Selected Podcast
Treatment of Sleep Apnea with Upper Airway Stimulation Therapy
Dr. Jeffery Phillips shares how common sleep apnea is, how it's diagnosed, the dangers if leaving it untreated, and treatment options available.
Featuring:
Jeffrey Phillips, MD, D, ABSM, FACS
Jeffrey Phillips, MD is an Ear, Nose & Throat Surgeon, and Sleep Medicine Specialist. Transcription:
Prakash Chandran (Host): Living with sleep apnea can require wearing clunky masks and other devices, but a new treatment is available called upper airway stimulation therapy that offers a mask free approach which simplifies treating this serious condition. Let’s talk with Dr. Jeffery Phillips, an ear, nose, and throat surgeon and sleep medicine specialist at North Florida Regional Medical Center. This is Helmet of Health, the podcast from North Florida Regional Medical Center. I'm Prakash Chandran. So Dr. Phillips, let’s start with the basics. What exactly is sleep apnea and how many people does it effect?
Jeffrey Phillips MD, D, ABSM, FACS (Guest): Well sleep apnea is a disorder that’s very common. It effects the airway when you sleep. Usually the tissues in your throat that are active and moving when you're breathing and swallowing, those tissues collapse. When you actually relax your body, they block your airway and don’t allow you to be able to get airflow through your nose and your mouth into your lungs when you need it just like you are when you are awake. So when that happens, it sends a signal to your brain to wake up, you need to start breathing. This leads to a significant disturbance in your sleep. Also, it makes major strain on your heart, on your lungs, and your metabolic system to increase your risk for many other health disorders.
Host: Yeah. You know I actually hear that it effects quite a number of people. Can you talk a little bit about how common it is?
Dr. Phillips: Yeah. And it’s extremely common. In fact, it’s estimated that about 100 million people worldwide are effected with this disorder. Actually what’s interesting 20%--it’s estimated—in the United States of males and 10% of females are estimated to have this disorder. Actually, about 75 to 80% of people actually go undiagnosed or undertreated for the disorder as well.
Host: Yeah, it’s so funny. It’s one of the things that I always hear people saying. Like oh, well maybe you have sleep apnea. I hear it talked about a lot, but I do also understand how undertreated it is. So maybe talk about some of the dangers in not treating it.
Dr. Phillips: A lot of people think that the only dangers are that they don’t get very good sleep or they're at risk for driving accidents or workplace accidents. All those things are true. In fact, you have a fivefold increased risk of driving accidents or accidents at work. Overtime when you have untreated sleep apnea, it puts a major strain on your heart, your blood vessels, on your lungs, on your brain. It can increase your risk for heart attacks, strokes, untreated hypertension, arrhythmias. Even early onset dementia, metabolic disease like diabetes, and even some forms of cancer you can be at risk for for untreated sleep apnea. That’s why we need to treat it to make sure people don’t get these disorders.
Host: Okay. So before we move into treatment, I'm really curious. Like how do we actually know if we have it? Or how can we tell if like, for example, our significant other has it? What are the symptoms we should look for?
Dr. Phillips: Most people will notice that snoring is the first symptom. Now not all people with sleep apnea have snoring and not all people that snore have sleep apnea, but that’s usually the first sign. People will often witness apneas or choking arousals. They’ll feel they're waking themselves up when they sleep or they're getting very unrestful sleep at night too. Typically that’s combined with usually people feeling like they don’t get enough sleep. They wake up feeling like they got hit by a truck or they feel very tired or headaches in the morning. They just feel like they just want to fall asleep at all times throughout the day or need to take a nap in the afternoon. Usually those are the most common symptoms. There are other milder symptoms that are sometimes not noticed, but those are the main symptoms.
Host: Okay. That’s good to know. So let’s move on to treatment. I know there’s this thing called a CPAP machine. The most layman understanding that I have about it is that it’s a mask that you wear while you sleep. It kind of makes you look like Darth Vader. Maybe talk a little bit about that.
Dr. Phillips: That’s right. A lot of people use the Darth Vader reference for sure. What it is is we’re trying to be able to push open your airway with air essentially to be able to relieve the instruction. The way that’s done is through a mask that goes over your nose and your mouth. It’s connected to a hose that’s connected to a machine that’s giving you forced air that pushes the airway open. The problem is it means that you're tethered to this machine. You're not able to really move around very much. A lot of people will complain that the cord gets wrapped around their neck or they feel like they can't move around or they inadvertently take off the mask at night. People just really don’t like the mask. It doesn’t allow them to sleep, but that’s essentially what happens with CPAP when it’s prescribed.
Host: I see. Well for some of the reasons that you mentioned, I know that not everyone tolerates the CPAP machine. So what options are there available to them?
Dr. Phillips: Well there are a few options, but they're pretty limited. For people that have very mild sleep apnea and snoring oftentimes you can consider doing a mouthguard or an oral appliance. Then for people with more moderate to severe apnea, there are some upper airway reconstructive surgeries. Often times those are good for only select people that have obstruction in one area of their throat. Most people with moderate to severe sleep apnea have really limited options because you have to address multiple levels of obstruction at the airway, usually at the level of the soft palette and the uvula, which is the tissue that hangs down by your tonsils. Your tonsils and even at the base of your tongue are all involved in the collapse and it’s hard to address all of those areas without major surgery.
So we actually have a much more exciting therapy that actually addresses all those levels which is really a great thing for us to be able to use for people that don’t tolerate CPAP. That’s called upper airway simulation therapy.
Host: Yeah, okay. Awesome. I have heard about it and I hear that it’s relatively unique to north Florida. So maybe talk a little bit about what exactly it is.
Dr. Phillips: Well upper airway stimulation therapy is a minimally invasive surgical therapy. What we do is we plant a small device that looks like a pacemaker. It’s about the size of a silver dollar, actually smaller than the size of a pacemaker. What this device does is it’s designed to identify when you're having apnea at night, and it actually is programmed to give a gentle stimulation to your tongue and the lower part of your palette to move the palette and the tongue base forward to open up your airway and protect your airway when you're sleeping. This is done by being able to directly identify that. Then what it is does is it gives a gentle stimulation to the nerve that controls the back of a tongue, the muscles that typically collapse. It stimulates those just gently so you can open up your airway.
Host: Yeah. So that sounds pretty amazing. So I imagine that this treatment is not necessarily for everyone. So maybe talk a little bit about who a good candidate is for this type of treatment and how they might learn more if they're interested.
Dr. Phillips: That’s right. It’s not for everyone. Most people are often candidates for this, but the people that we’re looking for, you have to be over age 22. That’s one of the recommendations. You have to fall in the category of having moderate to severe sleep apnea. So for people that have mild apnea, we usually can get away with less invasive or smaller type therapies too. So you have to have moderate to severe sleep apnea. You have to have tried CPAP and have not been able to use it very safely or correctly. The last thing is you have to have an airway anatomy that’s appropriate for it. Not everyone’s airway or their soft tissue in the back of their throat are designed to be able to respond to upper airway stimulation. So what we do is we look for those candidates and make sure that they are appropriate for this.
Host: Alright Dr. Phillips. I really appreciate your time today. That’s Dr. Jefferey Phillips, an ear, nose, and throat surgeon at North Florida Regional Medical Center. Thanks for checking out this episode of Helmet of Health. If you’re interested, you can call Dr. Phillips at 352-372-9414 and do extension 252 or email him at This email address is being protected from spambots. You need JavaScript enabled to view it.. If you found this podcast helpful, please share it on your social channels. That would really help us out. Be sure to check out the entire podcast library for topics of interest to you. Thanks and we’ll see you next time.
Prakash Chandran (Host): Living with sleep apnea can require wearing clunky masks and other devices, but a new treatment is available called upper airway stimulation therapy that offers a mask free approach which simplifies treating this serious condition. Let’s talk with Dr. Jeffery Phillips, an ear, nose, and throat surgeon and sleep medicine specialist at North Florida Regional Medical Center. This is Helmet of Health, the podcast from North Florida Regional Medical Center. I'm Prakash Chandran. So Dr. Phillips, let’s start with the basics. What exactly is sleep apnea and how many people does it effect?
Jeffrey Phillips MD, D, ABSM, FACS (Guest): Well sleep apnea is a disorder that’s very common. It effects the airway when you sleep. Usually the tissues in your throat that are active and moving when you're breathing and swallowing, those tissues collapse. When you actually relax your body, they block your airway and don’t allow you to be able to get airflow through your nose and your mouth into your lungs when you need it just like you are when you are awake. So when that happens, it sends a signal to your brain to wake up, you need to start breathing. This leads to a significant disturbance in your sleep. Also, it makes major strain on your heart, on your lungs, and your metabolic system to increase your risk for many other health disorders.
Host: Yeah. You know I actually hear that it effects quite a number of people. Can you talk a little bit about how common it is?
Dr. Phillips: Yeah. And it’s extremely common. In fact, it’s estimated that about 100 million people worldwide are effected with this disorder. Actually what’s interesting 20%--it’s estimated—in the United States of males and 10% of females are estimated to have this disorder. Actually, about 75 to 80% of people actually go undiagnosed or undertreated for the disorder as well.
Host: Yeah, it’s so funny. It’s one of the things that I always hear people saying. Like oh, well maybe you have sleep apnea. I hear it talked about a lot, but I do also understand how undertreated it is. So maybe talk about some of the dangers in not treating it.
Dr. Phillips: A lot of people think that the only dangers are that they don’t get very good sleep or they're at risk for driving accidents or workplace accidents. All those things are true. In fact, you have a fivefold increased risk of driving accidents or accidents at work. Overtime when you have untreated sleep apnea, it puts a major strain on your heart, your blood vessels, on your lungs, on your brain. It can increase your risk for heart attacks, strokes, untreated hypertension, arrhythmias. Even early onset dementia, metabolic disease like diabetes, and even some forms of cancer you can be at risk for for untreated sleep apnea. That’s why we need to treat it to make sure people don’t get these disorders.
Host: Okay. So before we move into treatment, I'm really curious. Like how do we actually know if we have it? Or how can we tell if like, for example, our significant other has it? What are the symptoms we should look for?
Dr. Phillips: Most people will notice that snoring is the first symptom. Now not all people with sleep apnea have snoring and not all people that snore have sleep apnea, but that’s usually the first sign. People will often witness apneas or choking arousals. They’ll feel they're waking themselves up when they sleep or they're getting very unrestful sleep at night too. Typically that’s combined with usually people feeling like they don’t get enough sleep. They wake up feeling like they got hit by a truck or they feel very tired or headaches in the morning. They just feel like they just want to fall asleep at all times throughout the day or need to take a nap in the afternoon. Usually those are the most common symptoms. There are other milder symptoms that are sometimes not noticed, but those are the main symptoms.
Host: Okay. That’s good to know. So let’s move on to treatment. I know there’s this thing called a CPAP machine. The most layman understanding that I have about it is that it’s a mask that you wear while you sleep. It kind of makes you look like Darth Vader. Maybe talk a little bit about that.
Dr. Phillips: That’s right. A lot of people use the Darth Vader reference for sure. What it is is we’re trying to be able to push open your airway with air essentially to be able to relieve the instruction. The way that’s done is through a mask that goes over your nose and your mouth. It’s connected to a hose that’s connected to a machine that’s giving you forced air that pushes the airway open. The problem is it means that you're tethered to this machine. You're not able to really move around very much. A lot of people will complain that the cord gets wrapped around their neck or they feel like they can't move around or they inadvertently take off the mask at night. People just really don’t like the mask. It doesn’t allow them to sleep, but that’s essentially what happens with CPAP when it’s prescribed.
Host: I see. Well for some of the reasons that you mentioned, I know that not everyone tolerates the CPAP machine. So what options are there available to them?
Dr. Phillips: Well there are a few options, but they're pretty limited. For people that have very mild sleep apnea and snoring oftentimes you can consider doing a mouthguard or an oral appliance. Then for people with more moderate to severe apnea, there are some upper airway reconstructive surgeries. Often times those are good for only select people that have obstruction in one area of their throat. Most people with moderate to severe sleep apnea have really limited options because you have to address multiple levels of obstruction at the airway, usually at the level of the soft palette and the uvula, which is the tissue that hangs down by your tonsils. Your tonsils and even at the base of your tongue are all involved in the collapse and it’s hard to address all of those areas without major surgery.
So we actually have a much more exciting therapy that actually addresses all those levels which is really a great thing for us to be able to use for people that don’t tolerate CPAP. That’s called upper airway simulation therapy.
Host: Yeah, okay. Awesome. I have heard about it and I hear that it’s relatively unique to north Florida. So maybe talk a little bit about what exactly it is.
Dr. Phillips: Well upper airway stimulation therapy is a minimally invasive surgical therapy. What we do is we plant a small device that looks like a pacemaker. It’s about the size of a silver dollar, actually smaller than the size of a pacemaker. What this device does is it’s designed to identify when you're having apnea at night, and it actually is programmed to give a gentle stimulation to your tongue and the lower part of your palette to move the palette and the tongue base forward to open up your airway and protect your airway when you're sleeping. This is done by being able to directly identify that. Then what it is does is it gives a gentle stimulation to the nerve that controls the back of a tongue, the muscles that typically collapse. It stimulates those just gently so you can open up your airway.
Host: Yeah. So that sounds pretty amazing. So I imagine that this treatment is not necessarily for everyone. So maybe talk a little bit about who a good candidate is for this type of treatment and how they might learn more if they're interested.
Dr. Phillips: That’s right. It’s not for everyone. Most people are often candidates for this, but the people that we’re looking for, you have to be over age 22. That’s one of the recommendations. You have to fall in the category of having moderate to severe sleep apnea. So for people that have mild apnea, we usually can get away with less invasive or smaller type therapies too. So you have to have moderate to severe sleep apnea. You have to have tried CPAP and have not been able to use it very safely or correctly. The last thing is you have to have an airway anatomy that’s appropriate for it. Not everyone’s airway or their soft tissue in the back of their throat are designed to be able to respond to upper airway stimulation. So what we do is we look for those candidates and make sure that they are appropriate for this.
Host: Alright Dr. Phillips. I really appreciate your time today. That’s Dr. Jefferey Phillips, an ear, nose, and throat surgeon at North Florida Regional Medical Center. Thanks for checking out this episode of Helmet of Health. If you’re interested, you can call Dr. Phillips at 352-372-9414 and do extension 252 or email him at This email address is being protected from spambots. You need JavaScript enabled to view it.. If you found this podcast helpful, please share it on your social channels. That would really help us out. Be sure to check out the entire podcast library for topics of interest to you. Thanks and we’ll see you next time.