What can make sleep apnea get worse?

A fellow caregiver asked...

My mom was previous diagnosed with moderate obstructive sleep apnea. After nearly a year of trying to tolerate a 13 setting on her CPAP, she underwent surgery to remove her uvula, bulky tissue in her throat and the correction of a deviated septum.

She recently had a follow-up sleep study, hoping to see an improvement and, thus, the ability to have a lower air setting on her CPAP. Unfortunately the results just came back and her sleep apnea appears to have gotten worse! The doc is now recommending a CPAP setting of 16. Mom is devastated.

In general, what makes sleep apnea worsen? I feel like we're going in to her upcoming follow-up appointment completely clueless as to what questions to ask about next steps.

Expert Answer

Steven Y. Park, M.D., is a board-certified otolaryngologist specializing in diagnosing and treating sleep-breathing problems such as obstructive sleep apnea, snoring, and upper airway resistance syndrome. Park is a blogger (doctorstevenpark.com) and author of the book Sleep, Interrupted: A Physician Reveals the #1 Reason Why So Many of Us Are Sick and Tired.

Unfortunately, your mother's experience is not too uncommon. The uvulopalatopharyngoplasty procedure by itself has a 40% chance of success, and the main reason why it doesn't work for many people is that tongue collapse wasn't addressed. If you perform multilevel surgery, then success rates can be as high as 80%. Jaw procedures that widen both the upper and lower jaws have success rates of 80 to 95%. Her options now include:

  • go back to CPAP at the recommended setting. There are a number of ways of improving CPAP use, whether it's trying different masks to other variations of CPAP machines.

  • see a dentist about a mandibular advancement device (or oral appliance). These devices pull the tongue forward by pulling the lower jaw forward at night.

  • undergo definitive tongue base surgery. There are various options with different indications for people with different anatomy.

It's important to discover where the obstructions are happening before undergoing any more invasive treatments. One simple technique is to examine the airway with the patient on his or her back. If there's significant tongue collapse, the airway behind the tongue will be very narrow. Thrusting the jaw forward can determine if an oral appliance can help.