Sleep Apnea is a sleep disorder characterized by pauses in breathing during sleep.
Each episode, called an apnea or hypopnea, lasts long enough so one or more breaths are missed, and such episodes occur repeatedly throughout sleep. In Obstructive Sleep Apnea (OSA), breathing is interrupted by a physical block to airflow despite respiratory effort. Rarely are OSA sufferers even aware of their condition and most simply become conditioned to the daytime sleepiness and fatigue associated with significant levels of sleep disturbance.
Spouses are often the person aware of a loved one’s snoring. We have also observed spouses can accommodate to the snoring bed partner and are not aware of the underlying problem. We have a bed partner questionaire to help you and us determine if a sleep study may be indicated.
For those who are aware of their condition, the gold standard for treating OSA has long been an oral appliance called the CPAP machine. Although very effective, many people find the CPAP to be very uncomfortable and cumbersome. In fact, it is well known after one year 67% of CPAP users are no longer use the machine. In many cases, sleep apnea sufferers may benefit from and prefer a more comfortable jaw-aligning oral appliance. The purpose of this device is to reposition the tongue forward and out of the throat to allow for a clear airway. Delivering more oxygen to the body allows you to wake up feeling more rested and energetic.
How Do I Determine If I Have a Problem?
The standard sleep study is done in a sleep lab or center, a techinician is watching you sleep. The team at Incredible Smiles together with a sleep physician can help you understand the results of your physician reviewed study. We offer our guests a method of doing a sleep study in the comfort of their own home. By taking home a monitor you are able to receive a report on the severity of your OSA and the results are back within 48 hours. This home device is a screening tool and not meant to replace a formal sleep study. A sleep physician will review your report to make recommendations for treatments such as an oral appliance (made by a dentist) or CPAP. Only with a sleep physician’s recommendation will we recommend an oral appliance.
The Home Sleep Study
The team at Incredible Smiles has tried several home sleep devices and we like the Ares from Watermarkmedical.com. This device is worn on the forehead. There are no leads or wires running from the fingers. This arrangement allows for ease of use especially when bathroom breaks are needed during the night.
What Will The Report Tell Me?
The report will give you the following information:
- Number of hours spent sleeping
- Number of times you woke up
- The decibel level of your snoring
- Your body positioning and how that relates to snoring
- Your oxygen saturation level
- Your average pulse rate
- The amount of REM vs. non-REM sleep
- THe number of apnic and hypopnic events
Schedule a consultation to find out if this comfortable alternative to CPAP is right for you.
Sleep Apnea FAQs
We custom fit a sleep appliance for you. This device is worn on your upper and lower teeth. The reason it works is because it pulls the bottom jaw forward. When the jaw is positioned forward, so is the tongue. The tongue is the largest obstacle to airway flow. We are simply opening the airway to provide you with the oxygen you need for a restful sleep.
Your health is in jeopardy in several ways. When you stop breathing, your body actually wakes itself up—without you consciously knowing it. One huge detrimental effect of this is you can never get into a deep sleep, so your body never gets the rejuvenating effect of deep sleep. Your body needs two things during the night; REM sleep and NREM sleep. Both are essential to a thriving functional person.
Your partner’s buzz saw-like snoring might make you want to pull your hair out, but restrain yourself and use the unwanted wakefulness to see if sleep apnea may indeed be their problem. The most critical thing to look for is a pause in breathing for more than 10 seconds. Be careful, breathing can be an illusion. When the lawn mower mouth suddenly falls silent, you may think he or she is breathing, but in fact the breathing and oxygen flow may have stopped! Gasping for air after a quiet spell often means there was no air exchange. Tossing and turning can also be an indication. THis movement is often to open the airway.
If you don’t have a bedmate who can personally witness your breathing breaks during the night, you can still gauge your risk. These are all big risk factors:
- Being overweight
- Being excessively sleepy during the day. For example, if you can fall asleep anywhere during the day (and you do not work or play all night long)
- Having a neck that’s over 17 inches in circumference.
- Tonsils and adenoids that are still present and often infected.
- A severely retruded chin, from a profile the chin appears further back toward the neck than desirable.
This is a serious sleep disorder that occurs when a person’s breathing is interrupted during sleep. Untreated people stop breathing repeatedly during their sleep, sometimes hundreds of times during the night. There are two types: obstructive and central. Obstructive sleep apnea (OSA) is the more common of the two. It occurs when repetitive episodes of complete or partial upper airway blockage happens during sleep. During the episode, the diaphragm and chest muscles work harder as the pressure increases to open the airway. Breathing usually resumes with a loud gasp or body jerk. These episodes can interfere with sound sleep, reduce the flow of oxygen to vital organs, and cause heart rhythm irregularities.
In central sleep apnea, the airway is not blocked but the brain fails to signal the muscles to breathe due to instability in the respiratory control center. Central apnea is named as such because it is related to the function of the central nervous system.
Suffering people can choose a number of treatment options, although none are perfect. The most popular being a C-PAP mask (or continuous positive airway pressure mask) that’s worn when the person sleeps. The mask, which looks like a traditional oxygen mask hooked up to a machine with tubes, gauges levels of the airway resistance and pushes air past the swollen tissue so oxygen is delivered. A Mandibular Repositioning Device (MRD) is made by a trained dentist and positions the jaw forward. It has no bells and whistles like th CPAP and may be more highly tolerated. The compliance or continued use of the CPAP after one year is only 33%.
There are a number of ways you can help your baby become a better sleeper. These include, shifting your baby’s sleep cycle more toward nighttime by 2-3 months of age. Newborns frequently have their days and nights reversed and often the awake/sleep cycle is governed by the need to feed. When there is a need to feed during the night, keep lights dim and reserve stimulating interaction for the daytime.
OSA is very common. Research has shown that about one in every five adults has enough sleep apnea to be considered abnormal. This makes OSA about twice as common as asthma. Most individuals with OSA have only mild disease when defined by the frequency of the abnormal breathing events during sleep and most of them don’t have daytime symptoms. About one in 20 adults has the OSA Syndrome, which is OSA associated with excessive daytime sleepiness. That is a lot of people with OSA, about 23 million in the United States with at least mild disease, and 16 million with moderate to severe disease. So it is very likely you know someone with OSA, although they may not tell you. If you travel by plane on a Boeing 747 with 451 uncomfortable fellow passengers, you have a one in 25 chance of sitting next to one who has significant OSA. If that person is a male, overweight, and a snorer, the chances that he has OSA are even higher. OSA is distributed in the population unequally. It is more common in males (24%) than females (9%), and in those who are obese. One out of every 10 habitual snorers has symptomatic OSA. Because OSA is strongly linked to obesity and age, and on average our population is growing older and more overweight, OSA is becoming more common all the time.
You will probably see someone with OSA today. It might be your bed-partner.
OSA is a uniquely human problem and can be considered a price we pay for our ability to talk. We use our throat in at least three different ways. We use it to form words when we speak, to propel food when we swallow, and to serve as a passageway for air when we breathe. We are stuck with a single tube that must be flexible and collapsible so we can talk and swallow, but must stiffen up to resist collapse when we suck air into our lungs. The solution to this design problem is a complex group of muscles that change the shape of our throat when we talk and swallow, but also stiffen and dilate the passageway when we breathe in. These muscles work well when we are awake, but like all muscles they relax – become less active – when we are asleep. If our airway is abnormal in its size or shape or “stiffness”, for example if it is too small because of excess tissue in or around it, then the muscles responsible for holding it open during sleep are unable to do their job. The airway collapses so no air (or not enough air) gets to the lungs.
So OSA is caused by conditions that narrow this passageway, the upper airway, or make it more collapsible. Chief among these is obesity, especially obesity with a large neck, although other conditions such as having “kissing” tonsils or a relatively small jaw (this gives one a relatively large tongue) also can promote upper airway collapse. Certain diseases such as hypothyroidism (low thyroid hormone levels) are also associated with OSA. The effect of gravity on the tongue and other structures surrounding the upper airway can narrow it when sleeping on your back. Drinking alcohol near bedtime can make the airway more collapsible.
For some carefully selected people the answer is yes, surgery is a good therapy option for their OSA. However, the majority of patients with OSA are best treated medically. Placing a breathing tube in the windpipe (tracheostomy) was the first treatment perscribed for OSA. It was always successful, but was poorly accepted and is seldom used today. The removal of pharyngeal tissue to open the airway may be indicated for a small percentage of people. As a dental office we always look in the throat to see if this could be a contributing factor toward soemone’s OSA. If these tissues are present we will discuss the possible referral to an ENT (Ear , Nose and Throat Physician) for evaluation for surgery.
For the vast majority of people with OSA their condition is a chronic disease. If you have OSA it will likely last your lifetime. It can be successfully managed, but it will not be cured. OSA is like other chronic diseases such as diabetes or high blood pressure. In highly selected patients surgical cures of OSA have been reported. Management of OSA with changes in lifestyle and the addition of a medical device have proven to be very effective. Loss of weight and neck size is very important as a first lifestyle change. Use of a medical device like a MRD (mandibular repositioning device) with a dentist or with CPAP from a sleep physician will likely help.