Snoring & Sleep Apnea Treatment



Obstructive Sleep Apnea

Obstructive Sleep Apnea (OSA) is a sleep breathing disorder in which a person stops breathing while they sleep. The tissues in the throat collapse, cutting off the airway despite efforts to breathe. Apnea is defined as "a cessation of airflow for 10 seconds or more." This can occur dozens and sometimes even hundreds of times an hour.

Typically, someone with sleep apnea snores heavily, and then stops breathing while still sleeping. A sleeping partner would observe that the person is struggling to breathe but there is no snoring sound. These periods of stopped breathing are followed by a gasping or choking sound. The person with sleep apnea will partially awaken in order to breathe, leading to fragmented, non-refreshing sleep which can be the cause of excessive daytime sleepiness.

The even greater concern is that when the airway collapses and oxygen is cut off, the body goes into a fight-or-flight response, putting a strain on the heart and increasing blood pressure. Over time, this can wear out the heart and lead to heart disease or a stroke.

Sleep Apnea Statistics

  • Doctors estimate that 9.1% of men and 4% of women have sleep apnea.
  • That translates to 18-25 million Americans (1 in every 15) living with sleep apnea.
  • Possibly as few as 5% have been diagnosed, or have taken a sleep study.
  • A person afflicted with untreated obstructive sleep apnea is up to 4 times more likely to have a stroke, as well as 3 times more likely to have heart disease.
  • Approximately 50% of all patients who have hypertension, or high blood pressure, are also afflicted with obstructive sleep apnea.
  • People suffering from OSA are as much as 6 times more likely to be involved in a car crash than those without sleep disorders. This is due to the fact that they are drowsy from lack of sleep.

Who Is At Risk For Sleep Apnea?

Even though sleep apnea can affect anyone regardless of age, weight, and gender, these factors indicate a higher likelihood of having sleep apnea:

  • Mouth breathing: Sleeping with the mouth open is a sign that the nasal airway is obstructed. Nasal obstruction causes the jaw to drop, reducing the diameter of the pharyngeal airway and increasing the likelihood of obstructive sleep apnea. If you know a sleeping mouth breather, they may be suffering from obstructive sleep apnea.
  • Excess weight: Fat deposits around the neck and chin may obstruct your breathing. Keep in mind though, not everyone who has sleep apnea is overweight. Thin people suffer from OSA as well.
  • Neck size (circumference): People with large neck circumferences tend to have narrowed airways as a result. Men with a 17 inch neck size and women with a 16 inch neck size are at higher risk. Another risk factor is excess skin from the chin to the neck, often referred to as a turkey neck.
  • Family history: If you have family members who suffer from OSA or snoring, you may be at increased risk. There is a hereditary link associated with sleep apnea.
  • Use of alcohol or other sedatives: These substances cause the muscles in your throat to relax, exacerbating sleep breathing issues such as OSA.
  • Smoking: Smokers are three times more likely to suffer from OSA than their non-smoking counterparts. Smoking tends to cause inflammation and fluid retention in the airway, resulting in less space for air to pass through the airway.
  • Being a male: Men are projected to be twice as likely to have sleep apnea. This gap narrows as age increases. Once women reach menopause, the ratio is almost equal.
  • Age: OSA occurs significantly more often in adults that are older than 40.
  • A narrowed airway: You may have a naturally narrowed airway. This is more common in women than in men, and could be a strong indicator of sleep apnea in women.
  • Enlarged tonsils and/or adenoids: Your tonsils and/or adenoids may become enlarged, which lessens the amount of room for air to pass through your airway. In children, this is the most common cause of sleep apnea, in which removal is the most effective solution.
  • Jaw structure: A lower jaw that is undersized compared to the upper jaw (retrognathia).

What Are The Symptoms Of Sleep Apnea?

Often the person with sleep apnea is totally unaware of the problem and will often deny the fact that he / she snores, but the bed partner will observe:

  • Loud snoring followed by cessation of breathing
  • Gasping and choking during sleep
  • Excessive daytime sleepiness
  • Morning headaches
  • More sleep apnea symptoms

Sleep Disorders Associated With Breathing

Determining if you have a sleep breathing disorder, or just snoring is as easy as consulting a health care provider who is trained in sleep disorders. Normally, the evaluation will begin with the Epworth Sleepiness Scale and from there it will be determined if a sleep study is necessary to determine what type of sleep disorder a person might be suffering from. The three most common sleep breathing disorders are:

  • Obstructive Sleep Apnea (OSA) means the muscles and tissues in the airway collapse and block off the airway, preventing airflow. When the oxygen in the brain becomes low enough, the sleeper partially awakens, the obstruction in the throat clears and the flow of air starts again, usually with a loud gasp. Often treated with oral appliance therapy (OAT), PAP therapy, weight loss, or surgery.
  • Central Sleep Apnea (CSA) is when the brain temporarily stops sending signals to the muscles that control breathing. Typically this sleep breathing disorder affects people with certain neurological medical conditions. Symptoms of this disorder are similar to those of OSA, but treatment options are different. CPAP or BiPAP therapy are common therapy choices, in addition to treating the underlying medical condition. In some cases oxygen treatment at night is suggested to ensure the lungs get enough oxygen during sleep.
  • Upper Airway Resistance Syndrome (UARS) is usually thought of as severe snoring. There are times when the airway narrows so much that the muscles in the chest and diaphragm have to work really hard to pull air into the lungs. UARS is in the middle of snoring and sleep apnea. Normally when snoring gets worse, it becomes UARS, then untreated UARS can turn into OSA. It is thought that UARS is more common in young, thin people, and is most commonly treated with OAT.

Measuring Sleep Apnea

Sleep apnea is measured by the number of times you stopped or reduced breathing per hour. Together, these events are counted and known as the Apnea-Hypopnea Index (AHI).

A sleep study will measure your AHI as well as the drop in your blood-oxygen levels to help determine the severity of the disease. If you have obstructive sleep apnea, your sleep study results will indicate mild, moderate or severe sleep apnea.

Untreated Sleep Apnea Health Consequences

Obstructive sleep apnea causes hypertension, diabetes, high blood pressure and if left untreated, could reduce life expectancy by 10 years or more. With 95% of those suffering from obstructive sleep apnea undiagnosed, sleep apnea may be the number one cause of death. Learn more about the dangers of untreated sleep apnea.

If you or a loved one has several risk factors above, it is important to consult a health care provider trained in sleep disorders to be evaluated for obstructive sleep apnea.


Treatment options

Oral Appliance Therapy
Oral Appliances are placed in the mouth and are worn much like an orthodontic appliance or sports mouth protector. Worn during sleep to prevent the collapse of the tongue and soft tissues in the back of the throat, oral appliances promote adequate air intake and help to provide normal sleep in people who snore and have sleep apnea.

Oral appliances can be used as the first-line therapy for patients who have been diagnosed with mild-to-moderate obstructive sleep apnea, or severe obstructive sleep apnea that cannot tolerate their prescribed CPAP. They can also be used in conjunction with other therapies such as continuous positive air pressure (C-PAP). Determination of proper therapy can only be made by joint consultation of your sleep physician and a qualified sleep medicine dentist.


C-PAP
C-PAP (continuous positive air pressure applied through a nasal mask) is the most common and standard form of treatment of obstructive sleep apnea (OSA). The C-PAP machine consists of a face or nasal mask that is connected to a pump, providing a positive flow of air into the nasal passages in order to keep the airway open. This pressure ensures that the airway doesn't collapse during sleep. C-PAP is recommended as the first line of treatment for patients with severe obstructive sleep apnea. Patients with mild-to-moderate sleep apnea can usually choose which therapy they would prefer.


Surgery
While not considered as the first line of treatment for snoring or sleep apnea, surgery may be an effective option for patients who cannot tolerate C-PAP or oral appliance therapy. With many surgical options available, it is up to the surgeon to find where the obstruction is in the patient’s upper airway or nasal passage and determine what the best solution is. Surgery is typically more effective in the treatment of snoring than for sleep apnea.


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Other Therapy Attempts
Many people’s first attempt at addressing health issues is to see if lifestyle adjustments will improve their condition.  Snoring can sometimes be improved by losing weight, limiting smoking and alcohol intake, or avoiding sedatives.  In some patients, snoring and obstructive sleep apnea are related to sleeping on one's back. In these instances, improvements can be seen by sleeping on the side rather than the back.