Sleep Apnea & Disorders

At Montefiore Einstein Otorhinolaryngology – Head and Neck Surgery, you can access exceptional care for sleep apnea. As a global leader in otorhinolaryngology and head and neck surgery, we are an academic-based, national and international referral site for the most complex and high-risk cases. For over a century, we have been at the forefront of innovation, research and clinical care for ear, nose and throat (ENT) and head and neck conditions.

Ranked in the top 1% of all hospitals in the nation for complex specialty care according to U.S. News & World Report, Montefiore Einstein continues to make advances in the diagnosis and treatment of ENT and head and neck conditions. We are a recognized leader in the treatment of sleep apnea and were among the first to participate in the pivotal clinical trial leading to approval by the Federal Food and Drug Administration (FDA) of hypoglossal nerve implantation. Our multidisciplinary team of world-renowned specialists has pioneered many of the otorhinolaryngological techniques used today and is passionate about uncovering the latest diagnostic approaches and treatments that can improve outcomes. We also performed the first pediatric hypoglossal nerve implant in the tri-state area to treat sleep apnea for a patient with Down syndrome.

At Montefiore Einstein Otorhinolaryngology – Head and Neck Surgery, you can expect compassionate, personalized, research-driven treatment plans that meet the highest standards for quality and safety.

When you need sleep apnea care, turn to our dedicated multidisciplinary team for a personalized treatment plan.

Sleep apnea occurs when your breathing is blocked or partly blocked while you sleep. It can be mild, moderate or severe, depending on the number of times per hour that you have less airflow to your lungs. The most common form of sleep apnea is obstructive sleep apnea (OSA), which happens when the airways in your nose, mouth or throat become blocked or narrow. Another type of sleep apnea is central sleep apnea (CSA), a condition caused by irregularities in the brain’s signals to breathe while sleeping. Sleep apnea negatively impacts your quality of sleep, often causing drowsiness during the day. If left untreated, chronic sleep apnea may increase risk for serious medical problems, including stroke, arrhythmia, diabetes and dementia. It can also lead to damage of blood vessels and other organs in your body.

Typical causes of sleep apnea include anatomical obstruction that prevents the proper flow of air through your airway, your throat muscles being unable to relax sufficiently to allow proper breathing during sleep or an irregularity in the way your brain controls the muscles involved in the process of breathing. For example:

• With obstructive sleep apnea (OSA), the airways in your nose, mouth or throat are blocked or become narrow. Everyone’s throat muscles and tongue relax during sleep. But in some people, this normal process can partly or completely block the airway.
   
• With central sleep apnea (CSA), your brain does not transmit signals in the proper way to your breathing muscles. In some cases, certain medical conditions, including Parkinson’s disease, amyotrophic lateral sclerosis (ALS) and other neurovascular diseases such as stroke, may cause these irregularities. Opioid drug use or high-altitude breathing may also contribute to CSA.

Symptoms of sleep apnea can include:

• Being so sleepy during the day that it gets in the way of normal things you do, such as work or school
• Waking up frequently throughout the night
• Feeling tired in the morning
• Having trouble concentrating
• Mood changes, including irritability, anxiety or depression
• Waking with a headache

If you have a bed partner, they may notice that you sleep with your mouth open or that you are restless while sleeping. You or your bed partner may notice while you sleep:

• You gasp or choke    
• You often snore loudly
• You stop breathing
• You toss and turn

Your physician may recommend a sleep study to discover the underlying cause(s) of your snoring and determine if you have sleep apnea. Sleep studies are tests that record what happens to your body during sleep and are conducted to find out what is causing your sleep problems. Sleep studies are done at home using portable equipment or in a sleep lab. Physicians use sleep studies to diagnose both obstructive sleep apnea and central sleep apnea.

You may be able to treat sleep apnea by making changes in your lifestyle and in the way you prepare for sleep, including:

• Limiting alcohol and medicines such as sedatives before you go to bed
• Losing weight if you’re overweight
• Quitting smoking
• Sleeping on your side and not your back
• Using a device in your mouth during sleep that helps you breathe. It pushes your tongue and jaw forward to improve airflow.
• Using nasal corticosteroid sprays if a stuffy nose makes your snoring worse
• Using nasal strips or nasal disks to help you breathe while you sleep

If lifestyle changes are ineffective, your physician may recommend the following:

• Continuous positive airway pressure (CPAP). This uses a machine to keep your airway open while you sleep.
• An oral appliance which helps keep the tissue from obstructing the airway
• A mask-free breathing solution that uses an implant for patients who have difficulties with CPAP. This hypoglossal nerve stimulator (INSPIRE) can electrically stimulate the tongue muscles to prevent airway obstruction during sleep.
• Surgery to open your airway

Uvulopalatopharyngoplasty (UPPP) is a type of surgery to remove tissue from the back of your throat. Your surgeon may remove extra tissue from the uvula, tonsils or part of the soft palate. After this tissue is removed, air may move through your throat better when you breathe. This surgery may be used to improve obstructive sleep apnea that has not been helped by other treatments. After surgery, you may be able to breathe more easily or even snore less. This surgery may not completely fix the problem if the tongue relaxes when you sleep and blocks the airway, which means you may still need to use continuous positive airway pressure (CPAP).

If other medical conditions are present or contributing to your sleep problems, such as congestive heart failure or nasal abnormalities, sleep apnea may resolve with the treatment of those conditions.