Sleep apnea: many treatment options

Breath stops and a short fuse

Nico de Vries has been working as an ENT doctor at the OLVG in Amsterdam since 1994. His specialty is sleep apnea. He explains that this is a condition that can occur in varying degrees: “Sleep apnea can affect anyone from time to time. It only becomes a problem if it happens more than five times an hour. Some people have 10 short breaths per hour, others have several. well over thirty.” The breathing stops occur when the windpipe is closed during sleep. This happens, for example, because the muscle tissue in the oral cavity is too weak, if there is a lot of body fat around the neck area or, for example, due to large tonsils. The oxygen level in the blood decreases during the breathing stop, and eventually the body responds by breathing again. You may be startled awake after an apnea, but you may also be only half awake and not aware of it. A bed partner will then notice, because they hear that the breath regularly stops during sleep.

sleep study

A comprehensive sleep study is needed to make the diagnosis. This can be done at home or in the hospital. Sleep is monitored by means of electrodes on the body and the number of breathing stops and the quality of sleep can be measured. De Vries: “That also explains that this is a relatively ‘new’ disease. Previously, we could not measure the sleep pattern properly, and sleep apnea was not noticed.”

The diagnosis is now being made more and more often. De Vries: “We are talking about a disease that occurs as often as diabetes mellitus, that is in more than 1 million people in the Netherlands. But many people are not aware that they have sleep apnea.” Good to know: Sleep apnea is more common in men than women, but women are more likely to seek help than men.

What are the consequences?

You can imagine that sleep apnea causes a lot of stress for the body, and that sleep is constantly disturbed by the breathing stops. De Vries: “People with sleep apnea are therefore often very tired, are sleepy during the day, have concentration problems and a ‘short fuse’. Sleep apnea also often leads to weight gain. Sleep deprivation causes a disruption in the satiety hormones, so that people are more hungry during the day. Unfortunately, being overweight is also one of the factors that causes sleep apnea. A vicious circle arises: people are then advised to lose weight, while the sleep apnea maintains their excess weight. That is of course very frustrating.”

These immediate complaints are a huge burden, but sleep apnea is also a health hazard in the long term. De Vries: “It increases the risk of cardiovascular diseases, such as a stroke or heart attack, and possibly even cancer. I therefore definitely think that sleep apnea should be treated. But there is also a trend among doctors who believe that not everyone with sleep apnea must be treated. Because there are too many patients, or because the costs of healthcare would then become too high. That is an interesting discussion, because you can of course also prevent health problems by taking timely action.”

Treatment: the sleeping mask

In the Netherlands there are many treatment options for sleep apnea, says De Vries: “Our country is unique in this regard, especially because many treatments are reimbursed by health insurers. In other countries this is often not the case.” What are the possibilities? De Vries: “By far the most prescribed is the sleeping mask, the so-called CPAP. This is a mask that gives excess pressure in the airways during sleep, so that the trachea remains open. In principle, this mask should be used for life. It reduces the symptoms, but there is no cure for sleep apnea. Many people find the mask uncomfortable or unpleasant to use when they have a bed partner. It is also taxing to have to use this mask for a long time, the rest of your life.”

didgeridoo

Nico de Vries emphasizes that the CPAP is only one of the many treatment options, and that a lot of scientific research is still being done into alternatives. For example, research has been done into the use of the didgeridoo, a wind instrument from Australia. People who played on the didgeridoo strengthened the muscles around the larynx and therefore had fewer complaints. “Of course you can ask yourself whether the didgeridoo is not worse than a sleeping mask,” says De Vries jokingly, “but this kind of research does provide directions for new methods.”

From braces to surgery

There are already many options. To start with, there is a special custom-made braces, which provide relief from the complaints for many people. There is a ‘sleep position trainer’ for people who only have complaints when they sleep on their back. And there are various surgical options: from the removal of the tonsils to very extensive (and painful) operations in the mouth area. The OLVG also has experience with inserting a pacemaker for the tongue. This stimulates the tongue nerve slightly during sleep, so that the muscles do not relax too much. As a result, the tongue does not fall backwards and the windpipe is not closed off. Each treatment has its pros and cons, and must be tailored to each patient. And of course every treatment also has a cost. De Vries: “Such a pacemaker costs 35,000 euros, for example. That is a lot of money, but a pacemaker is prescribed for people with heart rhythm disorders as a matter of course. While sleep apnea can also cause many complaints and risks.”

What can you do yourself?

Many people do not know that they suffer from sleep apnea. De Vries: “If you snore, and if your bed partner notices that you regularly stop breathing, that can be a good reason to go to the doctor. Especially if you are also overweight, if you are unable to lose weight and if you are very tired and sleepy.” A healthy lifestyle can help to prevent or reduce the symptoms of sleep apnea: get enough exercise, prevent obesity, do not drink alcohol and do not sleep on your back.

You can listen to the podcast about sleep apnea below.