Does your bed partner complain that you snore loudly or gasp for air in the middle of the night? Have you been nudged awake or kicked to the couch because your loved one can’t sleep? These are telltale symptoms of obstructive sleep apnea, and if you suspect you may have the condition, the person lying beside you may be your best ally.

Courtney Chou, MD, a sleep surgeon and an Assistant Professor of Otolaryngology at the Icahn School of Medicine at Mount Sinai, urges people to take this feedback seriously.

“Bed partners are an important referral source,” says Dr. Chou. “People with sleep apnea are often unaware of nighttime symptoms like snoring or interruptions in their breathing. And many either do not experience daytime symptoms, like drowsiness and difficulty concentrating, or think something else is to blame.”

What is obstructive sleep apnea?

Affecting as many as 22 million people in the United States, obstructive sleep apnea (OSA) is a serious sleep disorder that causes your breathing to repeatedly start and stop throughout the night. The condition occurs when the muscles of the upper airway relax and block the flow of air, which prevents your body from getting the oxygen it needs and causes you to wake up repeatedly during the night.

These nighttime disruptions can negatively affect the sleep of the OSA sufferer and can put a significant strain on relationships. In fact, frustrated companions are often the reason patients eventually visit a doctor.

“Bed partners end up suffering tremendously,” she adds. “They may struggle to fall asleep or stay asleep. Some couples end up sleeping in separate rooms.”

How do I know if my snoring is obstructive sleep apnea?

Consistent snoring, pauses in breathing, or gasping for air in the middle of the night are common symptoms of the condition and should be evaluated by a physician. If left untreated, sleep apnea can lead to serious complications. For instance, individuals with OSA are more likely to have high blood pressure, stroke, heart disease, and diabetes.

That being said, it is hard to make a diagnosis from symptoms alone. To know for sure, Dr. Chou explains, you need a sleep study. In the past, patients had to stay overnight at a sleep center for testing. But today, for most patients, a sleep study is performed at home using minimally invasive equipment, sometimes requiring only a special finger and wristband gadget that is connected to a smartphone. Home sleep tests record the number of times your breathing is interrupted throughout the night, revealing if you have OSA and, if so, how severe it is.

“I believe a lot of my patients would have come in sooner if they knew about home sleep studies,” explains Dr. Chou. “I have done it myself, and it was easy and comfortable. I don’t think anyone should be nervous about having a sleep study.”

How is obstructive sleep apnea treated?

If you are diagnosed with sleep apnea, there are three types of treatments that can help. Dr. Chou likes to start with the least invasive treatment.

• CPAP (continuous positive airway pressure) therapy has long been the gold standard treatment for OSA. This is a machine that uses air pressure to keep the airway open throughout the night. Patients wear a mask while sleeping—placed over the nose or both the nose and mouth—that connects to this device. Although several options and models are available, research shows that only half of patients can tolerate sleeping with the mask.
• Oral appliances are an alternative to CPAP machines or are sometimes used in conjunction with a CPAP device. Oral appliances are worn in the mouth to reposition your lower jaw while you sleep. These appliances are made by a dentist and molded specifically to fit your teeth.
• Surgery is recommended when noninvasive therapies fail to provide relief or patients struggle to successfully use CPAP, oral appliances, or both. There are numerous options that open, reshape, enhance, or stimulate the upper airway and eliminate symptoms like snoring and breathing interruptions.

What are the surgical options to treat sleep apnea?

The type of surgery required depends on the severity of your symptoms, the severity of the condition, and your unique anatomy. Dr. Chou works closely with patients to decide what procedure is right for them.

• Soft tissue procedures—Dr. Chou likes to compare the upper airway to a house. With soft tissue surgeries, the goal is to make more room by throwing out furniture or making it smaller. This may involve nasal, palate, or tonsil surgery, which creates more room in the passageways for air to flow.
• Skeletal surgeries—With skeletal surgeries, the goal is to make the house bigger by building it out as you would by adding a new room. These more extensive operations include widening or forward movement of the jaws and chin advancement. The goal of these surgeries is to improve the position, balance, and movement of the upper airway.
• Neurostimulation/Hypoglossal Nerve Stimulator—Inspire ™ therapy is a newer therapy that has been approved by the United States Food and Drug Administration. It stimulates the base of the tongue to expand the airway. Like a pacemaker, the device is surgically implanted into your chest and connected by a wire to the upper airway. You can control the device using a remote device. Mount Sinai’s Division of Sleep Surgery was one of the early adopters of Inspire therapy.

Loud snoring. Gasping for air. Feeling tired after getting plenty of sleep. Nearly one in every 15 adults in the U.S. suffer from obstructive sleep apnea, a common sleep disorder that causes the airway to collapse and breathing to be repeatedly interrupted throughout the night.

The first line of defense for individuals with this condition is a treatment known as continuous positive airway pressure (CPAP), a machine that helps push air into the lungs and keep the airway open. Unfortunately, as many as half of those who use the machine do not have success, and look to surgery as an alternative to CPAP to treat their sleep apnea.  But what surgery is the right one for the patient?  Drug-induced sleep endoscopy helps to answer this question.

Known as DISE, this advanced diagnostic tool allows sleep surgeons to assess the anatomy of the upper airway in 3D under sleep-like conditions. Studies have shown that the evaluation technique, which has become increasingly popular over the last 10 years, improves surgical outcomes in patients that do not respond to CPAP.

How does DISE help patients with sleep apnea?

Courtney Chou, MD

“Every individual’s anatomy is different,” explains Courtney Chou, MD, a sleep surgeon in the Department of Otolaryngology – Head and Neck Surgery at the Icahn School of Medicine at Mount Sinai, who specializes in treating patients with obstructive sleep apnea. It is her job is to figure out what is blocking the patient’s flow of air. In some patients, for example, the base of the tongue or the soft tissue palate collapses, which then causes the airway to close.

“DISE allows us to locate the sites of obstruction in individuals with sleep apnea and figure out a plan to alleviate these blockages,” says Dr. Chou. “There are several different types of sleep surgeries, and DISE really helps determine which one will benefit the patient the most.”

According to a recent study in Sleep and Breathing, the results of DISE changed the surgeon’s original treatment plan as much as 75 percent of the time. In the past, surgeons relied only on medical history, patient evaluation, and the results of a standard sleep study to decide on the best intervention.

“In general, sleep surgeries are quite successful for patients with obstructive sleep apnea. We really try to meet each individual’s needs. When we are deciding on a surgery, it is important to think about what the patient’s main complaint is—are they snoring so much that it affects their bed partner, or is their oxygen saturation dangerously low?” she explains. “It is also important to consider how severe their sleep apnea is on their sleep study.  But the key to identifying the intervention that is going to be maximally effective is understanding the patient’s anatomy. DISE is an important piece of the puzzle that helps us do that.”

In rare cases, DISE can also be used to troubleshoot nonsurgical therapies. If a patient is having some benefit with CPAP or an oral appliance, DISE may be used to evaluate if there is a tweak that could make the current treatment more effective or improve their ability to tolerate it.

What should patients expect during the procedure?

DISE is a minimally invasive, same-day procedure that is well tolerated by most patients. However, people who are pregnant, allergic to sedatives, or have severe cardiopulmonary disease that would prevent them from having surgery would not be candidates for DISE.

On the day of the surgery, after the patient checks in, they will meet with an anesthesiologist for a short evaluation. Afterward, a sedative will be administered intravenously. Once the patient is asleep, a sleep surgeon will place a thin flexible scope into one nostril that passes through to the upper airway. This scope has a small camera on the end that sends 3D real-time videos back to a monitor, allowing the surgeon to visualize exactly where and how the airway is collapsing while the patient is sleeping. The patient is then taken to a recovery room as the sedative wears off.

The procedure takes 30 minutes to an hour, is not uncomfortable, and patients do not deal with side effects besides post-surgery drowsiness, which means they will need a ride home after the procedure.

“Sleep is so critically important to our health,” says Dr. Chou. “With tools like DISE, Mount Sinai can help those who are struggling find the right plan and not suffer in silence.”