sleep apnea are typically tailored to the type and severity of symptoms as well as the type of sleep apnea diagnosed (obstructive or central).
Mild cases of sleep apnea can respond well to lifestyle changes and the addition of a night-time breathing aid such as a CPAP, VPAP or Nasal EPAP machine. Lifestyle changes typically include ceasing smoking, changing sleep positions, steering clear of sleeping pills and alcohol and not sleeping on a flat back.
For more severe or life-threatening cases of sleep apnea, one of the best treatments is jaw surgery, or orthognathic surgery. Orthognathic surgery, which is one of Dr. Jamali’s areas of particular expertise, can realign and reconstruct the jaw to eliminate obstructions contributing to sleep apnea symptoms.
As needed, additional corrections can be made during jaw surgery as follows:
Correct a deviated septum.
Clear out and enlarge sinus passages.
Remove some soft tissue from the soft palate area.
Correction of an overbite, underbite, or bite malocclusion.
Typically, orthognathic surgery can ease or eliminate sleep apnea symptoms in the case of obstructive type sleep apnea. For cases of central sleep apnea, it may be necessary to take a different approach since this type is not caused by obstruction of the airway passages.
About Dr. Jamali
Dr. Jamali practices in New York City, NY. He holds a board certification to practice as an oral and maxillofacial surgeon and is recognized as a Real Self Top Doctor. Dr. Jamali graduated from the prestigious Tufts University (doctorate degree) and then completed his residency at Kings County Hospital Center, which is well-known as one of the nation’s largest Level One trauma centers.
Dr. Jamali also completed a fellowship at Lenox Hill Hospital, where he studied Orthagnothic Surgery to pursue his passion for facial reconstructive surgery. Today, in addition to his busy practice and surgical schedule, Dr. Jamali continues his education and research into the latest cutting-edge medical practices in anesthesiology, general surgery, trauma, plastic surgery, ontolaryngology and orthognathic surgery.
To schedule your consultation with Dr. Jamali at his New York City, NY, office, contact us at 212-480-2777 or visit us online at www.omsofny.com.
If you find yourself waking up frequently throughout the night and never seem to have enough energy to do the things you want to do during the day, you may be suffering from sleep apnea.
“Apnea” is the cessation of breathing, and “sleep apnea” is the medical term that’s used to describe this process when it occurs while a person asleep. While approximately 20 million Americans are affected by sleep apnea, the majority of these people don’t realize it’s a medical diagnosis, so they never seek help for their condition.
What Are the Symptoms of Sleep Apnea?
Symptoms associated with sleep apnea include loud snoring, daytime headaches and daytime fatigue that can lead to irritability and an inability to concentrate. Additionally, untreated sleep apnea can put you at higher risk for a variety of serious health issues, including heart arrhythmias, heart attacks, high blood pressure, diabetes, depression and chronic headaches. Fitful sleep may also lead to excessive daytime sleepiness, which can increase the risk of accidents.
Central sleep apnea (CSA)
For as many as 20% of individuals suffering from sleep apnea, the underlying cause is neurological. The breathing centers in the brainstem fail to send the necessary impulses that signal respiratory muscles to breathe. Central sleep apnea may be related to small, cumulative insults to the brain caused by strokes, heart attacks and chronic conditions like Parkinson’s disease. Sometimes central sleep apnea is triggered by high altitudes.
Obstructive sleep apnea (OSA)
Most people who momentarily stop breathing while slumbering suffer from obstructive sleep apnea. When you’re asleep, your throat muscles relax, which can allow your tongue to roll up against the back of your throat, thereby restricting the flow of air into the lungs. Your brain responds to decreased blood oxygen levels by waking you up just enough to restart the flow of oxygen again. Typically a loud gasping or choking sound accompanies this partial awakening. Once oxygenation begins again, the brain falls back into deeper sleep. In people with mild obstructive sleep apnea, this process occurs as often as 15 times an hour. People with severe OSA, however, may stop breathing as many as 30 times an hour.
What Are the Common Risk Factors for Sleep Apnea?
Common risk factors associated with obstructive sleep apnea include:
Excess weight is one of the most common risk factors associated with obstructive sleep apnea, particularly if the excess weight is in the neck or trunk area. Fatty tissues around the throat can block the flow of air. Sleep-associated breathing disorders also lead to grogginess throughout the day that can make it difficult to sustain an exercise program that may be able to help you lose weight.
As people age, their muscles tend to lose tone. This is as true for the muscles in the throat area as it for muscles elsewhere in the body. Slack throat musculature can contribute to airway obstruction during sleep.
Men are twice as likely as women to be diagnosed with sleep apnea.
Statistically, people with thicker necks have a higher incidence of obstructive sleep apnea. Men whose neck circumference is 17 inches or higher and women whose neck circumference is 15 inches or higher are more likely to develop the symptoms associated with sleep apnea. Additionally, if your throat is more likely to be inflamed due to allergies, or you suffer from chronic nasal obstruction due to allergies, sinus problems or a
People with throats that are narrower, or deal with tonsils, adenoids or tongues that are larger than average may also be predisposed towards developing sleep-related breathing disorders. In fact, if a close family member has been diagnosed with obstructive sleep apnea, you have a higher likelihood of being diagnosed with it yourself.
Smoking and alcohol use
Smokers develop sleep apnea at three times the rates of nonsmokers. Smoking irritates the tissues of the nose and throat, which restricts the free flow of air. Nicotine withdrawal can also disrupt the natural sleeping-waking cycle. Alcohol consumption relaxes throat musculature and decreases the respiratory drive. People with significant blood alcohol levels breathe more slowly and more shallowly, which can lead to under-oxygenation.
What’s the Best Treatment for Obstructive Sleep Apnea?
Obstructive sleep apnea is a very serious health challenge. While patients with this disorder can implement some lifestyle changes such as weight loss and smoking cessation without medical supervision, if you suspect you’re suffering from OSA, it’s wise to tell your primary healthcare provider right away. A definitive diagnosis can only be made following a thorough physical examination of your nose and throat, and a sleep study.
The first line of treatment for OSA typically involves the use of medical devices such as mouth guard or a continuous positive airway pressure (CPAP) machine. A mouth guard may be able to keep your airway unimpeded by immobilizing your tongue while a CPAP machine uses a steady stream of air to keep your airway patent. Both these treatments, however, often feel very restrictive to patients in ways that may also interfere with restful sleep. Moreover, in instances when a significant anatomical irregularity is contributing to OSA, medical devices may be of only limited effectiveness.
Interventions such as orthognathic surgery promise a more permanent solution to OSA. Surgeons can actually make minor adjustments to maxillary and mandibular bones that can increase the size of the airway. The procedure is performed under general anesthesia and usually involves a one- or two-day stay in the hospital as surgical inflammation around the operation site subsides. Recognizing that obstructive sleep apnea is a major wellness issue, an increasing number of healthcare plans are electing to cover this procedure.
As a board-certified maxillofacial surgeon with extensive training in cosmetic dentistry, dental anesthesia and facial reconstructive (orthognathic) surgery, Dr. Majid Jamali performs numerous surgeries every year aimed at correcting obstructive sleep apnea. Dr. Jamali and his team are based in New York City. For more information and to set up an appointment to explore the surgical alternatives that may be available to you, contact Dr. Jamali’s office today.
Today, sleep apnea is a commonly recognized phrase. But what is less known is just how serious sleep apnea can be. For most people, the risk of heart attack is lowest between midnight and 6a.m. But the reverse is true for people who have obstructive sleep apnea. These early morning hours are quite literally deadly.
This makes treating sleep apnea an urgent medical matter. The American Sleep Apnea Association estimates that, of the 22+ million people (adults and children) suffering from sleep apnea, up to 80 percent may be currently unaware of their condition. The only way to remedy this is to make more information publicly available about the symptoms of sleep apnea.
In this article, learn the basic information you need to decide whether or not to seek a consultation with Dr. Jamali about sleep apnea for yourself or a loved one.
Sleep Apnea Defined
Sleep apnea can be either obstructive or central. Obstructive type, which is the one most people recognize and know about, is caused by an obstruction to the throat area that causes breathing to stop.
Central type, which is much less well known, is caused when there is a miscommunication between brain and respiratory muscles, with the result that breathing stops.
Because sleep apnea has become so closely associated with older men who are overweight, many sufferers who do not fit this criteria may not think they could possibly have sleep apnea. The truth is, sleep apnea can literally affect anyone, anywhere, regardless of age, weight, size, shape, ethnicity or gender.
What Are the Main Symptoms of Sleep Apnea?
The symptoms of central sleep apnea are largely confined to breathing cessation when the brain and body miscommunicate. The best-known symptom, loud snoring at night, is typically totally absent in cases of central sleep apnea.
Obstructive sleep apnea, on the other hand, has a list of more recognizable symptoms, making this type of sleep apnea far easier to spot:
Loud night-time snoring, often detected by a parent or partner.
Sudden waking, typically with the person gasping for air.
Continual trips to the bathroom at night.
Feeling like no amount of sleep is ever enough.
Morning headaches or dry mouth or sore throat (or all).
Thick neck, small jaw, large tongue and lots of soft palate tissue.
Males over 40 are at higher risk, but women and children can also get sleep apnea.
Family history of sleep apnea.
How is Sleep Apnea Diagnosed?
The first step in diagnosing sleep apnea is often due to the negative effect symptoms have on a person’s quality of life.
The person often has no idea they may have sleep apnea, but they do know they are tired all the time, especially first thing in the morning. Their parent (in the case of a child) or partner may also have noticed loud snoring and reported it to them.
So often the person will seek out an appointment with their family doctor, who will then refer them to a sleep specialist for a consultation and a sleep study. If the sleep study confirms that the person is in fact not breathing for short spurts during the night, then it is time to pursue treatment options for sleep apnea with Dr. Jamali.
What Role Do Tonsils Play in Sleep Apnea?
The structure of a person’s neck, jaw, tongue and soft palate (including tonsils, adenoids and uvula) plays a major role in cases of obstructive sleep apnea.
For example, a person who has a wider neck circumference, a large tongue, a small jaw and a more substantial soft palate area is more likely to experience night-time sleep obstructions than someone without these physical characteristics.
The tonsils are located on either side of the soft palate and can be seen just above and to either side of the uvula (the flap of skin that hangs down at the back of the mouth). The adenoids are usually not visible, since they are located higher up in the nasal passages above the uvula. But both are part of the soft tissue that makes up the soft palate, which is a principle cause of airway obstruction in cases of obstructive sleep apnea.
For this reason, sometimes a tonsillectomy and/or adenoidectomy is recommended to ease or eliminate sleep apnea symptoms, especially if either or both areas are larger than normal or tend to get swollen frequently due to illness or allergies.
What Types of Sleep Apnea Treatments Are Available?
The sleep apnea type and severity of symptoms typically indicates the recommended course of treatment.
For central sleep apnea, the most common treatment is lifestyle modification combined with a night-use breathing device.
For obstructive sleep apnea, many patients want a more permanent solution than ongoing use of a breathing device. For these patients, the best approach is often orthognathic (jaw) surgery to permanently realign and reconstruct the jaw and soft palate area to prevent night-time breathing obstructions. In certain cases, orthognathic surgery may be combined with correction for a deviated septum or tonsillectomy/adenoidectomy.
Contact Dr. Jamali’s Office Today
Dr. Jamali is a board-certified New York City, NY, oral and maxillofacial surgeon with specializations in anesthesia, trauma, dentistry, plastic surgery, otolaryngology (ENT) and orthognathic surgery (jaw surgery).
Dr. Jamali’s background includes earning his doctorate in dentistry at Tufts University and his surgical specialization at the renowned Kings County Hospital Center, one of the nation’s largest Level One trauma centers. His orthognathic (jaw) surgery fellowship was completed at Lenox Hill Hospital in New York.
Dr. Jamali’s practice is located in New York City, NY, and he maintains affiliations at several outpatient surgical centers and hospitals for the convenience of his patients. If you have questions or wish to schedule a consultation with Dr. Jamali, you can reach us at 212-480-2777 or online at www.omsofny.com.
If you’re a heavy snorer, you might be wondering if you have a condition that requires medical treatment. It turns out that some heavy snorers actually have a condition known as sleep apnea. Once you get the diagnosis of sleep apnea, there’s really two essential ways to treat sleep apnea. The first method is to use some type of external device to treat the sleep dysfunction. The second method is to treat the source of the problem by opting for either throat or jaw surgery (orthognathic surgery). Let’s look at both treatments and weigh the plusses and minuses of each.
Snoring vs. Sleep Apnea
Snoring is much more benign when compared to sleep apnea. Snoring occurs when your muscles in your throat and mouth relax. When they become too relaxed, they can begin to vibrate and partially obstruct your breathing. This is what produces the sound of “snoring.” According the the American Academy of Sleep Medicine, almost half of American men and approximately a quarter of American women snore during their sleep.
Sleep apnea literally means to be without breath. When your oxygen gets stopped, this condition can actually wake people up with a snort or a gasp. Waking up a bunch of times in the middle of the night is enough to impact anyone’s quality of life. There are two common kinds of sleep apnea: obstructive sleep apnea and central sleep apnea. Obstructive sleep apnea occurs when the airway becomes narrowed or obstructed. This means that you’re trying to breathe, but there’s no air coming from your nose or mouth. The other form of sleep apnea, central sleep apnea, is a phenomenon where your brain basically forgets to tell your body to breathe.
Treating Sleep Apnea Using Machines and Appliances
A popular sleep apnea treatment method is to use a CPAP machine that delivers air and breathes for you. CPAP machine is short for continuous positive airway pressure machine. This is generally some sort of a mask or nasal cannula that you put into your nose. The mask is hooked up to a machine that pumps oxygen into your airway. This keeps it open so that you can get the oxygen that you need. These simple devices are popular for treating sleep apnea.
Another device used to treat sleep apnea is some sort of oral appliance. These devices tend to be a little less invasive than CPAP machines, but patients will still have to get used to having a device in their mouth while they sleep. Patients tend to be able to sleep more freely compared to a CPAP machine, including on their side or on their back. A big benefit of oral appliances is that they don’t need electricity. This is great for people who travel every year and need something portable. People with sleep apnea are often already wearing braces, retainers or even a grinding splint at night. In the cases of patients that have sleep apnea combined with bruxism or grinding, an oral appliance would be appropriate. These co-morbid conditions would allow your doctor to treat both teeth grinding and sleep apnea at the same time.
The major problem with these sleep apnea treatments is that they’re not well-tolerated by patients. For example, patient compliance rates with CPAP machines average only about 50%. Whether it’s a mask or mouthpiece, many people can’t tolerate sleeping with something attached to their face. There are also some patients that have more complex types of central sleep apnea than these types of machines or appliances can treat.
Treating Sleep Apnea with Surgery
If you opt to have your sleep apnea treated with surgery, a doctor will first take an x-ray of your facial region. This is done to help gauge the level of obstruction in your airway. Some target regions of maxillofacial surgery for sleep apnea include the throat and the jaw. Surgery is sometimes performed to tighten the soft palate in an effort to improve breathing. If there is a large degree of obstruction, that might require orthognathic surgery to reposition the jaw. The drawbacks are that these surgeries will require some recovery time (overnight in the case of jaw surgery.) But not having to wear a mask when you sleep can outweigh that drawback for many patients.
If you’ve tried CPAP machines in the past and had a poor compliance rate, the good news is that surgery can do away with those cumbersome machines. When you don’t have anything to wear at bedtime, people tend to like that solution a lot better. Patients should get sleep tested to see if they’re a good candidate for sleep apnea surgery. If they have questions about the procedure, the consultation is also an opportunity to get those concerns answered. You will go through a questionnaire that will help determine what risk factors you have that result from sleep apnea. This could include memory problems, obesity and daytime sleepiness. The doctor will find a solution that works well for your specific condition.
Sleep apnea has been linked to many other-other problems like high blood pressure and lack of concentration during the day. If it goes untreated for a long period of time, there is an increased risk of early heart problems and a thickening of the arteries. If sleep apnea has affected the quality of your life, then a consultation might be helpful in determining your treatment options. Dr. Jamali has years of experience as a board certified oral and maxillofacial surgeon. His clinic is located at 42 Broadway, Suite 1501. Please call 212-480-2777 to setup an appointment.
Most people should be getting about eight hours of sleep a night. This sleep repairs the body and prepares the brain for a new day. Unfortunately, an estimated 10 percent of women and 25 percent of men have a serious disorder that keeps them from getting the sleep they need for good health. Obstructive sleep apnea affects millions of Americans, and as many as 80 percent of those who have it are not diagnosed.
What is Sleep Apnea?
Sleep apnea is a sleep disorder that occurs when the tongue or other soft tissues in and near the mouth obstruct the airway during sleep. This blocks the oxygen flow to the rest of the body, and when the brain senses the decreased oxygen levels, it will partially awaken the sleeper. The brief awakening enables the person to clear the obstruction in the airway and begin to breathe again.
The pauses in breathing can last just a few seconds or up to minutes each time they occur, and they can happen dozens of times every hour, significantly disrupting sleep. When breathing restarts, it may be accompanied by a loud gasp, snort or choking sound. Snoring is common. Obstructive sleep apnea is chronic and can lead to severe health problems.
Each time breathing stops, it puts stress on the cardiovascular system. Over time, this increases the risk of high blood pressure and cardiovascular disease. The repeated cycles of waking up can lead to excessive daytime sleepiness, depression, decreased concentration and a higher incidence of workplace or roadway accidents.
Sleep Apnea Risk Factors
Obstructive sleep apnea can affect both males and females of any age. However, several controllable and uncontrollable risk factors can affect the risk of suffering from sleep apnea.
Known risk factors for sleep apnea include:
A family history of snoring or sleep apnea
Being overweight or obese
Having a large neck
Having large tonsils
Having a small lower jaw
Excess alcohol consumption especially at night
Symptoms and Diagnosis
Obstructive sleep apnea often goes unrecognized because the symptoms occur during sleep. Being aware of daytime symptoms and seeking appropriate medical advice is the first step to getting relief. Oral and maxillofacial surgeons offer consultations and treatment options to those who are suffering from sleep apnea symptoms.
Along with snoring and daytime sleepiness, the symptoms of sleep apnea often include:
Depression, irritability and mood swings
A dry mouth or a sore throat when waking up
Frequently urinating at night
At a consultation, an oral and maxillofacial surgeon will take a detailed medical history and may request a sleep diary to better understand the patient’s symptoms. Then, the doctor will evaluate the various anatomic relationships in the maxillofacial region to determine the nature and the degree of the obstruction. A flexible fiber-optic camera might be used to perform a nasopharyngeal exam. A sleep study will often be recommended to confirm the diagnosis and determine the severity of the apnea and its effects on the body.
Several noninvasive treatment options are available for patients with sleep apnea. One common first-line treatment is called CPAP therapy. With CPAP therapy, the airway is kept open by pressurized oxygen that is delivered through a nasal mask. Nasal dilators, mouth pieces and lifestyle changes can also be helpful for some patients. Unfortunately, nonsurgical treatments only offer temporary relief. The source of the obstruction remains, and symptoms will return as soon as the patient stops using the treatment.
Surgical treatments are designed to address the underlying cause of sleep apnea. Excess or loose tissue around the throat or soft palate is a common cause of obstructive sleep apnea. It is often treated with a procedure called the uvulo-palato-pharyngo-plasty. Also known as UPPP, this procedure focuses on the soft palate and the back of the throat and widens the airway for easier breathing. It can be performed traditionally or with a laser. The doctor might also use a radio-frequency probe to tighten loose tissues in the soft palate area. These are outpatient procedures and can be performed in the office under light sedation.
In other cases, the size of the airway may be abnormally narrow or small. For these patients, orthognathic surgery can be necessary. Orthognathic surgery is a type of jaw surgery. It is performed in the hospital under general anesthesia, and patients will need to stay overnight in the hospital for one to two days depending on their needs. Orthognathic surgery is a highly effective procedure for sleep apnea because it enlarges the entire airway in those with sleep apnea. It can be appropriate for those with moderate to severe obstructive sleep apnea and for those who have jaw deformities that contribute to their sleep apnea.
There is no single treatment that is right for every patient. The best way to find the right treatment for your sleep apnea symptoms is to visit an experienced oral and maxillofacial surgeon who can evaluate your airway and recommend the best approach to a healthier night’s sleep. Dr. Jamali is a board-certified oral and maxillofacial surgeon who completed extensive training in plastic surgery, otolaryngology and anesthesia during his residency. He completed a fellowship in orthognathic surgery. Contact his New York, NY, office today by calling 212-480-2777 to schedule your appointment.