(from the Greek a (lack of) + pnea (air))

A medical condition in which the tongue, soft palate, and other soft tissues of the mouth and upper throat relax to the point where one's airway is blocked enough to interfere with respiration. It is often characterized by loud snoring, though snoring does not necessarily indicate the condition.

A sleep apnea sufferer will partially awaken in order to resume normal breathing. This can happen dozens or even hundreds of times over the course of a night. The constant partial awakenings, though the patient is not consciously aware of them, make it virtually impossible to reach REM sleep, and thus to get a proper night's sleep.

The patient's bed partner tends to fare little better, for he or she may be awakened by the loud snoring, and frequently must nudge the patient in order to get him or her to start breathing again.

In severe cases, breathing can actually stop completely for several seconds. This can result in a heart attack or stroke. Cass Elliot died due to a heart attack brought on by severe obstructive sleep apnea, and not by choking on a ham sandwich as the myth has it.

Sleep apnea can only be diagnosed properly by spending a night under observation at a sleep clinic. Heart rate, breathing rate, blood oxygen levels, and brain wave patterns (among other things) are monitored as the patient sleeps. This determines how often respiration is interrupted, and whether the apnea is severe enough to interfere with proper sleep. This test is expensive, but it is often covered by insurance.

There are several methods of treatment available. Since the condition is caused by the mass of soft tissue in the mouth and by poor muscle tone in that region, weight loss can make a difference. Surgery is another option, to remove the excess tissue which causes the obstruction, though this is effective only a little more than 50% of the time. The patient can also sleep with a machine known as a CPAP (continuous positive airway pressure), a respirator-like device which supplies pressurized air for the patient to breathe. The high-pressure air forces the patient's airway open. These machines are expensive (US$1500 or more) and count as durable medical equipment, which insurance may not cover completely.

If you suspect that you suffer from sleep apnea, consult your otolaryngologist or ear-nose-throat specialist. He or she can perform some simple tests which will indicate whether a full sleep study is necessary.

Aero does a great job in his writeup pointing out the ins and outs of Obstructive Sleep Apnea (OSA), as well as the common treatments (CPAP or BiPAP pressure masks), but for people who have trouble tolerating breathing apparatuses, oral appliances, and other anti-apneac devices, corrective surgical options (while not always 100% affective) provide an additional option.

One such surgical treatment for OSA is uvulopalatopharyngoplasty (aka U3P or UPPP). This is a particularly nasty-sounding procedure that often requires general anesthesia, so while the patient is under, surgeons often perform any other useful procedures (such as a septoplasty, tonsillectomy, or adenoidectomy) contemporaneously. (Hell, you're out cold and on the table, so you'd might as well get a two-for-one deal, right?)

As Aero points out, while each case of OSA is different, most apneaic events occur due to soft tissue in the back of the patient's throat falling back into a position that blocks the airway enough to impair breathing. This soft tissue can consist of tonsil or adenoid material, and often, an ill-formed uvula or palate can be just as disruptive.

Uvulopalatopharyngoplasty, as it's name suggests, is surgery targeted towards the uvula, soft palate, and pharynx. The basic thought behind U3P is that if the soft tissue in the back of one's neck is trimmed sufficiently, it won't cover the patient's windpipe while he or she is sleeping, thus curing the apnea.

The decision to perform a U3P usually comes at the discretion of an Ear, Nose, and Throat doctor, who will examine you for excessive soft palate tissue, enlarged tonsils, and an elongated uvula. If the decision to move forward is made, simple procedures (usually only those that involve a slight trimming of the uvula) can often be done on an outpatient basis using a laser. More complex procedures, such as those involving the removal of tonsil and/or pharynx tissue are usually done the old fashioned way, inpatient (with a scalpel), under general anesthesia, and with the supervision of a hospital ICU staff.

Healing time after a U3P seems to vary depending on age. I had the procedure done when I was 22 and I was out of bed in a day and eating solid foods the very next morning. (Took my fair share of pain meds, though.) I have friends, however, who waited longer to have the procedure done; and like most surgeries, if you're in your 40s or 50s when you go under the knife, you can expect a much lengthier stay in the hospital, coupled with a much longer recovery period.

So, here's the hundred thousand dollar question: does it work? In many cases, yes, it works splendidly. While not always 100% curative, a U3P surgery can often result in a patient being able to lower his or her CPAP/BiPAP pressure to a lower, more tolerable setting. In other cases, it may make the remaining apnea so benign that wearing a pressure mask is no longer necessary. Especially when coupled with a good cardiovascular exercise regimen (which is known to strengthen muscles in the chest and reduce apneaic episodes), a U3P can be a godsend--especially if you're young like me and you'd really prefer not to have to lug around a CPAP machine every time you have to travel. (Not to mention when you have women-friend stay the night--talk about embarrassing!)

The major downside I've experienced after having U3P surgery is pretty predictable: with a trimmed uvula, I sometimes have trouble making sure food/water "goes down the right pipe." Mind you, this isn't a common occurrence, but even years after the surgery, I still sometimes forget that I have to drink rather methodically to avoid choking on too much fluid. To some people, this might be an annoyance they're unwilling to suffer. I totally understand that outlook, especially since positive results from the surgery are in no way guaranteed. But for me, I'm pleased with the results of my U3P and I'd recommend it to anyone who can't stand being hooked up to a machine every night for the rest of their lives.

It's important to underscore, however, that while some people are excellent candidates for U3P surgery, others are not. See a qualified ENT before having cousin Bubba start hacking at your uvula with his Leatherman. And when you do find a surgeon, make sure he's done the procedure dozens (if not hundreds) of times. Remember: this is your throat we're talking about here... Find a qualified surgeon, always get a second opinion, weigh your options, and then and only then should you consider a surgical solution. (This is probably a good rule for all surgeries, but especially this one, because sleep is really damn important--and if you're already having trouble sleeping, the last thing you need is some goofball screwing it up even worse.)

Oh, and obviously, you should never consult an ENT about any kind of sleep-related surgery without first going to a sleep specialist and taking part in a full polysomnogram. Excessive daytime sleepiness can be caused by tons of different things and only a well-documented sleep study can give you the answers you need. That all goes without saying, but disclaimers are en vogue these days, so I figured I'd throw it in for the hell of it. Don't be stupid, okay--it's your body, for goodness sake!

Now get some sleep, already!

I should point out that there are several excellent web support centers out there for people with sleep disorders like OSA. If you're suffering from a sleep problem, you are not alone--not by a long shot. Just type "sleep disorder" or "sleep apnea" into Google and you'll find hundreds of excellent entries. The important thing is not to lose hope; we're learning more and more about these disorders every day, and new treatments are always just around the corner. Keep looking, and eventually you'll get the peaceful night of sleep you deserve.

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