Sleep deprivation is a standard 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 latest method, pacemaker therapy, could also be an alternate.
A pacemaker for sleep deprivation? That have to be a “typo”, right? Do you actually mean a heart pacemaker? No, this just isn't a typo. Pacemakers are among the most advanced treatments for sleep apnea. Before explaining how they work, a temporary lesson in physiology is so as.
Normally, if 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 supply 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 in consequence, air doesn't enter the lungs.
There are two sorts of sleep apnea. The most typical 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 typical 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 unintended 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 predominant nerve of the tongue. This causes the muscles of the tongue to stiffen and resist airway closure, thus stopping apnea.
Although the hypoglossal pacemaker feels 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 thus far. has been done Two reasons have hindered widespread use – cost (about $30,000) and lack of knowledge on individuals with severe obesity. This is essential because two-thirds of individuals with obstructive sleep apnea are chubby or obese. The insertion procedure just isn't complicated, even though it requires a brief surgical operation 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 can also be amenable to pacemaker therapy. Central apnea is usually seen in patients with heart failure, and is difficult to treat. Recent studies have shown that a pacemaker inserted through a central vein, just 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 just isn't yet available within the United States, FDA approval could also be forthcoming.