Plaza of Cosmetic Dentistry
Dr. Joseph Goodman, D.D.S D.M.D.
What Is Sleep Apnea?Sleep apnea (AP-ne-ah) is a common disorder in which you have one or more pauses in breathing or shallow breaths while you sleep.
Breathing pauses can last from a few seconds to several minutes. They may occur 30 times or more per hour. Typically, normal breathing then starts again, sometimes with a loud snort or choking sound.
Sleep apnea usually is a chronic (ongoing) condition that disrupts your sleep. When your breathing pauses or becomes shallow, you’ll often move out of deep sleep and into light sleep. This results in a poor quality of your sleep, which makes you tired during the day. Sleep apnea is the leading cause of excessive daytime sleepiness.
Sleep apnea often goes undiagnosed. Doctors usually can't detect the condition during routine office visits. A blood test can not help diagnose the condition either. Most people who have sleep apnea don't know they have it because it only occurs during sleep. A family member or bed partner might be the first to notice signs of sleep apnea.
The most common type of sleep apnea is obstructive sleep apnea. In this condition, the airway collapses or becomes blocked during sleep. This causes shallow breathing or breathing pauses.
When you try to breathe, any air that squeezes past the blockage can cause loud snoring.
Obstructive sleep apnea is more common in people who are overweight, but it can affect anyone. For example, small children who have enlarged tonsil tissues in their throats may have obstructive sleep apnea.
What Are the Signs and Symptoms of Sleep Apnea?
Major Signs and Symptoms
One of the most common signs of obstructive sleep apnea is loud and chronic (ongoing) snoring. Pauses may occur in the snoring. Choking or gasping may follow the pauses.
The snoring usually is loudest when you sleep on your back; it might be less noisy when you turn on your side. You might not snore every night. Over time, however, the snoring can happen more often and get louder.
You're asleep when the snoring or gasping happens. You likely won't know that you're having problems breathing or be able to judge how severe the problem is. A family member or bed partner often will notice these problems before you do.
Not everyone who snores has sleep apnea.
Another common sign of sleep apnea is fighting sleepiness during the day, at work, or while driving. You may find yourself rapidly falling asleep during the quiet moments of the day when you're not active. Even if you don't have daytime sleepiness, talk with your doctor if you have problems breathing during sleep.
Other Signs and Symptoms
Others signs and symptoms of sleep apnea include:
• Feeling irritable, depressed, or having mood swings or personality changes
• Dry mouth or sore throat when you wake up
• Morning headaches
• Memory or learning problems and not being able to concentrate
• Waking up frequently to urinate
In children, sleep apnea can cause hyperactivity, poor school performance, and angry or hostile behavior. Children who have sleep apnea also may breathe through their mouths instead of their noses during the day.
About 70 percent of people with obstructive sleep apnea are overweight or obese. Their health care professionals usually encourage them to lose weight.
Surprisingly, there have been few formal studies of how effectively weight loss leads to lesser, lighter snoring and diminished incidents of apnea and hypopnea during sleep. Despite this, anecdotally practitioners report striking improvements in both OSA and snoring among patients who lose weight.
Nasal decongestants are more likely to be effective in cases of snoring or mild sleep apnea. In some cases, surgery is an effective way to improve airflow through the nose.
The traditional technique to induce side-sleeping is dropping a tennis ball in a sock and then pinning the sock to the back of the pajama top. There are also a couple of companies that make a products designed to discourage supine sleeping.
Some people snore or have sleep apnea only when sleeping on their back. Such people can eliminate or reduce airway blockage simply by learning to sleep on their side.
Positional therapy generally works only in mild casesIn more severe cases, the airway collapses no matter what position the patient assumes.
Surgery is often effective in treating snoring. It is less effective in treating obstructive sleep apnea.
The challenge that confronts the surgeon is determining what part of the upper airway is causing the obstruction to airflow. There are many possible sites, and conventional sleep testing does not identify the area the surgeon should modify. If the surgeon does not treat that site in the airway, or if there are multiple sites of obstruction, it is unlikely that the sleep apnea will diminish to a degree that eliminates the need for other treatment.
Given the several sites where airway obstruction may exist, there are several types of operations currently used to treat sleep apnea. The most common is uvulopalatopharyngoplasty, or UPPP. The success rate of this operation is about 50 percent. Some surgeons have achieved very high success rates using multiple, staged operations.2 Nonetheless, most authorities recommend routine re-assessment for sleep apnea after surgery. See the caution below. There's more about surgery here
Most children with snoring or sleep apnea have enlarged tonsils, or adenoids, or both. In 75 percent of those cases, surgical removal of these tissues cures sleep breathing problems.
The American Academy of Pediatrics has endorsed removal of the tonsils and adenoids as the initial treatment of choice for sleep breathing problems in children. There is more information children's sleep apnea and its treatment here.
Oral Appliances from your dentist.
Oral appliances look like the mouth guards worn by football players. After you have been diagnosed with sleep Apnea, Dr. Goodman will take custom impressions of your teeth. The oral appliances for treating sleep apnea and snoring are specially designed for that purpose.
The appliance is worn in the mouth during sleep. Most appliances work by positioning the lower jaw slightly forward of its usual rest position. This small change is, for most people, good enough to keep the airway open during sleep.
Tip :You can simulate the effect of an oral appliance with a simple experiment. If you make a snoring sound right now and, in the middle of it, thrust your jaw forward, you will see that the snoring sound stops.
The American Academy of Sleep Medicinehas endorsed oral appliance therapy for selected patients with sleep apnea. Please come in and consult with Dr. Goodman if you are a good candidate. Your medical insurance (PPO) may cover up to 100% of this treatment. HMO’s cover nothing unfortunately.
Positive Airway Pressure Devices
Positive airway pressure machines, used with a variety of breathing masks, are the most widely used treatment for moderate and severe sleep apnea. They have been endorsed by the American Academy of Sleep Medicine.
The mask, worn snugly over the nose, or sometimes nose and mouth, during sleep, supplies pressurized air that flows continuously or intermittently into the sleeper's throat. The increased air pressure prevents the sleeper's airway from collapsing.
The pressurized air is supplied through a flexible tube from one of several types of machines: CPAP (continuous positive airway pressure), BiPAP (bilevel positive airway pressure), VPAP (variable positive airway pressure), and so on. Studies of the effect of PAP therapy show that OSA patients who consistently use their machines feel better and, as a result of the reduction of apnea and hypopnea episodes during sleep, encounter fewer complications of the disease.
Abstinence from alcohol before bedtime is an important part of treating sleep apnea.
In one study, several persons who received cardiac pacemakers were reported to have shown an improvement in their sleep apnea. No major organizations have endorsed this type of treatment, however. Further studies are underway.
Alternative healing methods are also in use. There is some evidence that playing the didgeridoo or other wind instruments may help in managing OSA. In Brazil, acupuncture researchers who are physicians report positive results in treating OSA withacupuncture.
Positive pressure device.