When it comes to the treatment of sleep apnea, it is important that we start off by understanding the problem first. This clinical-concept video's goals are to help you to understand the levels at which patients may obstruct from sleep apnea. We will also briefly discuss various treatments for each level of obstruction. Ideally, air will enter your nose while you are sleeping and not your mouth; this will set up a streamlined airflow. It should move into your nasal passageway and superiorly, so it can be filtered out of dirt dust and other particulate matter. It becomes warmed, humidified, and conditioned and then moves back the – to the posterior, or the back, part of your nose behind the little uvula. The uvula is often referred to as the punching bag.
This is the uvula dangling down in the back of the throat. Many physicians will try to encourage you to have that cut off, or removed, or reduced in size. While this is occasionally necessary, in our experience, it is rarely necessary. In the first year of our business, we had to perform this procedure zero times, so be very cautious before someone takes you to the O.R. to have this removed from the back of your throat. Once the air moves through your nose into the posterior aspect, it then moves into the deeper part of your throat, and this is behind the tongue. What happens for many people – the majority of people – as it turns out, is that the tongue moves backwards when you're asleep and blocks your airway at that level. This is why, oftentimes, sleeping on your back leads to more snoring and more difficulties with sleeping. We can either prescribe CPAP, or we can use an oral appliance to move to tongue forward. In doing so, this eliminates the second barrier of airflow in your anatomy.
The final level of obstruction is lower in the tongue where there's a little piece of flappy tissue that we call the epiglottis. It is delineated with a line pointing to that white structure. The problem with CPAP is as air is forced down your throat, it will go both into the false passageway (above it and to the right) and the true passageway (above it and to the left), causing the epiglottis to flop back and forth. The advantage of the oral appliance is that it pulls the entire structure forward, thus opening the airway to smooth airflow.
Doug Skarada with the Modern Nose Clinic, and we hope this short video helps to orient you. It's necessary that we treat all levels, and everyone might need a different treatment at each level.
Your nose? May be of allergies. Simple as that. You may have anatomic problems like a deviated septum or large turbinates. You may have physiologic problems that could benefit from a procedure called cryotherapy.
The throat? You could benefit from CPAP, from weight loss, avoiding sleeping on your back, from an oral appliance, or a combination thereof. And lower in your throat, again, if we're using CPAP and it's catching that little flippy-floppy thing, it could be a problem. Otherwise, the oral appliance typically will pull that forward. So one of those treatments will often help at that level. Whenever possible, we try to avoid taking out the tonsils and the back of the throat where that little punching bag is called a uvulopalatopharyngoplasty. We find that that helps perhaps with snoring but not with sleep apnea.
Thank you! Signing off. Dr. Douglas Skarada.
The Modern Nose Clinic will comprehensively treat your airway to give you the best results for your sleep apnea. Thank you.