also called an apnea or hypopnea, that last long enough so that one or more breaths is missed. This may be accompanied by snoring that a person may or may not even be aware of. In Obstructive Sleep Apnea (OSA), breathing is interrupted by a physical airway blockage. Many OSA sufferers are unaware of their condition, and have simply become accustomed to the daytime sleepiness and generalized fatigue associated with significant levels of sleep disturbance.
Often it’s a spouse or significant other who first becomes aware of a loved one’s sleep disorder. We have a bed partner questionnaire to help you and us determine if a sleep study may be indicated for your partner.
For those who are aware of their condition, the gold standard for treating OSA has long been an oral appliance called the Continuous Positive Airway Pressure (CPAP) machine. Although very effective, many people find the CPAP to be very uncomfortable and cumbersome, and after one year, 67% of CPAP users no longer use the machine. A preferable and more comfortable treatment may be a jaw-aligning oral appliance that repositions the tongue forward and out of the throat, allowing for a clear airway. With more oxygen delivered to the body, you wake up feeling more rested and energetic.
Typically, you would be referred for a sleep study to be performed in a sleep lab or center, where a technician observes your sleep behavior overnight and sends reports to a sleep physician. Our team at ILAS teams with your sleep physician to help you understand the results of your study.
For an at-home option, we offer our guests the opportunity to take home a monitor that can report on the severity of your OSA and provide results within 48 hours. However, a home device is a screening tool and isn’t meant to replace a formal sleep study. Once a sleep physician reviews your report, a recommendation may be made for an oral appliance (made by a dentist) or a CPAP.
Based on our experience, at ILAS we recommend the ARES (Apnea Risk Evaluation System) by Watermark Medical. The device is worn on the forehead and there are no cumbersome leads or wires running from the fingers. It also allows for ease of use if you need to move or get up in the middle of the night.
Number of hours you spent sleeping
Number of times you woke up
The decibel level of your snoring
Your body positioning and how that relates to your snoring
Your oxygen saturation level
Your average pulse rate
The amount of REM vs. non-REM sleep
The number of apneic and hypopneic events
We can custom fit a sleep appliance for you that is worn on your upper and lower teeth. It works by pulling your bottom jaw forward, which also positions your tongue forward, allowing for less obstruction of your airway. Since the tongue is the largest obstacle to airway flow, the appliance opens the airway and allows you to breathe in more oxygen for a better and healthier night’s sleep.
Sleep apnea presents several dangers to your health. When you stop breathing in your sleep, your body actually wakes you up without your consciously knowing it. Therefore, you never fall into a deep sleep, so your body never gets the rejuvenation of a deep night’s sleep. Since both REM sleep and NREM sleep are both essential to health, having sleep apnea can prevent a person from being fully thriving and functional.
Your partner’s snoring may drive you up the wall, but you can use the time you’re lying in bed awake to see if sleep apnea may be the culprit behind the noise. Listen to your partner’s breathing and see if there is a pause in his or her breathing for more than ten seconds. Look for your partner taking an actual breath, not just a quiet spell, as the quiet may in fact mean that breathing and oxygen flow have stopped. Gasping for air after a quiet spell and tossing and turning to open the airways are other signs that sleep apnea may be an issue.
If you don’t have a bedmate who can personally assess your breathing breaks during the night, you can still gauge your risk. Here are common risk factors:
More about sleep apnea treatment options:
Sleep apnea is a serious sleep disorder in which sufferers stop breathing repeatedly in their sleep, sometimes hundreds of times during the night. There are two types of sleep apnea: obstructive and central. Obstructive sleep apnea (OSA) is the more common of the two, and occurs when repetitive episodes of complete or partial upper airway blockage occur during sleep.
During an OSA 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 an instability in the respiratory control center. In other words, the brain momentarily “forgets” to breath. Central apnea is named as such because it is related to the function of the central nervous system. Treatment of central sleep apnea may include: Addressing associated medical problems; Reduction of opioid medications.
Sleep apnea sufferers can choose from a number of treatment options, although none of them offers a perfect solution. The most popular treatment is a Continuous Positive Airway Pressure (CPAP) 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 the levels of airway resistance and pushes air past the swollen tissue so oxygen is delivered. A Mandibular Repositioning Device (MRD) is fashioned by a trained dentist and positions the jaw forward. It has no bells and whistles like the CPAP and may be more highly tolerated. Due to the uncomfortable nature of the CPAP, compliance or continued use after one year is only 33%.
OSA is very common; research has shown that about one in every five adults has enough sleep apnea to be considered abnormal, making OSA about twice as common as asthma. Most people with OSA have only a mild case and most don’t experience daytime symptoms. However, one out of every 20 adults suffers from OSA Syndrome, which is OSA with excessive daytime sleepiness. That means approximately 23 million people in the U.S. have at least mild disease, and 16 million suffer from moderate to severe disease.
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 ten 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.
The human throat is essentially a single tube that must be flexible and collapsible so we can talk and swallow, yet must able to stiffen up to resist collapse when we suck air into our lungs. These actions are completed by a complex group of muscles that change the shape of our throat when we talk and swallow, but then stiffen and dilate the passageway when we breathe in. These muscles work well when we are awake, but like all muscles, they relax and 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.
Other causes include obesity, obesity with a large neck, having tonsils that are too close together, or a small jaw (making for a relatively large tongue.) Diseases such as hypothyroidism (low thyroid hormone levels), unfavorable sleeping positions, and alcohol consumption near bedtime can also make an airway more collapsible.
For some specific cases, the answer is yes, surgery can be a viable option for OSA. However, the majority of patients with OSA are best treated medically. The removal of pharyngeal tissue to open the airway may be indicated for a small percentage of people. At Riley Dental, we always look in the throat to see if a structural tissue problem could be a contributing factor to a guest’s OSA, and we may refer the guest to an ENT (Ear , Nose, and Throat Physician) for a surgical evaluation.
For the vast majority of people with OSA, it is a chronic disease that will likely last a lifetime.
Like other chronic diseases such as diabetes or high blood pressure, OSA can be successfully managed or improved, but not completely cured.
In 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 are very important as a first lifestyle change. Use of a medical device like a MRD (mandibular repositioning device) from a dentist or a CPAP from a sleep physician will likely help.