Sleep deprivation is a typical condition. About 26% of all Americans may suffer from this condition, which involves long pauses between breaths during sleep. Unfortunately, many patients with sleep apnea don't tolerate probably the most effective current therapy, continuous positive airway pressure, or CPAP. For a few of these people, a brand new method, pacemaker therapy, could also be another.
A pacemaker for sleep deprivation? That should be a “typo”, right? Do you actually mean a heart pacemaker? No, this will not be a typo. Pacemakers are a number of the most advanced treatments for sleep apnea. Before explaining how they work, a transient lesson in physiology is so as.
Normally, while you breathe in, air passes through your nose and mouth, past the back of your tongue, through the trachea, and down into your lungs. This happens because nerve signals from the brain trigger the diaphragm to provide movement. The resulting negative pressure draws air in. However, these nerve signals also activate the muscles across the throat, including the tongue, to stop suctioning of the airway from closing with inhalation. Sleep apnea occurs when these processes fail during sleep, and because of this, air doesn't enter the lungs.
There are two forms of sleep apnea. The commonest obstruction is obstructive sleep apnea, which occurs when the airway at the back of the throat repeatedly collapses. In obstructive apnea, the stimulation of the throat muscles is insufficient to stop them from collapsing and the airway becomes blocked. Central sleep apnea is less common. In central apnea, nerve signals from the brain are absent for long periods, and through these intervals no effort is made to breathe.
Research on the treatment of sleep apnea
In a recent study, stimulating the hypoglossal nerve within the neck during sleep was an efficient treatment for individuals with moderate to severe obstructive sleep apnea. Twelve months after pacemaker implantation, the common variety of episodes of obstructive respiratory decreased by about 50%. In addition, nighttime oxygen levels improved, as did measures of quality of life and daytime sleepiness. There were few negative effects.
How does a hypoglossal pacemaker work? A pacemaker has three major components. The first is the stimulating electrode, which is surgically implanted on a hypoglossal nerve (there are two nerves, right and left). The other is a sensing electrode, which is surgically inserted into the chest and detects when an individual begins to breathe. The third is the electrical generator, which provides battery power for the pacemaker. When the sensing electrode indicates the beginning of a breath, it signals the stimulating electrode to activate the hypoglossal nerve, the foremost nerve of the tongue. This causes the muscles of the tongue to stiffen and resist airway closure, thus stopping apnea.
Although the hypoglossal pacemaker appears like a dream for individuals with obstructive sleep apnea who've difficulty using continuous positive airway pressure (CPAP), it has not been utilized in large numbers of patients up to now. has been done Two reasons have hindered widespread use – cost (about $30,000) and lack of knowledge on individuals with severe obesity. This is vital because two-thirds of individuals with obstructive sleep apnea are chubby or obese. The insertion procedure will not be complicated, even though it requires a brief surgical treatment and follow-up to regulate the pacemaker settings. However, as more experience with it accumulates, the usage of this novel therapy may increase.
Central sleep apnea may additionally be amenable to pacemaker therapy. Central apnea is commonly seen in patients with heart failure, and is difficult to treat. Recent studies have shown that a pacemaker inserted through a central vein, much like a heart pacemaker, can stimulate the phrenic nerve, which controls the contraction of the diaphragm. This pacemaker senses the absence of any respiratory effort after which stimulates the phrenic nerve. The phrenic nerve then causes the diaphragm to contract, initiating inspiration. Studies show that central apnea is reduced and sleep quality is improved. Although the pacemaker will not be yet available within the United States, FDA approval could also be forthcoming.