How to Treat Sleep Apnoea - This Changes Everything!

hi there my name is vic v i'm an ent surgeon that works for the nhs in central london and today i want to tell you about surgery for snoring and how the national guidelines have recently changed in the uk the national institute for clinical excellence or nice the nice guidelines have changed at the end of 2021 i want to explain how they've changed what i think is for the better for people in this country you see for many years in this country sleep centers up and down the country have only really been allowed to give cpap to their patients because they're mostly run by respiratory physicians and that's their thing they give cpap to patients with abstract sleep apnea which is great it's the first line treatment for most people with obstructive sleep apnea because it's very safe and when you use it it works very well for abstraction sleep apnea and people are very happy the people who can use it all the time tolerate it very well the problem is that some people can't use cpap all the time and then they're left in limbo they say well i've got lots of sleep apnea i know it's bad i know if my life expectancy is reduced i'm worried about heart attacks and strokes and diabetes and high blood pressure what can i do about it unfortunately in this country up until recently a lot of the time we've had to say some sorry you've only got cpap but now these guidelines have changed i want to tell you all about that now one of the first things i want to mention about these new national guidelines for england is that they've really pushed for mandibular advancement devices these are these like a gum shield that goes into your mouth and brings your jaw forward they've specified that really it should be put in by or designed by a proper dental professional that can make it as comfortable as possible when they're put in it fits nicely so you don't end up spitting it out in the middle of the night so that's a great change so i think that will really help getting more of these other sort of conservative options available would really help people avoid struggling with one device and not getting onto something else now obviously the bit i'm most interested in is a bit about surgery with obstructive sleep apnea and as i think most of you will be aware particularly if you're from england surgery was not included in any sort of guidelines with abstract sleep apnea for the first time in this country the nice guidelines have looked at the evidence and found yes there is a role for surgery and obstruction sleep apnea is out there clearly in the nice guidelines and national guidelines for this country what i want to do is explain those guidelines and see how they fit into the management of people with obstructive sleep apnea so the first point is that if you have big tonsils and we would call it grade three or grade four tonsils tonsils that you can actually see at the back of your throat those sorts of size tonsils often cause obstructive sleep apnea and it even says in the nice guidelines that if you have big tonsils really you should consider having those taken out first rather than going for cpap in a way it's a bit like what we do with the children for decades we've been saying ah if a child has obstructed sleep apnea you should take out their tonsils and adenoids it's simple we don't put cpap on a five-year-old no one does that but we do know that taking their tonsils adenoids out often helps them with their sleep apnea and they're often sort of cured and we don't need to worry about it anymore but the strange thing in this country for many years was that okay so if you're a 16 year old boy in full-time education and you had obstruction of sleep apnea i would take out your tonsils and adenoids but when you hit your 17th birthday oh no everything's changed now you're gonna have to have cpap for the rest of your life because you're now an adult that doesn't make any sense and most of us said look obviously you've got big tonsils big add-ons let's take those out but my feeling was and has been for many years and this is what we said to the nice committee if you've got big tonsils no matter what age you are why does it matter if you're 17 or 27 or 57 if you've got huge tonsils that clearly causing abstract sleep apnea why not take those tonsils out by all means give them cpap afterwards all before it doesn't matter but that's clearly obstruction it works for the kids why doesn't it not work for people who are older and often i've heard from patients who said well they just looked at the numbers of my sleep study and said that i've got sleep apnea and gave me a cpap machine but no one actually looked in my mouth and you know some of these people have got huge tonsils and they can't breathe at all there's no way that air can push the tonsils apart it's really really difficult for these people all of a sudden you say look we'll just take out your tonsils that appears to be the only thing that's blocking your throat let's do that and then they get suddenly better they don't need their cpap anymore and they think to someone why did i spend the last five years on cpap surely this would have been a better idea if they someone looked in my mouth in the first place well now the guidelines are there everyone should be looking in your mouth before they prescribe your cpap make sure you don't have big tonsils hopefully you can avoid having a mask on for the rest of your life so another thing that the guidelines talk about is about having a blocked nose if you have a blocked nose it's very very difficult to use cpap the reason for this is that you're trying to pump air through your nose into your mouth whatever if there's a lot of resistance there because it's blocked the cpap has to work doubly hard to get air in and when it does that the pressures become very intense if it's very intense that the pressure gets so bad it sort of leaks around and goes into your eye and wakes you up at night what you want to have is the pressures to be as low as possible so you can sleep comfortably and the cpap doesn't disturb you at night so pressures are really high you're not going to get much sleep so if you have a blocked nose someone should be looking up your nose to check why it's blocked and give you some treatment for that also you need to remember that cpap causes a blocked nose and the way this works is that there are turbinates in your nose so you've got the midline partition here called the septum and on the side bit here coming down there are these things called turbinates they look like sort of gills if you look at it from the side view and these turbinates are covered with sort of nose lining and they increase and decrease in size so they can they increase a lot they can block up your nose completely now the point of these turbans the reason why we have them is that when you breathe in air through your nose the air that comes in is moisturized so it doesn't become all sort of crusty and sort of claggy in your throat and it also warms it up so it doesn't feel sort of painful in your lungs or in your throat this is what the turbulence do and it can only tolerate a certain amount of flow through the nose because you can't it doesn't work infinitely you can't blast air in and expect it to work beautifully so what it does is to slow down the air as it goes through your nose if you go like this all the time and the turbulence if it's going too fast will swell up to slow down the air as it goes through you know so it has time to moisten it and to warm it up if it's going too quickly doesn't get a chance to do those things so it actively swells up to stop the air from going in so quickly i'm guessing you could understand now that if you've got cpap and it's blasting air in the first thing these turbines are going to do is swell up and start slowing down that air which would work it means that you can slow it down to the right level so that you can warm it up etcetera but the problem is the cpap goes well i need more pressure to get this throat to open up so i have to push more air in you get this horrible cycle where your nose is filling up because your turbans are getting bigger your cpap's working really hard to get overcome that as one goes up the other one goes up and it's sort of like a race to the top to the point where it's so much pressure that it starts again leaking out the outside and waking you up and you feel like i can't use this anymore so there are an awful lot of people out there when they get their seat back they say it works beautifully for the first few weeks but with time the pressures go up and they feel like oh i can't use it now and it's getting harder and harder all these patients should be given examination of their nose and given treatment for their nose if they're even slightly blocked up now often when you see people in clinic it says you know i don't have any obstruction my nose i feel like i walk around all day and it seems fine but if you ask people when you wake up first thing in the morning does your nose feel quite blocked up or are your mouth breathing you know all those sorts of questions because often people at night have house dust mite allergy so when they wake up and when they feel very congested and they feel like they can't breathe but when they walk around a little bit and they sniff a little bit and have some breakfast it all goes away and they feel normal again so if you're in one of those categories where you feel like actually i wake up with a slightly blocked nose but once i walk around i'm feeling better it may be that you do need a nasal spray and you're not actually completely fine and there's no problems you may be just getting a blocked nose at night so seeing your doctor and them saying your nose looks fine it'd be best if we saw you whilst you're asleep whilst you're at the end of the night we can just peer into your nose at that point we can't do that sort of explaining that to your doctor will really help them because you know something as simple as steroid spray so you don't have to start oh god i can't use this cpap i know i need to use it i just can't just think about it and tell your doctor because they should be looking at your tonsils looking at your nose examining them making sure there's no other problems so you can use cpap effectively so the third thing i want to talk about in these guidelines is that finally the nice guidelines the national guidelines have said that if you have tried cpap and you've not got on with it or you can't use it you haven't got the teeth for a mandible advanced device or something like that if you can't get on with conservative measures you can be eligible for surgery now this is national guidelines anyone in the country can now ask for this free on the nhs you just go to your sleep center and say look i've tried this i've tried this you you know we've got nowhere i'm i'm now untreated for abstract sleep apnea my you know my life expectancy reduced i'm likely to have a heart attack straight all those things i need something to help me what can you do and in the past they used to say oh look there's nothing for you you just got to live with it or something like that but that's not true anymore there's new evidence that's coming out every year about how surgery can help people with obstructive sleep apnea and finally the national institute of clinical excellence have said yes there's enough data out there to prove that having surgery can help some people with attractive sleep apnea so you should see an ent surgeon or someone who deals with this sort of surgery to see if we can get this sorted out so hopefully with time other people around the country will be starting to provide this sort of surgery for their patients if they really can't use some of the other treatments available to them so i think this is really exciting i think this is great for the uk i'm really really happy about this and i hope you are as well i appreciate this video is going a bit longer than most of my videos so i'm sorry about that i'm quite excited obviously about the new guidelines um in time i'll talk about the evidence for surgery for sleep apnea you know there are huge trials with 873 000 people in them and showing how good surgery works over 20 year periods and there's all sorts of stuff out there for these sorts of evidence and i'll go through that one by one for you in a few videos time hopefully i'll be talking about this new thing this is remember i talked about the inspire device the junior device hypoglossal nerve stimulators things to bring your tongue forward this is a new device called the the zeus device which is not implantable it's not a device that goes in it sort of sticks like this like here and i can't use it because i've got a beard but i will be talking about this device and the idea is here it stimulates your tongue brings your tongue forward a bit like those implants and i'll be talking about that soon as well i've got other things on the horizon i'm writing my book i'm going to put out some nfts to help charity all the proceeds will go to charity so you know hopefully i'll get somewhere with all this and thank you again so so much for watching my channel thank you ever so much bye you

Channel: Vik Veer - ENT Surgeon

Views: 185,258

Keywords: sleep apnoea treatment options, sleep apnoea treatment, cpap machine for sleep apnea, mandibular advancement device for sleep apnea, surgery for sleep apnoea, surgery for snoring, snoring, blocked nose, treatment for nasal congestion, does snoring come from my nose, how to fix sleep apnoea, sleep apnoea cure, NFTs, Zeus hypoglossal nerve stimuation, zeus sleep apnoea

Id: LNbPhogMTzM

Length: 10min 23sec (623 seconds)

Published: Wed Feb 02 2022