The Specialist:
As the director of the sleep surgery program at
Mount Sinai, Dr. Fred Lin treats patients who have complicated cases of
sleep apnea that require surgery. Lin works with more than 500 patients
a year with sleep apnea.
Who’s at risk:
About 50% of Americans snore while they’re sleeping. And for millions of people, that snoring is a symptom of sleep apnea.
“Sleep apnea is a form of sleep-disordered breathing in which the
airway becomes narrowed as the tissues and muscles surrounding it
relax,” says Dr. Fred Lin, director of the sleep surgery program at
Mount Sinai. “The brain corrects for this suffocation by jerking the
patient between deep sleep and light sleep, and even momentary
awakening, though the individual doesn’t necessarily remember it.” Some
18-20 million Americans are living with sleep apnea, though doctors
estimate that 80-90% of them remain undiagnosed.
Untreated sleep apnea majorly impacts quality of life — and also carries major health risks. “Because sleep apnea
causes significant stress to the heart, it increases your risk of high
blood pressure, stroke, heart failure and irregular heartbeats,” Lin
says. “Besides the fact that patients are sleep deprived and often feel
terrible, it’s crucial to treat this disease to protect your heart
health. Thankfully, we have a range of highly effective treatments.”
What is the underlying cause of sleep apnea?
“There are a lot of different theories, but the general principle is
that the airway gets narrowed due to tissue/muscle obstruction. Your
body usually has a sense when the airway is being narrowed, but after a
while the nerve endings can get less sensitive,” Lin says. “Especially
as people get older, many people gain weight and lose muscle tone. Women
are at higher risk post-menopause due to hormonal changes.”
Doctors have identified a set of risk factors associated with sleep apnea.
“Major risk factors include being male, being obese, having a history
of hypertension and diabetes, and having a family history of sleep apnea,” Lin says. “People who snore are also more likely to have sleep apnea.”
Signs and symptoms:
One of the major red flags to be on the alert for is snoring.
“Snoring is considered a partial obstruction or blockage of the airway,
and many times it is only the bed partner who realizes that the
individual snores,” Lin says. “Other warning signs are daytime
tiredness, not feeling like you’ve gotten enough sleep when you get up,
headaches, irritation, mood changes and things related to sleep
deprivation, like falling asleep at the wheel or falling asleep in
meetings.” If you experience any of these symptoms, ask your doctor if
you might be a candidate for a sleep study to measure the quality of
your sleep.
Traditional treatment:
The good news is that sleep apnea is a highly treatable disease. “We have both medical and surgical options that can bring sleep apnea
under control,” Lin says. “The gold standard of therapy is the CPAP
(Continuous Positive Airway Pressure), a device that uses air pressure
to stent the airway open. But we also have options for patients who
don’t respond well to CPAP.”
Patients wear the CPAP device at night while sleeping. “The patient
wears a mask that covers the mouth and nose, while a tube delivers
pressurized air,” says Lin. “There are several different variations
available and the patient needs to wear it at least five nights a week,
five hours a night for it to be effective.”
For patients who don’t respond well to CPAP, there are options that
range from surgery to wearing an appliance similar to an oral
mouthguard. “The surgical options generally entail doing a sleep
endoscopy that allows us to use a camera to visualize the back of the
mouth and base of the tongue where the obstruction is happening,” Lin
says. “Then the surgery can remove or reshape tissue to prevent
obstruction.” There are also robotic surgery options.
Sleep apnea
drags down your overall health and your quality of life, but you do not
have live with it. “This is something that is treatable in a lot of
ways, so if one doesn’t work, we can try something else,” Lin says. “We
can help you feel better and decrease the cardiovascular problems
associated with sleep apnea.”
Research breakthroughs:
The treatment options available to sleep apnea
patients continue to grow. “One of the newer options works as a
stimulator for the tongue, which is the cause of the airway blockage for
a subset of patients,” Lin says. “Surgically, there are always things
coming down the pipeline. We’re still looking for a magic bullet.”
Questions for your doctor:
There’s no harm in asking, “Am I at risk of sleep apnea?” If your partner complains about your snoring, then ask, “Am I a candidate for a sleep study?” If you are diagnosed with sleep apnea, the question becomes, “How severe is my sleep apnea?” and “What treatment options do I have?”
“Sleep apnea and snoring can affect your day-to-day quality of life and your bed partner’s quality of life,” Lin says. “Having sleep apnea treated is crucial, both medically and in terms of your quality of life.”
What you can do:
Get informed. For reliable information on the web, start your search with the American Academy of Sleep Medicine (aasmnet.org/) and Mount Sinai ENT (mountsinai.org/patient-care/service-areas/ent).
Sleep in the right position. “If you’re snoring or having sleep issues,
sleeping on your side is usually better than your back,” advises Lin.
Don’t ignore symptoms. And that includes feedback from your partner.
“You can’t hear yourself snoring or when you stop breathing, but your
partner can,” Lin says. If you sleep alone, be alert for symptoms and
don’t hesitate to ask your doctor if you are a candidate for a sleep
study.
Take preventive steps. Maintaining a healthy weight and avoiding alcohol and other sedatives at night cuts your risk of sleep apnea.
By the numbers:
— Sleep apnea affects 18-20 million Americans.
— 24% of all men and 9-10% of women have sleep apnea.
— 80-90% of sleep apnea cases remain undiagnosed.
Source: Dr. Fred Lin
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