During college, one of the most influential coursers that I took was called “Paradigms of Health and Disease.” It was taught by my advisor in the biophysics department. This course looked at how we define what is is to be healthy or sick, and compare and contrast our definitions with other cultures and societies. One important concept that stuck with me from this course is that no disease can ever be truly “cured.” We as physicians can help to alleviate the severity of disease, but we can never completely eradicate conditions like cancer, Alzheimer’s disease, or asthma. The same concept also applies to obstructive sleep apnea.
Obstructive sleep apnea is a distinct clinical condition that can only be made based on a formal sleep study. However, I’ve argued that all modern humans are susceptible to partial or totally obstructed breathing, leading to various degrees of deep-disordered breathing. Only the more severe extreme is called obstructive sleep apnea. All of us are on a continuum, with various degrees of obstructed breathing that generally worsens with age and various other factors such as menopause, weight gain, and sleep position. This is due to our ability to talk, which unprotected our upper airways. Modern diets and infant feeding patterns may have accelerated this problem by causing more dental crowding and smaller oral cavity dimensions.
Unfortunately, as we all age, not only does our skin sag on the outside, but also sags and relaxes on the inside of your upper airway. It’s only natural that as your ability to breathe or sleep gradually goes downwards, the more rapidly your body will get sick or not function properly. The major treatment options we have for sleep apnea only help to alleviate this blockage using air pressure, dental gadgets or surgery, but they never really “cure” the problem. At one extreme, a tracheotomy (making a surgical hole in your windpipe below your voice box) can be described as a “cure”, but not too many people will be happy with this option.
One way of looking CPAP and dental appliances is to think of it as a cane, or a wheelchair. As you get older, many people will require one of these devices to help get around. Similarly, these nonsurgical options for OSA will help you breathe and sleep better, but it’s never an ideal situation. Throat surgery is similar to undergoing a facelift. Sooner or later, your face will continue to sag, and you may require another facelift. The same issues can rise with throat surgery, no matter how good the initial results. This “relapse” happens slowly and may take years or decades to occur. You may then ask, what’s the point of doing surgery if it’s going to come back?
Even with CPAP or dental appliances, you’ll have to make constant adjustments and modifications every few months to years. The same goes with surgery. Ultimately, it’s a choice between using a device on your face or in your mouth for the rest of your life, or undergo surgery every few decades. Some people will need a combination of CPAP, dental appliance and surgery to achieve optimum results.
Regardless of which option you choose, what’s most important is that you think of OSA as a lifelong condition, like diabetes or even cancer. You’ll have to be vigilant and constantly monitor your condition, or be on the lookout to make sure it’s not slowly coming back. Not only do you have to make significant lifestyle changes but also a mindset shift. It’s not like a broken leg that’s treated and never have to worry about it after it’s been fixed. Unfortunately, there’s no quick “fix” for OSA.
For those of you with obstructive sleep apnea, what kind of lifestyle changes have you made? Has this condition altered the way you look at health or wellness?