Q. How is obstructive sleep apnea treated?
Hello doctor,
I was diagnosed with obstructive sleep apnea and secondary pulmonary hypertension two years back. I am using a CPAP but, not too regularly now. When sleeping, I often feel a blockage of my air passage, especially while exhaling, as if suddenly clogged by some tissues. This would repeat several times and would be normal when changing sleeping positions or with some intentional jaw movements. Further, I find it difficult to breathe or become breathless while traveling by bus or car at a speed of 70 km/h or more, when the air rushes in from the outside. Could this be a case of ENT problems? If it is, please advice on its treatment.
Hello,
Welcome to icliniq.com.
We need to find your apnea score . You must have done polysomnography before using the CPAP (continuous positive airway pressure) machine. Kindly share the reports so that we can know your apnea score. OSA (obstructive sleep apnea) can be treated by the surgical removal of the tissue causing the blockage. We put you to sleep medically and pass a flexible scope from your nose to the throat to find the exact location of the blockage and accordingly design the surgery customized to the individual. Revert with the reports and we shall guide you on the next step of action.
Hello doctor,
Many thanks for your care and prompt reply. As you see, when I was admitted to the cardiology department of this remote town, it was mainly due to the severe swelling of my lower limbs and daytime sleepiness and fatigue coupled with an abnormal and erratic heartbeat. So, till the day I was discharged, my sleep apnea was never addressed properly and there was no ENT specialist in that hospital. I was referred to some other private clinic for ENT-related evaluation. The doctors suggested the CPAP usage. It was more of a suggestion than a confirmed diagnosis and as such, no sleep study was conducted on me. As per their suggestions, I bought the CPAP machine from an outside source and the doctors themselves requested me to come back and show them my acquired CPAP machine and its workings after my discharge. So far, I have consulted one ENT specialist who recommends the removal of my tonsils. As my postings are in remote areas, I have not yet consulted a specialist again but, I am still suffering from the prior mentioned ailments. Please advise the steps needed for treatment.
Hello,
Welcome back to icliniq.com.
Sleep apnea requires a proper assessment. The assessment includes a clear history, physical examination, polysomnography and drug-induced sleep endoscopy. With regards to history, do you have daytime sleepiness? Do you have dry mouth? Do you wake up in the middle of the night gasping for breath? Do you fall asleep in the daytime while watching TV or talking to someone or driving? Are your personal relationships affected by the sleep problem? In physical examination, what are your height and weight? With this, we calculate your BMI. Usually, we note that the patients with sleep apnea have a higher BMI. Can you take a picture of your neck from the front and sides? Can you take a picture of your throat with the mouth open, paying attention to the posterior pharyngeal wall and tonsils? What is your waist size? What is your neck circumference? Have you done any neck X-ray? If so, please upload the same. This will help us assess the soft tissue in the neck and try and relate it to the sleep problem. If you can do a neck X-ray in lateral view for soft tissue, it will be helpful for initial assessment. Further assessment would require MRI neck to see the soft tissue thickness. Polysomnography or a sleep study is vital to the management of sleep problem. It assesses your hypoxia levels. It shows the number of apneic episodes in the night. It shows how much the problem is affecting the heart and the brain and what parameters are getting affected. The sleep study is done in many places. All major hospitals and ENT hospitals have the facility. In bigger cities, we have technicians who take the polysomnography machine to the patients home and measures the parameters while the patient sleeps in his home. Lastly, the drug induced sleep endoscopy gives us a picture of the actual obstruction during sleep. We give an intravenous medicine which puts you to sleep and we pass a flexible fiber-optic endoscope through the nose into the throat and observe where exactly the block occurs. Accordingly, we design our surgery. The surgery can be the removal of tonsils with parts of palate or parts of lateral pharynx or reduction of tongue base or epiglottopexy or septoplasty or sinus surgery or adenoid removal or inferior turbinate channeling or tongue channeling etc. Some procedures can be accomplished on OPD basis also. Meanwhile, there is Epworth sleepiness scale. It is a set of questions which you can download from the internet. Please fill up the same and send it to us in your next query. Do revert back with whatever details you can provide. Sleep apnea is a problem that we have a solution for. Based on proper history and assessment we have given comfortable sleep to many patients and made sure that their quality of life improves. Hope to see you in better health soon.
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