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Obstructive Sleep Apnea and Snoring
Obstructive Sleep Apnea and Snoring
AN OVERVIEW:
Dentists are now able to play a very important role in the treatment of snoring problems as well as in the recognition and treatment of the life threatening condition known as Sleep Apnea.
Patients may complain of snoring problems and be unaware of the presence of sleep apnea. Such common complaints as headaches, daytime drowsiness, lack of energy, low resistance to disease, and hypertension may actually be the result of numerous sleep apnea episodes during the night. During these episodes, breathing temporarily stops causing reduced oxygen levels in the blood. If left untreated apnea can cause serious medical conditions ranging from increased hypertension to cardiac changes that can lead to sudden death.
During an obstructive sleep apnea episode, a blockage of the airway occurs when there is a collapse of the nasopharyngeal, oropharyngeal, and hypopharyngeal tissues. Research has shown that many dental appliances are quite effective at alleviating this blockage and can now be considered an alternative when choosing a treatment modality. In fact, sleep appliances offer several advantages over other therapy choices. They are inexpensive, non-invasive, easy to fabricate, reversible, and quite well accepted by patients.
Sleep appliances seem to work in one or a combination of three ways. Appliances can reposition the tissues by lifting up the soft palate, bringing the tongue forward, or lifting the hyoid bone. As they reposition, they also act to stabilize the tissues, preventing airway collapse. Lastly, appliances seem to increase muscle tone. Specifically, there seems to he an increase in pharyngeal and genioglossus muscle activity. The key to successful appliance therapy is to properly identify the cause and location of the obstruction. If this is not done, your rate of successful appliance therapy will drop to less than 50% regardless of the appliance chosen.
Variations in design range from the method of retention, the type of material being used, the method and ease of adjustability, the ability to control the vertical dimension, differences in mandibular movement and whether it is lab fabricated or made in the office. The appliance design that you choose will be dependent upon your knowledge of these variations and the oral conditions of the patient. Several of the more frequently used designs are shown on the pages that follow.
For a more in depth discussion on Snoring and Obstructive Sleep Apnea, please call our office at 949-551-5600
FAQ's
About Sleep Disorders
What is obstructive sleep apnea?
Obstructive sleep apnea or OSA is the result of skeletal muscle tissue losing its tone and collapsing into the airway during sleep. When a person falls asleep, the central nervous system is more relaxed causing the electrical activity to the skeletal muscle to decrease. When the muscle loses its tone, gravity pulls it into the airway causing the person to stop breathing for ten seconds or more. The brain senses a decrease in oxygen and causes an arousal and the person wakes up and takes a breath. When the person falls asleep again, this process can repeat itself up to hundreds of times during the night. The diagnostic instruments at REM Sleep Labs can pick up OSA so that a doctor can diagnose it and treat it, helping to improve the quality of life.
What happens if OSA is not properly treated? People with Obstructive Sleep Apnea (OSA) or even those who are not properly treated are at great risks of developing a domino effect of health problems. Abnormal breathing during sleep and frequent reductions in the oxygen level in the blood can lead to permanent problems with your heart or blood vessels. Unusual heartbeats and swollen ankles may also occur. Hypertension and depression are among the most common complications of untreated or not properly treated sleep apnea. When you don’t breathe for even a short period of time, it causes your body to produce a burst of adrenaline, which in turn causes sudden spikes in blood pressure. This can damage the heart and other organs, triggering strokes and heart attacks and greatly worsening congestive heart failure whether you are obese or not.
What are the signs and symptoms of OSA? The signs and symptoms that are suggestive of OSA include obesity, loud snoring, excessive daytime sleepiness, erectile dysfunction (impotence), morning headaches, personality changes (depression), high blood pressure and frequent nocturnal urination. A large neck girth in both males and females who snore is also a good predictor of OSA. In general, men with a neck circumference of 17 inches or greater and women with a neck circumference of 16 inches or greater are at a higher risk for sleep apnea. Patients with OSA often say that their bed partner complains about their snoring. A large number of people who snore are believed to have OSA. Many times, a sleep partner will witness gasping or choking episodes during sleep.
What are the issues with sleep apnea and driving? OSA, left untreated, will have a negative affect on you over time. OSA causes disruptive sleep and the chances that you may doze off while driving increases considerably. The chances of falling asleep and possibly getting into an accident have increased exponentially, when sleep apnea goes untreated. Driving requires attention to the road. OSA deprives your body of rest, making you feel tired, less alert, and can thus become a hazard.
What should I do if I suspect that I might have OSA? Steps:
1. If you routinely wake up feeling non-refreshed, if you fall asleep during the day, feel a decline in mental sharpness or have feelings of depression, consider talking to your doctor about having a sleep study. Waking up several times during the night and maybe more frequently towards the end of your sleep cycle is when sleep apnea is at its worst. If you sometimes do not remember covering the last few miles while driving, or even doze off when you are the passenger in a car traveling any distance, you also should consider seeing a Sleep Specialist. These are all signs of non-restorative sleep, and OSA is a major cause of non-restorative sleep.
2. Asking your bed partner if they have ever heard you snoring or have even witnessed you not breathing at any point during the night can be useful information for your physician. Loud snoring can be a predictive indicator that you may have underlying Obstructive Sleep Apnea, which can be easily treated.
3. If your doctor feels that you might have Obstructive Sleep Apnea, he will recommend that you undergo an overnight sleep study. At your sleep study visit, electrodes will be used to monitor your brain waves, your breathing, and blood oxygen levels during the night.
4. If your overnight sleep study reveals OSA, your doctor will discuss the treatment options with you. The most common treatment, CPAP (Continuous Positive Airway Pressure) a machine that blows room filtered air into your airway to keep your airway from collapsing at night. Other treatments include surgical procedures and behavioral treatment modalities that can also be discussed with your physician.
AN OVERVIEW:
Dentists are now able to play a very important role in the treatment of snoring problems as well as in the recognition and treatment of the life threatening condition known as Sleep Apnea.
Patients may complain of snoring problems and be unaware of the presence of sleep apnea. Such common complaints as headaches, daytime drowsiness, lack of energy, low resistance to disease, and hypertension may actually be the result of numerous sleep apnea episodes during the night. During these episodes, breathing temporarily stops causing reduced oxygen levels in the blood. If left untreated apnea can cause serious medical conditions ranging from increased hypertension to cardiac changes that can lead to sudden death.
During an obstructive sleep apnea episode, a blockage of the airway occurs when there is a collapse of the nasopharyngeal, oropharyngeal, and hypopharyngeal tissues. Research has shown that many dental appliances are quite effective at alleviating this blockage and can now be considered an alternative when choosing a treatment modality. In fact, sleep appliances offer several advantages over other therapy choices. They are inexpensive, non-invasive, easy to fabricate, reversible, and quite well accepted by patients.
Sleep appliances seem to work in one or a combination of three ways. Appliances can reposition the tissues by lifting up the soft palate, bringing the tongue forward, or lifting the hyoid bone. As they reposition, they also act to stabilize the tissues, preventing airway collapse. Lastly, appliances seem to increase muscle tone. Specifically, there seems to he an increase in pharyngeal and genioglossus muscle activity. The key to successful appliance therapy is to properly identify the cause and location of the obstruction. If this is not done, your rate of successful appliance therapy will drop to less than 50% regardless of the appliance chosen.
Variations in design range from the method of retention, the type of material being used, the method and ease of adjustability, the ability to control the vertical dimension, differences in mandibular movement and whether it is lab fabricated or made in the office. The appliance design that you choose will be dependent upon your knowledge of these variations and the oral conditions of the patient. Several of the more frequently used designs are shown on the pages that follow.
For a more in depth discussion on Snoring and Obstructive Sleep Apnea, please call our office at 949-551-5600
FAQ's
About Sleep Disorders
What is obstructive sleep apnea?
Obstructive sleep apnea or OSA is the result of skeletal muscle tissue losing its tone and collapsing into the airway during sleep. When a person falls asleep, the central nervous system is more relaxed causing the electrical activity to the skeletal muscle to decrease. When the muscle loses its tone, gravity pulls it into the airway causing the person to stop breathing for ten seconds or more. The brain senses a decrease in oxygen and causes an arousal and the person wakes up and takes a breath. When the person falls asleep again, this process can repeat itself up to hundreds of times during the night. The diagnostic instruments at REM Sleep Labs can pick up OSA so that a doctor can diagnose it and treat it, helping to improve the quality of life.
What happens if OSA is not properly treated? People with Obstructive Sleep Apnea (OSA) or even those who are not properly treated are at great risks of developing a domino effect of health problems. Abnormal breathing during sleep and frequent reductions in the oxygen level in the blood can lead to permanent problems with your heart or blood vessels. Unusual heartbeats and swollen ankles may also occur. Hypertension and depression are among the most common complications of untreated or not properly treated sleep apnea. When you don’t breathe for even a short period of time, it causes your body to produce a burst of adrenaline, which in turn causes sudden spikes in blood pressure. This can damage the heart and other organs, triggering strokes and heart attacks and greatly worsening congestive heart failure whether you are obese or not.
What are the signs and symptoms of OSA? The signs and symptoms that are suggestive of OSA include obesity, loud snoring, excessive daytime sleepiness, erectile dysfunction (impotence), morning headaches, personality changes (depression), high blood pressure and frequent nocturnal urination. A large neck girth in both males and females who snore is also a good predictor of OSA. In general, men with a neck circumference of 17 inches or greater and women with a neck circumference of 16 inches or greater are at a higher risk for sleep apnea. Patients with OSA often say that their bed partner complains about their snoring. A large number of people who snore are believed to have OSA. Many times, a sleep partner will witness gasping or choking episodes during sleep.
What are the issues with sleep apnea and driving? OSA, left untreated, will have a negative affect on you over time. OSA causes disruptive sleep and the chances that you may doze off while driving increases considerably. The chances of falling asleep and possibly getting into an accident have increased exponentially, when sleep apnea goes untreated. Driving requires attention to the road. OSA deprives your body of rest, making you feel tired, less alert, and can thus become a hazard.
What should I do if I suspect that I might have OSA? Steps:
1. If you routinely wake up feeling non-refreshed, if you fall asleep during the day, feel a decline in mental sharpness or have feelings of depression, consider talking to your doctor about having a sleep study. Waking up several times during the night and maybe more frequently towards the end of your sleep cycle is when sleep apnea is at its worst. If you sometimes do not remember covering the last few miles while driving, or even doze off when you are the passenger in a car traveling any distance, you also should consider seeing a Sleep Specialist. These are all signs of non-restorative sleep, and OSA is a major cause of non-restorative sleep.
2. Asking your bed partner if they have ever heard you snoring or have even witnessed you not breathing at any point during the night can be useful information for your physician. Loud snoring can be a predictive indicator that you may have underlying Obstructive Sleep Apnea, which can be easily treated.
3. If your doctor feels that you might have Obstructive Sleep Apnea, he will recommend that you undergo an overnight sleep study. At your sleep study visit, electrodes will be used to monitor your brain waves, your breathing, and blood oxygen levels during the night.
4. If your overnight sleep study reveals OSA, your doctor will discuss the treatment options with you. The most common treatment, CPAP (Continuous Positive Airway Pressure) a machine that blows room filtered air into your airway to keep your airway from collapsing at night. Other treatments include surgical procedures and behavioral treatment modalities that can also be discussed with your physician.