The Biggest Throat Problem for Sleep Apnea Sufferers
August 21, 2010
If you wake up every morning needing to hack up lots of thick mucous, or have throat pain, hoarseness, or a chronic cough, you’re not alone. You may think it’s the beginning of a cold, but a cold doesn’t continue for weeks to months without progressing into the full-blown viral symptoms.
Instead, these symptoms are the beginnings of the most common throat problem sleep apnea sufferers face. And as I explain below, without understanding why this occurs, it can be one of the hardest problems to treat.
Beware of the “Vacuum Effect”
People with obstructive sleep apnea are more prone to breathing problems at night due to partial or total collapse of one or more areas of the entire upper airway, from the nose to the tongue. It’s usually worse when on your back, since the tongue can fall back more in this position. During deep sleep, your muscles naturally relax and you’ll be more susceptible to breathing stoppages.
Pressure sensors placed inside sleep apnea patients reveal that every time an apnea occurs, a tremendous vacuum effect is created inside the chest and throat, which literally suctions up your normal stomach juices into your esophagus and throat. This can happen occasionally, even for normal people, but if you happen to have a late meal or a snack just before bedtime, there will be even more stomach juices lingering in your stomach to come up into the throat. If you happened to drink a nightcap, the situation is even worse since alcohol is a strong muscle relaxant.
What comes up into your throat is not only acid, but also bile, digestive enzymes, and even bacteria. Washings of lung, sinus and ear contents have shown H. pylori, a common stomach bacteria, and pepsin, a major stomach digestive enzyme. So what comes up can cause severe irritation in your throat, provoking the mucous secreting glands of your throat to try to dilute these substances.
Although people generally attribute throat mucous to post-nasal drip, in most cases there’s nothing dripping down the back of the throat. It’s actually coming from your stomach. However, in some cases, since your stomach juices can reach your nose, it can cause nasal congestion and inflammation, which can aggravate tongue and soft palate collapse by creating a vacuum effect downstream. Ultimately, it’s a vicious cycle.
Chronic acid and other irritating substances lingering in your throat can have other detrimental effects. One recent study showed that chronic acid exposure can numb or deaden the protective chemoreceptors in your throat. These are sensors that detect any acid in the throat to prevent aspiration of your stomach contents into your lungs. If these chemoreceptors sense any acid in your throat, a feedback signal is sent to the brain, causing you to wake up so that you can swallow. This is what’s called a reflux arousal.
Treating Reflux For Good
So besides not eating late and avoiding alcohol close to bedtime, what else can you do?
I’m assuming that many of you that are reading this article are already being treated for obstructive sleep apnea, via either CPAP, oral appliances, or even with surgery. The problem is that no matter which option you choose, there will always be some degree of reflux. Taking acid reflux medications can help sometimes, but for the most part, these reflux medications don’t really do anything for reflux. All they do is to lower the acid content content before it comes up into your throat.
Other options include stimulating your stomach via natural remedies or prescription medications to empty your stomach much faster. One fascinating study showed that using a combination of pseudoephedrine (Sudafed) and a pro-motility agent (domperidone) eliminated snoring in most people. Unfortunately, we don’t have the equivalent of domperidone here in the US. Other similar medications are available, but have more serious side effects.
This is why eating early at least 3-4 hours of bedtime is so important whether or not you have obstructive sleep apnea. The same also applies to alcohol. If your nose is stuffy, talk with your doctor to find a way to breathe better through your nose. Make sure you’re sleeping in your preferred or optimal sleep position. Lastly, work with your sleep physician to fully optimize your sleep apnea treatment, no matter which option you choose.
Tips for Traveling with Your CPAP Machine
July 20, 2010
One of the most common excuses for not wanting to use CPAP is that "I travel a lot." Even after I explain that many people travel just fine with their CPAP machines, some people are stll reluctant. With advances in technology and increased awareness by the lay public, government officials and medical professionals about the importance of using CPAP for obstructive sleep apnea, traveling with CPAP, although initially a challenge, can be done with relative ease. People use CPAP on planes, and even go camping with it. With the FAA's recent ruling and instructions on carrying and using CPAP on airlines, it's become even easier to travel with CPAP machine. I know there are various types of PAP devices, but for the sake of simplicity, I'll call these devices the generic name, CPAP.
Flying with Your CPAP
The Federal Aviation Administration (FAA) recently ruled that airline passengers must be allowed to use respiratory assistive devices, such as a CPAP machine (Nondiscrimination on the Basis of Disability in Air Travel – May 13, 2009). However, don't think that you'll just breeze by security checkpoints at the airport. Here are some common tips that are recommended when you fly with your CPAP machine:
1. Never check your CPAP machine.
2. Always have with you a prescription for your CPAP machine and your latest sleep study. You never know if your unit gets lost or stolen, or breaks down.
3. Attach a medical equipment tag, identifying the contents as such.
4. Let the TSA security agent know that you have a CPAP machine. Remove it from the back and have it scanned separately.
5. Request that security agents change gloves and wipe down the table before inspecting your machine. Wrap your device in a clear bag while being scanned to prevent contamination with germs and other chemicals.
6. Keep a record of the model and serial number in hand, just in case.
7. If you're going to use your CPAP machine in-flight, check beforehand if there's an outlet next to your seat, and if you have the right adaptor.
8. If the flight attendant says something about your CPAP being another carry-on, let him or her know that it's a CPAP machine and under the Americans with Disability Act, it's not counted as an added carry-on.
9. Consider having your doctor give you a letter describing the need for your CPAP machine.
10. Most CPAP units will automatically convert to the correct local voltage. Check with your instruction manual or manufacturer to confirm this. You may, however, need a plug adaptor, as well as an extension cord, in case your outlet is far away.
Tips On Water
Many people are so focused on the logistics of their machines, that sometimes they forget about distilled water. Make sure you have plenty of distilled water available if you're going to use it on the plane, or at your final destination.
If you're not going to use your CPAP device on the plane, then make sure you empty and dry the water chamber before flying. If you're planning on using your CPAP device on-board, there are two options to be able to pass large amounts of fluids past TSA security checkpoints: Have your doctor prescribe distilled water in a pharmaceutical grade bottle. A 500 mL bottle should hold about 16 oz. Another option is to purchase papFLASK, which is designed to pass through security checkpoints with ease.
For whatever reason you don't have distilled water available, using bottled or even tap water is OK, but try to find distilled water as soon as reasonably possible. Mineral deposits in tap water can build up within the PAP machine and can cause damage if it continues long-term.
Camping or Backing Up with CPAP
For travel to areas that don't have electricity, or in case you have a blackout, there are numerous battery options available. Each manufacturer will usually have a back up battery recommendations and adaptors.
For more extended periods, various people have written about using a 12 volt deep cycle marine battery with a sine wave inverter. There are numerous other battery options so do your research. Different manufacturers have different voltage needs, so also check with your manufacturer. Since a humidifier uses a lot of energy, most people recommend not using the humidifier if you're only camping for a few days. There's lots more information about batteries in CPAP support sites such as sleepguide.com, cpaptalk.com, talkaboutsleep.com, or apneasupport.com.
Have A Back Up Plan
Some patients carry around their oral appliances with them whenever they travel, either using it in place of their CPAP machines or just in case the device breaks. Some people use both the oral appliance and their CPAP machines simultaneously. If you've never tried an oral appliance and you're interested in an alternative option, it may be worth giving it a try now before you need to travel for long extended periods.
No More Excuses
With advances in technology and more acceptance by the medical community as well as the lay public, there's basically no reason (unless it's psychological) you can't travel with a CPAP machine. With knowledge and some flexibility and creativity, anyone can travel with CPAP, even in the more remote areas of the world. There have even been descriptions of solar power being used to recharge batteries used for CPAP. If you travel frequently to the same location, consider purchasing a second unit. Prices for middle of the road CPAP models are in the $300 to $700 range.
The first major challenge is in finding a way to make CPAP work for you. The second major challenge is in un-tethering your machine from your bedroom. Many people are living vibrant and normal lives, despite having to use their CPAP machines while traveling. Or is it because they are using their CPAP machines regularly while traveling? You decide.
Ask Dr. Park: An Insider’s Guide To Sleep Apnea Surgery
July 2, 2010
Secrets To Sleep Apnea Surgery…
Are you confused by all the conflicting information about sleep apnea surgery? Does it work? Which procedure is right for you? Which surgeon do you choose? In this Ask Dr. Park Teleseminar Program you will learn about Sleep Apnea Surgery. Even if you’re not considering surgery the good think to learned what the other option are and the rational of offering a surgery.
Learn:
- Why consider Sleep Apnea Surgery?
- Are you a candidate Sleep Apnea Surgery?
- In-depth descriptions of different Sleep Apnea procedures.
- How to find the right Sleep Apnea surgeon.
Click here to purchase MP3 recording.
10 Tips For CPAP Success
June 30, 2010
Learn the Insider Secrets of Highly Successful CPAP Users…
Get your FREE access to the audio replay and mp3 download of this interview with Aurelio Henriquez who has extensive experience helping patients with sleep apnea succeed in using their CPAP machine.
Since 2002, Aurelio has helped hundreds of CPAP users overcome their struggles while he was with the NY Methodist Sleep Disordered Center as a Polysomnographic technologist and then later as the technical lab director for the Columbia University Sleep Disorder Center.
Learn:
• What to expect when you first try CPAP in the lab
• How to avoid the #1 mistake every new CPAP user makes
• Where to get the best CPAP equipment for the best price
• What one thing you MUST do BEFORE using CPAP to dramatically increase your chance of success
• What makes some people fail and some to succeed on CPAP and how you can be successful
The Biggest Ear Problems for Sleep Apnea Sufferers
June 10, 2010
If you have obstructive sleep apnea, chances are, you’re likely to have some sort of an ear problem. There are a number of reasons why you’re going to be prone to various ear problems, but in many cases, the problem is not actually coming from the ear. To better manage your ear issues, you first have to understand your ear anatomy, and the different types of inflammation caused by sleep apnea. In the last part of this article, I’ll go over some tips to help you solve many of your ear-related issues.
What You Must Know About Ear Anatomy
The ear drum is a thin membrane that separates the middle ear cavity from the outer ear canal. Sounds waves vibrate the ear drum, which connects via a sophisticated lever and piston amplifier system that transmits sound waves to the inner ear. Normally, the middle ear cavity should have the same pressure as the outer ear canal. This is made possible by the function of the eustachian tube, which connects your middle ear cavity to the back of your nose. Whenever you swallow or yawn, your palatal and throat muscles open up the eustachian tube temporarily, equalizing pressure between the middle ear and the nose. You can think of the middle ear as a sinus—an out-pouching from the nose into an adjacent pocket of bone or soft tissue.
Whenever you go up an elevator or descend during a flight, the atmospheric pressure either goes up or down, and this creates either positive or negative pressure in your middle ear. With very slight pressure changes, you’ll feels a bit of fullness and hearing loss, but with severe pressure changes, you may even have pain and discomfort. If you keep swallowing, then you’ll keep popping open your ears. As a result, you’ll feel anything from fullness, hearing loss, popping, clicking, buzzing, or even ringing. This is why it’s recommended that you chew gum during descents in flights, or give the baby a bottle to feed.
Causes Of Inflammation
However, if you have any degree of inflammation in your nose, then additional swelling can prevent proper equilibration of air between your middle ear and nose. A number of different causes can aggravate swelling, including viral colds, allergies, weather changes, and even acid reflux.
You’re probably very familiar with the effects that a simple cold or allergy can have on your nose and ears. In most cases, you’ll have a few days of discomfort. But in certain situations, your cold or allergy may go away, but your ears will continue to be stuffed for days or weeks. Sometimes, the vacuum pressures that are created can cause fluid to accumulate, giving you what’s called serous otitis media. Rarely, this fluid can get infected and turn into the classic bacterial infection or otitis media. Fortunately, not too many people have true bacterial infections—most never make it past the vacuum pressure or clear fluid stages.
A Vicious Cycle
If you don’t have obstructive sleep apnea, the entire process can come and go within a few days to weeks. However, if you have sleep apnea, due to the additional inflammation that’s created, a simple ear or sinus problems can linger for weeks, and sometimes even months for the following reason: Any additional inflammation in the nose or throat causes swelling which can aggravate more frequent obstructions, leading to stomach juices to come up into the throat and nose, including in the area of the eustachian tubes. Furthermore, frequent obstructions and arousals leads to an imbalance of your involuntary nervous system, where your nose is going to be overly sensitive, especially to weather changes (pressure, temperature, and humidity changes). This is called chronic or non-allergic rhinitis.
For some people using a CPAP machine can blow air into the middle ears, through positive pressure. This can be a frustrating issue that’s difficult to cure completely.
Solutions For Your Ear Problems
So if you have obstructive sleep apnea and are prone to ear problems, what can you do? The first thing to make sure of is that you’re treating your sleep apnea condition optimally. If your CPAP pressure is too low, or your dental device is undercalibrated, or your UPPP procedure was only partially effective, then you’ll still have residual obstructive sleep apnea and are still feeling the effects of intermittent obstructions and arousals.
Second, make sure that your nasal breathing is optimal. By definition, your nasal passageways will be either narrowed, inflamed, or both. Having a chronically stuffy nose can create more of a vacuum effect downstream, which allows the tongue to fall back more often when in deep sleep, due to muscle relaxation. If you’re using CPAP, then it’s likely that your pressures may be too high, which can make it uncomfortable, and even blow air into your ears. Whether through vigorous saline irrigation, allergy avoidance, medications, or surgery, it’s important to make sure you’re able to breathe well through your nose.
Lastly, it’s important to lower inflammation in your throat by making sure you’re not eating within 3-4 hours of bedtime. Having even 2-3 apnea or hypopnea episodes per hour, although acceptable, can still suction up juices into your throat. Since you’re going to suction up normal stomach juices anyway, it’s important to keep the acidity and juice volume as low as possible. The same rule applies to alcohol, since not only does it produce more stomach acid, it also relaxes your tongue and throat muscles, causing you to stop breathing more often.
Ear problems are an inevitable part of having obstructive sleep apnea. By knowing what can cause ear problems and how you can deal with it, you can minimize the discomfort to a point where it’s tolerable or minimal.
Is Your Father Going Through Menopause?
June 8, 2010
Over the past year, ever since the birth of our third son, Brennan, I've been more tired than usual. Not too unexpected when you have a newborn, right? Add to this having to help my wife tend to the needs of our two older boys, who are 7 and 10. But even now when Brennan is sleeping well through the night, and I'm sleeping about 7 hours every night, I'm still more tired than I used to be, despite running 3 times per week, and being as fit as ever. Could I be going through male menopause?
The Facts of Male Menopause
I wrote last month about how mothers can suffer from poor sleep due to the effects of menopause on sleep quality, but what about fathers? You may have heard about male menopause, or more precisely, andropause. It's not that well known, and even if it happens, it's so slow and insidious that most men don't realize it's happening.
Well, it turns out that men go through a similar transition during the mid-life years. Not only does testosterone slowly drop, but thyroid levels as well. Our traditional medical culture and even holistic and alternative doctors sometimes argue that aging is a deficiency of certain hormones, vitamins or minerals, and that replacement using synthetic or natural supplements is the answer. But is that the only answer?
Most people think that this is a natural part of aging, along with the typical memory loss, balding, wrinkles and lowered energy and stamina. But what if I told you that I routinely see even young to middle aged men who complain about hot flashes, night sweats, mood swings, insomnia and irritability—or all the prevailing symptoms of menopause?
Aging As A Consequence of Poor Sleep
In my book, Sleep, Interrupted, I describe a sleep-breathing paradigm where all modern humans are on a continuum, where we're all susceptible to sleep-breathing problems to various degrees.
As you age, it's expected that overall, you'll keep moving up this continuum to the point where sleep breathing problems become much more serious as in obstructive sleep apnea. Not only do we sag and bulge on the outside as we get older, it also happens on the inside, including your upper airway. And as your airway becomes narrower, the more trouble you'll have breathing while sleeping, and this in turn will make you wake up more and obstruct more.
Women experience more dramatic changes in hormone levels (particularly progesterone) that affect upper airway patency, but levels of testosterone and even small amounts of progesterone can also influence upper airway muscle tone in men as well; Not to mention the typical weight gain that occurs in the middle years, leading to even more narrowing of the upper airway. Adding any degree of inflammation to the upper airway (such as from a cold, allergies, or reflux) can cause more frequent obstructions and arousals. Poor sleep efficiency leads to weight gain, and weight gain narrows the throat.
Sleep Apnea And Aging
It's a given that as you age, your upper airway begins to narrow gradually, aggravated intermittently with additional narrowing from inflammation. This is also why men begin to develop cardiovascular disease as they get older. Women are somewhat protected before menopause, but afterwards, they begin to catch up when it comes to rates of heart disease. As you slowly move up the sleep-breathing continuum, your risk of developing obstructive sleep apnea increases, and once it begins, a vicious cycle begins, where poor sleep aggravates weight gain, and weight gain aggravates poor sleep.
Poor sleep (by causing a physiologic form of stress) also causes major hormonal changes by lowering your thyroid levels, as well as your reproductive hormones. So naturally, if you test for thyroid or testosterone levels, it may come back on the low side. Not too unexpectedly, supplementing with replacement hormones helps in some cases, but not all the time.
We know that untreated obstructive sleep apnea (OSA) can aggravate or cause routine medical conditions such as diabetes, high blood pressure, depression/anxiety, heart disease, heart attack and stroke. Your risk of car accidents also increases anywhere from 3 to 10 times normal if you have OSA. Add to this all the other common expected conditions that you may experience as you get older: frequent bathroom trips, balding, erectile dysfunction, hearing loss, and even Alzheimer's.
Taken at face value these seemingly disparate symptoms of old age aren’t all that unexpected. However, if you look at them from the perspective of my sleep breathing paradigm, you’ll begin to see how it’s your breathing and not necessarily your age that’s making you feel sick and tired.
Too Many Bathroom Trip—Risky For Your Health
It's been shown that going to the bathroom frequently at night is not because you're making too much urine, but because you stop breathing and you think you have to go to the bathroom. One recent study showed that going to the bathroom two or more times per night increases your chances of dying by 50%. There have even been many anecdotal reports of hair regrowth after definitive treatment for sleep apnea. Erectile dysfunction (ED) is a very well-known complication of sleep apnea. Having ED can predict the presence of sleep apnea in the majority of patients.
Brain Damage From Poor Breathing While Asleep
Untreated sleep apnea also increases your chances of microscopic strokes and small vessel blockages in multiple, critical areas of the brain. One recent study showed that sleep apnea patients have 20% smaller brain volume in the Mammary bodies. Another showed smaller brain tissue densities in critical areas of the brain that controls memory, executive function, breathing and respiration. Untreated sleep apnea patients have much more viscous (thick) blood that can stagnate and clot in small vessels in the brain. One area that's particularly sensitive are the small vessels that supply the high-frequency sensing areas of the inner ear.
All these issues begin when you're young, but begin to manifest in your middle years, progressing to full-blown medical complications when you reach your 60’s and 70’s. As you can see, how narrow you upper breathing passageways are determines how quickly you age or how often you become sick. Now that I'm in my mid-40s, if I don't get at least 7 hours of sleep, or if I eat later than usual, I definitely feel worse the next day. This is why it's important to do everything possible to breathe well at night while sleeping, in addition to a healthy lifestyle that includes a good diet, regular exercise and smart decisions when it comes to your sleep.
Proven Weight Loss Strategies for Sleep Apnea Sufferers
May 21, 2010
My wife just commented to me that just by eating dinner about one hour earlier than usual for the past few weeks, she's automatically lost about 2-3 pounds. We normally eat about 3 hours before bedtime, but by the time we finish dinner and have fruit for dessert, it's about two and a half hours before we go to bed at 10PM. Even our children now seem less tired and more alert during the day. Although we decided to make this change to increase our sleep quality, my wife's weight loss was an unexpected side effect. So how does this apply to sleep apnea sufferers?
The Sleep Apnea Stereotype
At almost every sleep apnea lecture that I've seen in my career, the speaker almost always puts up a picture of Joe the fat boy from Dickens' The Pickwick Papers. If you read any scientific study about obstructive sleep apnea, it almost always starts with, "…typically seen in middle aged or older obese men who snore heavily with large necks."
Although described 30 or so years ago in these stereotypical men, now we know that it can occur even in young, thin women who don't snore. But many overweight people, especially as they get older, will snore or have obstructive sleep apnea. It's estimated that overall, about 24% of men and 9% of women will have it, but by the time you reach your 70 to 80s, the incidence about 55%. Being overweight is still a major risk factor for development of obstructive sleep apnea. If you're overweight and have sleep apnea, then it's much harder to lose weight than if you didn't have sleep apnea. Let me explain why.
How Hormones Affect Your Appetite
It's been proven that poor sleep (quality or quantity) can promote weight gain through various mechanisms. Leptin is one major hormone that provides information about energy status to your brain—essentially, it tells your brain that you have enough energy. Low levels of leptin causes hunger. Normally, leptin increases after you eat, but sleep deprivation lowers this hormone, making you hungry. As leptin drops, your cortisol levels will also increase. As I've mentioned numerous times in my book, Sleep, Interrupted, poor sleep efficiency cause a low-grade physiologic stress reaction that increases your cortisol levels. This hormone also makes you more hungry. Other studies have shown that not only will you be more hungry, you'll tend to crave fattier, sugary, high carb foods.
You can imagine how once this process starts, it's a vicious cycle: Poor sleep makes you more hungry, so you eat more or snack close to bedtime. More frequent obstructions causes your stomach juices to be suctioned up into your throat, causing more inflammation and swelling. These juices can then go into your nose and lungs, causing further inflammation and swelling. Weight gain then narrows your throat further, aggravating sleep apnea, which makes you sleep less efficiently.
First Steps Toward Losing Weight
So what can you do if you have sleep apnea and are overweight? Is it hopeless?
Fortunately, there are steps that you can take that if followed properly, can not only help most people lose pounds, but also sleep better in the process. The first and most important thing is to eat as early as possible before bedtime. I know I keep repeating this, but you'll be surprised by how many people continue to eat late or snack just before bedtime. Three to four hours is the general recommendation to avoid eating before going to bed. The only thing you can have is water within this timeframe. The same goes for any kind of alcohol, since alcohol relaxes your throat muscles, aggravating obstructions and arousals.
The second most important thing to do is to make sure that you can breathe well through your nose. If your nose is stuffy, the challenge is in figuring out what's causing your nasal congestion, since there are a number of different reasons. In many cases, there's more than one reason. This is a huge topic that I cover in my Ask Dr. Park teleseminar called Un-Stuff Your Stuffy Nose. I also have various articles and blogs about this issue on my website at doctorstevenpark.com.
Needless to say, you also have to eat healthy and exercise regularly. I'll leave the specific recommendations for other respective experts in this area. One thing to point out, though, is that if you lift weights or engage in any activity that bulks up your upper chest and neck muscles, remember that your upper airway is unprotected, and that that any degree of neck muscle enlargement and press in on your upper airway. This is why many bodybuilders and weightlifters snore.
Eating earlier helps to reduce inflammation and swelling in your throat, and better nasal breathing lessens the vacuum effect that's created in the throat when you breathe in while sleeping. These two steps alone (along with eating healthy and regular exercise) will help many people, but to various degrees. For some, making these conservative changes alone may be enough, but with others, they will need some form of formal treatment for their obstructive sleep apnea. I won't get into the treatment options for sleep apnea since that's a HUGE topic in itself. For more information about sleep apnea treatment, I have lots of practical information on my website or you can find one comprehensive resource by reading my book, Sleep. Interrupted.
Sleep More, Lose Weight
Lastly, most people in general are sleep deprived. Lack of sleep, in addition to inefficient sleep due to sleep-breathing problems, can also cause similar weight promoting issues. A great example is when Glamour magazine asked women volunteers to try to get consistently 7.5 hours of sleep every night for 10 weeks. Many women lost anywhere from 6 to 15 pounds, all just by sleeping more. Studies have shown that lack of sleep (5 hours or less) per night is a major risk factor for significant weight gain.
So whether or not you are overweight, the recommendations outlined above will help you to breathe better and sleep better. Even if you are thin and don't have obstructive sleep apnea, following these recommendations can the onset of sleep-breathing problems and ultimately lessen the risks that can go along with obstructive sleep apnea. If you are overweight, this is the first step toward losing unwanted pounds.
Understanding Your Sleep Study Report
April 10, 2010
Expert Interview with Dr. Anita Bhola
The sleep study report may look like a jumble of numbers and cryptic medical terms that's impossible to decipher. However, with a bit of guidance from Dr. Anita Bhola, a board-certified sleep medicine physician in New York City, you'll be able to understand the basics in how to read and interpret your sleep study.
During this information packed hour, you'll learn:
• What your sleep study measures
• The difference between sleep efficiency and latency
• How apneas are different from hypopneas and how you'd measure this on
your sleep study
• How to tell if you may have obstructive and central sleep apnea why knowing this can help you and your doctor decide on the right course of treatment
• How to see the various sleep stages on your report and notice hypnograms
• Answers to most frequently asked questions regarding sleep studies
An Insider’s Guide to Septoplasty
March 25, 2010
The septoplasty operation is one of the most misunderstood surgical procedures that lay people, and even many physicians have. Some people even equate septoplasty with having a nose job, which is not true. Although, some people use having a crooked septum as
an excuse to undergo a rhinoplasty, septoplasty, done correctly, can help patients breathe better, and more importantly, sleep better.
Understanding the Anatomy
In order to fully appreciate if septoplasty is the right procedure for you, you must understand the anatomy of how it’s done.
However, having a crooked septum doesn't mean that you'll have a stuffy nose, or that you'll need a septoplasty. No one has a perfectly straight septum. There are other parts of your nasal anatomy that contributes to your ability to breathe, which includes your nasal turbinates and your nostrils. The turbinates are wing-like structures that jut in from the side-walls of your nose that look like wings. They normally warm, filter, smooth and humidify the air that you breathe. Inside this structure is the bone and the outside is a mucous membrane lining. The middle part is made of very vascular tissues that can swell tremendously when filled with blood. This is regulated by your involuntary nervous system. This nervous system normally swells and shrinks the turbinates, alternating from side to side, every few hours (called the nasal cycle).
Do You Have Flimsy Nostrils?
The other structure that is often overlooked is your nostrils. For most people, breathing in causes a mild vacuum effect that causes a mild collapse and a constriction of the nostrils. But in some people with either flimsy or weakened nostrils (from a prior rhinoplasty), they collapse very easily, even with a slight bit of inspiration. If you are one of these people, you may benefit from nasal dilator strips (Breathe-rite is one brand). Sometimes these strips are not strong enough, or it can irritate the skin. Another option is to use internal nasal dilators which work much better. Some of the more common brands are Breathewitheez, Nasal Cones, and Nozovent.
What's Involved with Septal Surgery?
The septoplasty procedure can be done in conjunction with a turbinate procedure. There are many ways to perform a septoplasty, but the most important point is that it should be done well. The septum is covered on both sides by a mucous membrane. After an incision is made inside the nose on the mucous membrane, this layer is peeled away from the septal cartilage. The other side is also entered, which creates two tunnels on either side of the septal cartilage. The crooked part of the septal cartilage is next removed. Some surgeons either soften the cartilage or flatten it out and place it back, and others leave it out completely. In many cases, a small portion of bony spur that juts out at the base of the septal cartilage is also removed. The last part of the operation is where different surgeons use different techniques. Traditionally, thin plastic sheets with or without soft sponge-like packs are placed against the septum on both sides to keep the mucous membrane together for proper healing. If a large clot of blood forms between the two mucous membrane layers, the remaining cartilage may lose it's blood supply and literally melt away.
Because the entire procedure in done inside the nose (or endoscopically), there is no swelling, bruising or changes to the outside of the nose or face (unless a rhinoplasty is done simultaneously).
What to Expect After Surgery
Most people don't use any pain medications, but one is prescribed just in case. You'll probably be more bothered by the sore throat from having a breathing tube placed during intubation.
What Are The Risks?
Complications are rare, but with any surgical procedure, there is a small chance of infection or bleeding. There is also a small risk any time someone undergoes general anesthesia, which includes, allergic or medication reactions or airway problems. In terms of overall risk, it's riskier when you cross the street. Other very rare complications such as smell loss or a hole in your septum have been reported.
A septoplasty, if done properly, is one of the most gratifying procedures for both the patient and the surgeon. Success rates are very high. However, there are a few percent of patients where nasal congestion still persists, or it comes back after a few weeks to months. In this situation, there are two main possible reasons: there is persistent turbinate swelling due to inflammation, or you have flimsy nostrils. There are treatment options for both theses conditions.
Everything You Ever Wanted to Know About CPAP Masks
February 16, 2010
Are you having problems with your CPAP mask? Are you newly diagnosed with sleep apnea, and want to find out which options you have? If so, hear me interview Chip Smith and Brian Werther of Restoration Medical on "Everything You Ever Wanted to Know About CPAP Masks."
During this information packed hour, you'll learn:
- The key to getting the right fit
- An insider's guide to finding the right mask for you
- How to overcome the most common mistake people make when they're choosing a mask
- Most common problems people have with their CPAP mask and how to avoid them
Title: Everything You Ever Wanted to Know About CPAP Masks
Format: MP3 download
Price: $17
Click here to order.
Featured Videos
Latest Video
Somnoplasty for Snoring
Archives
Somnoplasty for Snoring
Somnoplasty Radiofrequency of the Tongue for Sleep Apnea
A New Snoring Cure? The Snoreplasty Procedure
Provent Nose Plugs for Sleep Apnea
The LAUP Procedure for Snoring and Sleep Apnea
Is the XMRV the True Cause Of Chronic Fatigue Syndrome?
Mandatory Sleep Apnea Screening for Everyone?
A Link Between Sleep Apnea and Diabetes Confirmed Again
Can Sleep Problems Cause Benign Positional Vertigo?
The Deviated Septum Myth
Rss
Email
Upcoming Event
