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Is gasping for air while sleeping keeping your partner awake?
The cessation of breathing, or "apnea" while sleeping, initiates impulses from the brain to awaken the person just enough to restart the breathing process.This cycle repeats itself many times during the night and may result in sleep deprivation and a number of health-related problems including heart attack and stroke.
Scientific evidence shows that CPAP is the best treatment for Severe OSA and Oral Appliance Therapy for mild and moderate OSA, plus cases of severe OSA when the patient can not tolerate CPAP.
Obstructive sleep apnea (OSA) affects more than 18 million Americans and can lead to hypertension, heart attack, stroke, diabetes, depression, reduced libido, muscle pain, TMJ Dysfunction, fibromyalgia, morning headaches and excessive daytime sleepiness which can lead to work and car accidents. Currently, 93% of women and 82% of men with moderate to severe OSA remain undiagnosed.
Unlike simple snoring, obstructive sleep apnea is a potentially life-threatening condition that requires medical attention. A physician's diagnosis is necessary in order to differentiate OSA from other breathing disorders (there are about 80 sleep disorders) and central sleep apnea, which is originated in the brain and needs urgent medical care.
The risks of undiagnosed OSA include heart attack, stroke, irregular heartbeat, high blood pressure, heart disease and decreased libido. In addition, OSA causes daytime drowsiness that can result in accidents, lost productivity and interpersonal relationship problems. The symptoms may be mild, moderate or severe.
Obstructive Sleep apnea is fairly common. One in five adults has at least mild sleep apnea and one in 15 adults has at least moderate sleep apnea. OSA also affects 1% to 3% of children. During sleep, the upper airway can be obstructed by excess tissue, large tonsils and/or a large tongue. Also contributing to the problem may be the airway muscles, which relax and collapse during sleep, nasal passages, and the position of the jaw.
Sleep disordered breathing encompasses several sleep disorders associated with varying degrees of airway blockage due to large tonsils, long soft palate or uvula, excessive fleshy tissue, or excessive relaxation of the tongue. In our dental sleep practice we see some of the conditions that lead to snoring such as a small or retruded jaw and airway obstruction.
Dentists play an important role in the team approach to the treatment of OSA. Physicians, dentists, psychologists, and respiratory therapists all pool their knowledge to treat each patient appropriately and effectively.
We have acquired intense and scientific training in aspects of sleep medicine and have a command of multiple appliance modalities that provide an alternative or an adjunct to surgery and CPAP, and are of great help to physicians in treating patients with sleep disordered breathing problems.
The cessation of breathing, or "apnea," brought about by these factors initiates impulses from the brain to awaken the person just enough to restart the breathing process.This cycle repeats itself many times during the night and may result in sleep deprivation and a number of health-related problems. Obstructive Sleep Apnea, a disease that occurs when the tongue and soft palate collapse onto the back of the throat, leading to partial or complete reductions in breathing during sleep, is classified by AHI -Apnea Hypopnea Index-as follows:
* Mild Obstructive Sleep apnea: Presence of 5 to 15 apneas/hipoapneas per hour.
* Moderate Obstructive Sleep Apnea: 15 to 30 apnea hypopnea index.
* Severe Obstructive Sleep Apnea: AHI index more than 30.
Combined periods of not or/and partially breathing may last for as long as 10 to 90 seconds and may recur up to 500 times a night. Just imaging what happens with the lack of oxygen in your brain and the consequences in blood pressure and heart conditions.
Risk factors for sleep apnea include:
• Male gender
• Being overweight
• Being over the age of forty
• Having a large neck size (17 inches or greater in men and 16 inches or greater in women)
• Having large tonsils, a large tongue, or a small jaw bone, Crowded teeth
• Having a family history of sleep apnea
• Gastroesophageal reflux, or GERD
• Nasal obstruction due to a deviated septum, allergies, or sinus problems
Symptoms of Obstructive Sleep Apnea (OSA)
Those who have OSA are often unaware of their condition and think they sleep well. The symptoms that usually cause these individuals to seek help are daytime sleepiness or drowsiness, complaints of snoring and breathing cessations observed by a bed partner.
Other symptoms may include:
• Snoring with pauses in breathing (apnea)
• Excessive daytime sleepiness/drowsiness -Dozing when driving, reading or seating
• Gasping or choking during sleep
• Restless sleep
• Restless Leg Syndrome
• Problems with mental function- Intellectual deterioration
• Poor judgment/can't focus
• Memory loss or cloudy memory
• Poor job performance
• Occupational accidents
• Quick to anger - Personality changes
• High blood pressure and other heart conditions
• Nighttime chest pain
• Frequent arousals during sleep
• Nausea
• Depression
• Overweight
• Large neck (>17" around in men, >16" around in women)
• Airway crowding: Large tonsils and adenoids in children that can block the airway;Large tongue, which may fall back and block the airway; Small dental arches and teeth crowding.
• Tongue Scalloping: indentation marks on the lateral borders of the tongue. Like teeth impressions or ridges on the sides of the tongue.
• Morning headaches
• Dry mouth when you awaken
• Scratchy throat
• Reduced libido - lost interest in sex
• ED -Erectile Dysfunction - Due to lower production of testosterone
• TMJ soreness on awakening and/or bruxism
• Frequent trips to the bathroom at night
• Anxiety with breathlessness
• ADHD- Can be diagnosed by mistake in children with OSA.
• Fatigue
Treating OSA:
When our office suspects a patient is experiencing apneic episodes, they are referred to an ENT, pulmonologist or sleep specialist for a complete medical assessment and usually overnight polysomnogram (as directed by a physician). Our office evaluates "red flags" such as:
-Snoring (90 Million Americans Snore)
-Daytime sleepiness
-Awakening headache
-TMJ soreness on awakening
-Fatigue
-Restless/fragmented sleep, gasping
-Anxiety with breathlessness
-Dozing when reading or sitting
Treatments:
-CPAP and BIPAP are the most recognized treatment, patients may feel claustrophobic and some may find the equipment and sound to be aggravating. Compliance is often a struggle, 30 to 50% of patients are intolerant to CPAP or not compliance to CPAP.
-Surgery: Sometimes is the only option. it's an invasive surgery and statistics show that the success rate is only 25 to 50%.
-Oral Appliance Therapy (OAT): Many ENT specialist recommend to use it before surgery. As of February 1, 2006, the Academy of Sleep Medicine has designated “…sleep oral appliances as the NUMBER ONE treatment avenue for mild and moderate sleep apnea and snoring.” and number two treatment avenue for severe OSA when the patient is intolerant to CPAP or needs to be used in conjunction with CPAP. Most medical insurance companies and medicare pay for oral appliance theraphy.
The cost of an oral appliance to treat snoring and obstructive sleep apnea varies from $150.00 to $7.000.00. For those patients without insurance, we offer a complimentary initial consultation for snoring and sleep apnea treatment.
Behavioral Treatments for OSA: Weight loss, sleep on the side, establish a regular sleep routine, reduce consumption of alcohol, tobacco and sedatives,
Talk With Your Doctor, Obstructive Sleep apnea is a serious condition and individuals with OSA may not be aware they have a problem. If someone close to you has spoken of your loud snoring and has noticed that you often wake up abruptly, gasping for air, you should consult a dentist with experience and training in sleep apnea treatment. We can help.
In Our offices we have many options for Sleep Apnea Treatment without CPAP. We know the importance of a team approach with your ENT, family physician, cardiologist, endocrinologist, Pulmonologist and Sleep Physician and usually we refer the patients back to a sleep physician for a follow-up polysomnogram to evaluate effectiveness of the oral sleep appliance -OTA- and solve any complication.
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.
Call us today to schedule a complimentary consultation: 949.551.5600