Sleep apnea is a common sleep disorder that involves repeated breathing interruptions during sleep that may occur hundred of times each night as a result of structural abnormalities or brain malfunctions. This condition affects about 18 million people of all ages in the US with a risk of serious complications. Sleep apnea occurs when the upper airway and airflow are blocked, causing the oxygen levels to drop in both in the brain and the blood. This causes shallow breathing or breathing pauses during sleep.
Patients who are overweight, have high blood pressure, are older, smoke or have a family history of sleep apnea may have an increased risk of developing obstructive sleep apnea, while those with heart disease or a stroke are at an increased risk for central sleep apnea. Fortunately, most cases of sleep apnea can be effectively diagnosed and treated.
Types of Sleep Apnea
There are two main types of sleep apnea: obstructive and central.
Obstructive sleep apnea is more common, and involves a blocked or collapsed airway during sleep that may result in breathing abnormalities.
Central sleep apnea is less common, and involves a malfunction in which the brain doesn’t send the proper signals to control breathing during sleep.
Symptoms of Sleep Apnea
Many patients with sleep apnea may not be aware that they have this condition, as breathing interruptions are not usually remembered upon waking. However, patients with sleep apnea may experience:
- Excessive daytime sleepiness
- Waking up with a dry mouth or sore throat
- Morning headaches
- Waking up to shortness of breath
Interrupted breathing during sleep may be noticed by your partner or by your doctor during a sleep study. If left untreated, sleep apnea can lead to high blood pressure, cardiovascular disease, stroke, memory problems, weight gain, impotency, headaches and daytime fatigue leading to job impairment and motor vehicle crashes.
Treatment of Sleep Apnea
There are many different treatment options available for sleep apnea, depending on each patient's individual case. Many patients can experience significant results from continuous positive airway pressure (CPAP) machines, adjustable airway pressure devices or oral appliances, all used while sleeping. While treatment often begins with conservative techniques, many patients require surgery in order to effectively treat their condition.
Surgery for sleep apnea aims to remove the excess tissue from the nose or throat that causes snoring or sleep apnea. This can be done through procedures such as:
This procedure involves removing tissue from the rear of the mouth, as well as removing the tonsils and adenoids to stop vibration and snoring. UPPP is performed under general anesthesia.
During this procedure, the upper and lower part of the jaw are moved forward to create more space behind the tongue and soft palate and reduce the risk of obstruction during sleep.
Often performed after other treatments have failed, this procedure involves inserting a metal or plastic tube into the throat to help the patient breathe during sleep. The opening remains covered during the day but helps air pass directly in and out of the lungs during sleep. Tracheostomy is reserved for severe, life-threatening cases of sleep apnea.
These procedures can be performed using minimally invasive techniques to provide effective treatment with reduced downtime, bleeding and pain. You will likely experience throat pain for one to two weeks after surgery as the area heals.
Your doctor will determine which procedure is best for you based on a thorough evaluation of your individual condition. Patients can take certain steps to handle symptoms of sleep apnea on their own, including losing excess weight, sleeping on your side and using a saline nasal spray to keep your nasal passages open at night.
Snoring and Obstructive Sleep Apnea
We all at one time or another have heard someone snore and to varying degrees. We may even joke about it “It sounds like a train”, “I could hear you from the other room.” The fact of the matter is obstructive sleep apnea (O.S.A.) is not a joke it is a serious sign of what we will call respiratory deficiency and can lead to other medical conditions. What is O.S.A. without getting to technical for the purpose of this discussion it’s our attempt to breathe through a narrow airway. When we lie down to sleep muscles that keep the airway open relax and allow the lower jaw and tongue to slide back where by obstructing the airway. Think of it this way, imagine you are able to breathe through a large garden hose with good air flow. Now let’s switch the garden hose to something narrower like a straw. The volume of air is greatly reduced and it would clearly be a struggle. That in short is what sleep apnea is, it’s our attempt at night to breathe through a narrow opening. In severe cases the obstruction is so great the air can be completely blocked almost suffocating the patient. Without enough oxygen the brain forces us to wake up and restart the breathing process. It is not uncommon that patients with O.S.A. will wake up as much as 75 times per hour.
Diagnosis Systems and Signs
People who suffer from O.S.A. often complain of always feeling tired, and complain they don’t sleep well. This poor quality of sleep and the patients struggle to breathe causes other manifestations.
- High Blood Pressure
- Increased risk of stroke
- Increased risk of heart attack
- Sudden death
- Exhaustion and low energy levels
- Dental manifestations damage to your teeth from grinding as well but not always. T.M.J. (Temporo Mandibular Joint Dysfunction)
Easy Diagnosis and Easy to Test
Often people with O.S.A. are unaware and often it’s their partner who informs them that they are snoring. Many patients are often in denial and just as readily take high blood pressure medication, sleeping pills, and other medication just to treat the symptoms. Just as easily it would be recommended and prudent to get a prescription from your Physician or Dentist for a sleep study. It is an overnight affair, so get comfortable as you will be monitored over the course of the night. Once diagnosed treatment options will be recommended. Another alternative way to measure Airway space is with a Dental Cone Beam Scan. This scan also known as C.B.C.T. is based on the fundamentals of a Cat Scan unit that are found in radiology offices. The modification and software of the C.B.C.T. allows for precise measurements, evaluation, and airway analysis.
The American Academy of Sleep Medicine recommend oral appliances as the first line of treatment for mild to moderate O.S.A. with a 95% success rate. The second option is a C.P.A.P. machine that is bulky and fits over the face. It is like a fighter pilots mask forcing a constant flow of air into the lungs. Unfortunately patient compliance is less than hoped, as well as difficulty in maintaining sterility unit. Often the mask and line become contaminated with bacteria and biofilm and can cause other forms of infection. With proper maintenance this can be avoided and can provide profound results with patient compliance.
So in conclusion although O.S.A. is prevalent in approximately 20% of our adult population and with all it’s systemic medical and dental manifestations it is good to know there is treatment. And options available that will control O.S.A. The dental appliance therapy provides for a faster, easier, and more consistent patient compliance. The C.P.A.P. also has its place in O.S.A. treatment and is excellent treatment option. It is most important to address the diagnosis of O.S.A. as the treatments can restore ones health and improve your quality of life.