Sleep Apnea

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Sleep apnea is a traumatic brain injury.
— Anil Rama, MD

Intermittent pauses in breathing during sleep characterize sleep apnea. The breathing lapses can fragment sleep and reduce oxygen supply, leading to sleep and brain health consequences. Sleep apnea affects children and adults, men and women.

What we offer at Sleep and Brain

At Sleep and Brain, we conduct a detailed clinical history to detect the subtle symptoms of sleep-disordered breathing. We prudently search for clues during your sleep and wake period, as exampled below:

  • Sleep

    • Snoring

    • Bruxism

    • Sweating

    • Cold hands and feet

    • Drooling

    • Clenching

    • Dry Mouth

    • Nocturia

  • Wake

    • Sleepiness

    • Fatigue

    • Impotence

    • Anxiety

    • Depression

    • Irritability

    • Forgetful

    • Inattention

When you think of the term sleep apnea, you are likely considering obstructive sleep apnea. However, there are other types of sleep-disordered breathing. We discern the various types of sleep-disordered breathing, such as:

  • Snoring

    • Respiratory noise typically occurring during inspiration

  • Obstructive sleep apnea

    • Intermittent lapses in breathing due to a physical obstruction

  • Central sleep apnea

    • Intermittent lapses in breathing due to faulty brain signals in the absence of a physical obstruction

  • Hypoventilation syndrome

    • Insufficient sleep-related ventilation with high carbon dioxide levels

  • Hypoxemia syndrome

    • Low sleep-related oxygen saturations

Following a thorough history, we conduct a specialized physical examination, as exampled below, to help determine the etiology of your sleep-disordered breathing:

  • Obstructive sleep apnea

    • Facial dimensions

    • Dental occlusion

    • Tongue endurance and strength

    • Nasal resistance

  • Central sleep apnea

    • Peripheral edema

    • Shortness of breath

  • Hypoventilation syndrome

    • Obesity

    • Muscular weakness

We give additional considerations to medical conditions that may increase the risk for sleep-related breathing disorders. Hormone conditions like hypothyroidism (low thyroid hormone) and acromegaly (high growth hormone) may increase OSA risk by causing airway tissue swelling and obesity. Stroke and brain tumors and infections can damage the brain stem and cause central sleep apnea. Heart failure can cause a special type of central sleep apnea called Cheyne-Stokes respiration. Obesity and opioids can reduce ventilation. Consequently, we may recommend laboratory tests, imaging, and echocardiograms.

Sleep and Brain aims to identify a disease process, establish a differential diagnosis, determine an etiology, and render treatment options to ensure optimal health. We gather as much information as possible through a comprehensive exam, data collection, and photography.

Radiographic imaging using Cone Beam CT offers insight into causes and treatment solutions by visualizing anatomy. CBCT provides detailed images of the jaw, teeth, upper airway, nasal cavity, and sinuses. The best clinical outcomes occur when we can see what is happening.

The Sleep and Brain Cone Beam CT case images below illustrate an unmatched diagnostic precision and clinical expertise.

Laboratory sleep testing with carbon dioxide monitoring, performed in your home, may be necessary to evaluate additional sleep-disordered breathing such as hypoventilation.

We typically begin with sensitive home sleep testing with peripheral arterial tonometry to quantify your sleep patterns and evaluate sleep-disordered breathing and sympathetic arousal frequency.

Sleep apnea is a traumatic brain injury. We offer sophisticated testing to elucidate areas of brain imbalance. A brain map can pinpoint which brain areas are hyperactive and hypoactive and assess which networks between brain areas are improperly functioning. Our goal is to restore brain function.

Fortunately, a plethora of therapeutic treatment options are available for sleep-disordered breathing. Unfortunately, many individuals are unsuccessful with standard therapy. We direct individualized treatment toward sleep-disordered breathing, depending upon your age, anatomy, and life experience, and as exampled below:   

Obstructive Sleep Apnea

  • Lifestyle modifications (e.g., alcohol, tobacco, sedatives)

  • Weight loss

  • Positional therapy

  • Positive airway pressure

  • Mandibular advancement splint

  • Allergy evaluation and treatment

  • Myofunctional therapy

  • ExciteOSA neuromuscular stimulation device

  • iNAP

  • Nasal surgery

  • Palate expansion

    • EASE, FME, MSE, Double MSE, MARPE, Custom MARPE, MIND

  • Rhinomanometry provides a quantitative measure of nasal airway resistance that can be used to investigate positive airway pressure intolerance and the indication for nasal surgery.

  • Maxillomandibular advancement

  • Inspire hypoglossal nerve stimulator

We use Sleeptracker-AI to assess the effectiveness of sleep apnea treatment and identify areas where it may fall short. Sleeptracker-AI is clinically validated to accurately monitor sleep patterns, cardiovascular and breathing metrics, breathing anomaly index, and other biometrics. The accuracy of the Sleeptracker-AI system has been validated in collaboration with Stanford Sleep Medicine, ensuring that the data collected is reliable and comparable to gold-standard polysomnography measurements. 

Sleep apnea is associated with reduced airway muscle tone, especially during sleep. Respiratory muscle weakness can exacerbate airway collapse and breathing disturbances. Maximum Inspiratory Pressure and Maximum Expiratory Pressure are respiratory muscle strength measures that are helpful for managing obstructive sleep apnea and insomnia. If testing reveals respiratory muscle weakness, treatments targeting inspiratory and expiratory muscle strength (i.e., respiratory muscle strength training) may help improve apnea. This holistic approach ensures accurate diagnosis and optimizes treatment.

Respiratory Muscle Strength Training (RMST) is a specialized form of exercise aimed at improving the strength and endurance of the muscles involved in breathing, including the diaphragm, intercostal muscles (between the ribs), and accessory muscles. RMST typically involves targeted exercises and the use of resistance devices that create resistance to breathing, which can enhance both inspiratory (breathing in) and expiratory (breathing out) muscle strength.