Treatment For Obstructive Sleep Apnoea In Children
Large tonsils and adenoids can block the throat during sleep and cause snoring. In some cases, this is bad enough to cause obstructive sleep apnoea .
The more severe your childs OSA is, the more likely it is that removing the tonsils and adenoids will help improve their health and quality of life.
Tonsillectomy for sleep apnoea is considered if your child usually breathes noisily during sleep and has at least 2 of these other related problems when they are not sick:
- Struggling to breathe while asleep.
- Pauses in breathing during sleep.
- Gasping or choking during sleep.
- Persistent daytime mouth breathing.
- Daytime tiredness, concentration or behaviour problems not related to other causes.
Two out of three children with mild sleep apnoea get better over 6 months without surgery. If your child is young, you may wish to wait 6 months before deciding whether surgery is an option.
If you are unsure, you may like to read this fact sheet by Safer Care Victoria which can help you make an informed decision about tonsillectomy with the support of your childs doctor.
Safer Care Victoria has also developed several personal story videos and fact sheets on tonsil surgery for families. These include:
What Are The Signs Of Sleep Apnea
There are two kinds of sleep apnea: obstructive sleep apnea and central sleep apnea. Obstructive sleep apnea happens when air cant flow into or out of the nose or mouth, although youre trying to breathe. Central sleep apnea happens when the brain fails to send the right signals to your muscles to make you start breathing.
Sleep apnea may be noticed more by the bed partner than by the sleeper, says Jun. Your bed partner might notice that your breathing pauses, or they may complain of your loud snoring.
That said, snoring itselfthough annoyingisnt the same as sleep apnea. Snoring is just the vibration sound created by airway resistance. You can snore loudly and not have sleep apnea, and you may even have sleep apnea without much snoring.
People with sleep apnea might also suffer from unexplained fatigue and mood swings, because their breathing interruptions continually wake them and prevent them from settling into a deep, nourishing sleep.
The consequences can be significant, Jun says. We’re talking about car accidents in the daytime, lost productivity at work, mood swings, waking up feeling groggy and falling asleep in class.
Other sufferers might wake up with a dry mouth, since sleep apnea tends to make you breathe with an open mouth, drying out your saliva. Some awaken with a headache, which may be caused by low oxygen or high carbon dioxide levels during sleep.
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Positive Airway Pressure Devices
Positive airway pressure machines, used with a variety of breathing masks, are the most widely used treatment for moderate and severe sleep apnea.
The mask, worn snugly over the nose, or sometimes nose and mouth, during sleep, supplies pressurized air that flows continuously or intermittently into the sleepers throat. The increased air pressure prevents the sleepers airway from collapsing.
The pressurized air is supplied through a flexible tube from one of several types of machines: CPAP , BiPAP , VPAP , and so on. Studies of the effect of PAP therapy show that people with sleep apnea who consistently use their machines feel better and, as a result of the reduction of apnea and hypopnea episodes during sleep, encounter fewer complications of the disease. Theres more information about PAP therapy here.
Although PAP devices are not used to treat snoring alone, they do eliminate snoring in addition to treating obstructive sleep apnea.
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Palate Procedures For Sleep Apnea
This category of sleep apnea surgeries includes uvulopalatopharyngoplasty , expansion sphincter pharyngoplasty, lateral pharyngoplasty, uvulopalatal flap, the pillar procedure, palatal advancement pharyngoplasty, z-palatoplasty, and relocation pharyngoplasty.
In general, these procedures involve removing the tonsils and removing or repositioning of the soft palate, uvula, and soft tissues next to the palate and tonsils on the side of the throat. While each surgery for sleep apnea has its own complex process, here is a quick summary of each.
Continued Excessive Daytime Sleepiness
Sometimes individuals with treated sleep apnea still experience excessive daytime sleepiness , a chronic condition, and need help with improving wakefulness. We know this sleep deficit is contributing to worsening co-existing medical conditions and impacts human performance as well as cognitive abilities.
For this reason, physicians may prescribe medications, after diagnosing EDS, to improve daytime functioning for those who suffer from this chronic condition.
Treatment of EDS relies on identifying and treating the underlying disorder which may alleviate the symptoms from EDS. The medications used to treat EDS work in the brain to help keep an individual alert and awake during the day. There is declining usage of older, previously prescribed medications to treat EDS due to several adverse effects risk of dependency, especially when illicitly misused. A new generation of medications, more specifically targeted to treat EDS cases is becoming the standard of care.
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Lifestyle Changes To Treat Sleep Apnea
Multiple lifestyle factors may be able to reduce severity of OSA symptoms.
- Weight Loss: Research shows that for many people, losing weight can lead to an improvement in OSA symptoms. For this reason, medical professionals might recommend diet and exercise or even bariatric surgery to their obese patients with OSA.
- Throat Exercises: Also called oropharyngeal exercises, these repeated movements of the tongue, soft palate, and throat have been demonstrated to reduce OSA symptom severity. In several studies using these exercises, participants see improvements in OSA symptoms after doing the exercises regularly for three months. Experts do not yet know why these exercises are effective.
- Changing Your Sleeping Position: Positional therapy can reduce OSA symptom severity in some people. Back sleeping is associated with more severe symptoms for many people with OSA, so positional therapy generally involves trying to train a person to stop sleeping on their back.
- Avoiding Alcohol and Certain Medications: People with OSA should avoid alcohol and sedatives in the hours before sleeping, if possible. Alcohol is thought to increase OSA symptoms by relaxing muscles associated with the airway, thereby causing blockages.
- Quitting Smoking: Smoking cigarettes increases a persons risk of having OSA, so doctors often recommend that smokers with OSA quit smoking. However, more research is needed before we can be certain that quitting smoking helps reduce OSA symptoms.
And Speaking Of Research
More clinical observation, study, and research is needed to identify potential cures for many sleep disorders.
Of course, as our nonprofit name suggests, our most pressing concern surrounds more than just the identification of underlying and undiagnosed sleep apnea and its successful treatment. We need to prevent sleep apnea, or find a solution that cures it.
Right now, a person who is diagnosed with sleep apnea is expected to treat their condition for the rest of their life. For this reason, sleep apnea belongs to a category of healthcare concerns known as chronic illness.
Chronic illness is a condition which has no cure and which must be treated for the lifetime of the person who has it.
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Strengthening Your Breathing Muscles
Symptoms Of Central Sleep Apnea
Central Sleep Apnea has symptoms that are both long term and short term. Symptoms of central sleep apnea include:2-3
Inability to fall asleepor get restful sleep
Many patients with CSA also have heart disease, especially heart failure.4 Within this population, patients with CSA are at increased risk for hospitalizations and even death.5,6
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Raise The Head Of The Bed
Sleeping with the head of the bed at an angle of about 60 degrees may help reduce the number of apnea episodes. This solution may be effective for people who have sleep apnea that worsens when they lie on their back but who find it difficult to sleep on their side.
People will be able to achieve this position by sleeping in a bed or chair that has an adjustable upper portion. Alternatively, they can use pillows or purchase a body wedge for their torso to keep their head elevated.
Can I Cure Myself Of Obstructive Sleep Apnea
Now that we know which home remedies can help and hurt OSA, the real question becomes…can any of these cure it? Losing weight, reducing high blood pressure, and being mindful of your sleep apnea causes are great ways to improve your OSA, but sleep apnea does not go away. Sleep apnea treatments are the only ways to ensure your health and wellness.
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Check If You Have Sleep Apnoea
Symptoms of sleep apnoea mainly happen while you sleep.
- making gasping, snorting or choking noises
- waking up a lot
During the day, you may also:
- feel very tired
- find it hard to concentrate
- have mood swings
- have a headache when you wake up
It can be hard to tell if you have sleep apnoea. It may help to ask someone to stay with you while you sleep so they can check for the symptoms.
Central Sleep Apnea Causes And Risk Factors
Like obstructive sleep apnea, central sleep apnea is more common in men and people over the age of 65. But unlike obstructive sleep apnea, central sleep apnea is often associated with serious illness, such as heart disease, stroke, neurological disease, or spinal or brainstem injury. Some people with obstructive sleep apnea can also develop central sleep apnea when theyre being treated with positive airway pressure devices.
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Continuous Positive Airway Pressure Device
In addition to lifestyle changes, the most effective treatment available is a mask worn at night that transmits increased air pressure into the airway to prevent the throat from collapsing. This is called nasal continuous positive airway pressure .
CPAP is the most common treatment for sleep apnoea. It is non-invasive and uses a small pump that blows air through tubing into a mask that is worn on the nose and/or mouth. This air pressure goes into the back of the throat holding it open, even if the throat muscles have relaxed too much during sleep.
The key to CPAP treatment is finding a mask and machine that match your needs.
How Do Doctors Diagnose Sleep Apnea
If you believe that you have sleep apnea please talk to your doctor or healthcare provider. They can help you get a diagnosis and treatment for sleep apnea.
Your doctor can listen to your symptoms to help determine if you have sleep apnea. Your doctor can also do a physical exam and check your health history for more information about your risk factors. There are also some tests that can be done to help diagnose sleep apnea. These tests can include:
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What Happens When You Stop Breathing
When you stop breathing, your heart rate also tends to drop the longer your body is deprived of oxygen. Then, your involuntary reflexes cause you to startle awake at the end of that period of not breathing. When this occurs, your heart rate tends to accelerate quickly and your blood pressure rises.
These are changes that take place acutely when you stop breathing. However, your body starts to experience chronic effects if you experience frequent apnea. Data suggests increased risk, particularly when you stop breathing roughly 30 times or more per hour. But there is likely a risk at even lower frequency rates.
For example, your blood pressure tends to go up, your heart walls thicken due to increased workload and the structure of your heart changes. It tends to become stiffer and less flexible because there are more fibrous cells growing in between the muscle cells.
All of those things increase the risk that you can have either atrial or ventricular arrhythmias. They also tend to reduce the function of the heart so that its less efficient at pumping blood.
Consultative Services For People At Risk Of Developing Sleep Apnea
People who have certain conditions have a greater risk of developing sleep apnea. These conditions include:
People who live with someone who has these conditions should be on alert for signs of sleep apnea. The physicians at the Pain Center at Cedars-Sinai are always available to work with other physicians and specialists in addressing sleep apnea issues in patients with risk factors for sleep apnea
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The Dangers Of Uncontrolled Sleep Apnea
Youve probably heard that regular exercise and a heart-healthy diet arethe most important things you can do for your cardiovascular health. As itturns out, though, the quality of sleep you receive is also critical toyour hearts wellbeing.
In particular, undiagnosed sleep apnea is directly tied to an increased risk in cardiovascular and metabolic health. The scariest part? You might not even know you have this very common problem.
Sleep apnea happens when upper airway muscles relax during sleep and pinch off the airway, which prevents you from getting enough air. Your breathing may pause for 10 seconds or more at a time, until your reflexes kick in and you start breathing again, explains Jonathan Jun, M.D. , a pulmonary and sleep medicine specialist at the Johns Hopkins Sleep Disorders Center.
Sleep apnea occurs in about 3 percent of normal weight individuals but affects over 20 percent of obese people, Jun says. In general, sleep apnea affects men more than women. However, sleep apnea rates increase sharply in women after menopause. Sleep apnea is often linked to heart disease and metabolic issues like diabetes.
Avoid Alcohol And Smoking
Alcohol relaxes the throat muscles that control your breathing. This can lead to snoring and an interrupted sleep cycle. It can also lead to inflammation in your airways, blocking your airflow.
Similar to alcohol, tobacco use can also contribute to inflammation and swelling in your airways. This can worsen your snoring and your sleep apnea.
A identified smoking as a risk factor for developing sleep apnea. The study noted that people with sleep apnea may have a predisposition to smoking as well, so treating sleep apnea may help in quitting smoking.
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What Are The Symptoms Of Sleep Apnea
There are several common symptoms but the most common symptom of sleep apnea is snoring. Snoring can be a sign that your upper airway is blocked, especially if you cant breathe when you snore. Other sleep apnea symptoms can include:
- Fatigue during the day even after a good nights sleep. This is called extreme daytime sleepiness or EDS and is due to poor sleep quality.
- Difficulty staying asleep or waking up frequently during the night
- Headaches in the morning
There are several risk factors that can increase your chances of having sleep apnea. These include:
Alternative Sleep Apnea Treatment Options
If your patients don’t want to wear a CPAP mask, then you can try recommending alternative sleep apnea treatment options. We’ve written about how sleep apnea is a serious sleep disorder that requires professional medical attention when diagnosed.
CPAP therapy is one of the most common treatment methods technologists and sleep physicians recommend to those who have sleep apnea. But what if a patient prefers to avoid CPAP therapy altogether?
The good news is that there are several alternative sleep apnea treatment options available to those who want to avoid wearing a mask as much as possible. Below, we’ve listed 5 alternatives.
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Treating Sleep Apnea At Home
You may be able to treat mild sleep apnea with some lifestyle changes. Your doctor may recommend that you:
- Lose weight. About half of people with sleep apnea are overweight. If you have some extra weight, you might also have extra tissue in your throat that makes it harder to breathe. Losing weight — even a few pounds — can often improve your symptoms.
- Donât use alcohol and sleeping pills. They decrease the muscle tone in the back of your throat, which can interfere with air flow.
- Change sleep positions. You may breathe more easily if you stay off your back. Hereâs a trick to keep from rolling over: Put two tennis balls into a tube sock and pin it to the back of your pajamas.
- Stop smoking. Smoking can increase swelling in your upper airway, which may make both snoring and apnea worse.
- Treat allergies. Nasal allergies swell the tissues in your airways and make them narrower, so itâs harder to breathe. Ask your doctor how to get them under control.