SLEEP APNEA

Snoring is a problem which plagues many people, and, in particular, their sleep partners. When snoring is accompanied by sleep apnea, the problem goes far beyond disturbing a partner’s sleep.

What is the difference between snoring and sleep apnea?

Snoring is caused by soft tissues of the upper airway collapsing onto themselves and vibrating against each other as we attempt to move air through the area. The sound that is created in this way is snoring. Obstructive sleep apnea occurs when the tongue or soft palate collapses at the back of the throat, blocking the upper airway so that the airflow actually stops. When the oxygen level drops low enough, the brain moves out of deep sleep and a person awakens, often with a loud gasp. They fall back to sleep and the pattern repeats many times over.

The low levels of oxygen lead to a chronic inflammation that accounts for many of the symptoms associated with sleep apnea: elevated blood pressure, heart disease, strokes, sexual dysfunction, diabetes, problems with memory and learning, and increased work related driving accidents.

What warning signs, should you or your partner, watch for?

Loud snoring, which may or not be associated with sleep apnea.

Cessation of breathing while sleeping.

Startled awakenings.

Waking up tired and unrefreshed.

Waking up with a headache and/or a very dry mouth.

Dozing off during the day, especially at inappropriate times.

There are three types of sleep apnea. The most common is called obstructive sleep apnea (OSA). Central sleep apnea, which is rare, involves a problem with the brain signals which tell your body to breathe. The third type is a mix of the first two.

In OSA, like the name implies, there is a problem with obstruction of airflow. It can be caused by enlarged tonsils and/or adenoids (necessitating their removal) or by an enlarged tongue. Being overweight can be a problem. However, 50% of people with sleep apnea are not obese. Nasal congestion and blockages and sinus problems can also be causative.

What can be done? If your sleep apnea is mild, there are several things that may help.

1. Lose weight. Even a 10% loss of weight has helped dramatically in some people.

2. Avoid drinking alcohol. Alcohol increases the relaxation of the tongue and throat muscles blocking air flow.

3. Avoid using tobacco. Tobacco also relaxes muscles and can cause congestion of your nasal passages.

4. Avoid sleeping pills. These also relax your muscles.

5. Sleep on your side. Some people only have a problem when they sleep on their back, as this allows the flesh of the throat to relax back. A simple trick is to place a tennis ball in the small of your back, to make sure you sleep on your side or stomach (try taping the ball to your back).

6. Normalize your sleep patterns. Go to bed and awaken at the same time each day.

If your problem is not helped by any of the above there are other options available.

Some dentists specialize in making appliances, which often are very helpful with sleep apnea or snoring. The appliances move the lower jaw forward, increasing the airway space. Some appliances reposition the tongue and/or the soft palate.

Surgery to remove an enlarged tonsils and adenoids can be helpful. Also, surgery to increase the size of the airway and to remedy nasal blockages may be of benefit. Treatment of sinus problems is also critical.

If none of the above works, you may need to sleep using a CPAP machine. This appliance delivers Continuous Positive Airway Pressure, which keeps the airway from collapsing.

How do you know, if you have sleep apnea?

90% of people who have sleep apnea are unaware of the problem. If you have any of the warning signs, and especially if you have any of the possible concomitant health problems previously mentioned, i.e., hypertension, heart problems, etc., it would be a good idea to the tested for sleep apnea.

Test for sleep apnea is usually done at a sleep center. Here you spend the night hooked up to a device called a polysomnogram. This monitors how often breathing is disrupted, your quality of sleep, heart rate, blood levels of oxygen, and excessive body movement. Based on the results, the severity of sleep apnea is determined and treatment recommendations are given. Many people are reluctant to go to a sleep center, or there may not be one close to where they live.

An alternate solution.

There is now a sophisticated simple disposable instrument, The Sleep Strip®, which can be used in the comfort of your home. After reading about The Sleep Strip®, I started using them in my office. The strip is a small device which is taped between your mouth and nose upon going to bed and removed in the morning. There are three airflow sensors, one below each nostril and one by your mouth. There is a microprocessor, which processes information from the sensor 10 times each second. The results are given as an absolute number corresponding to the severity of the problem. It is a simple, inexpensive way to screen for obstructive sleep apnea. Studies have shown it to be on a par with the results obtained with a polysomnogram.

Because, obstructive sleep apnea can have such a deleterious effect on a person’s health, I would urge anyone who thinks that they may be at risk to be tested.

© 2007, Mark A. Breiner, DDS

The information presented is for educational purposes only. You should consult a qualified dentist or health practitioner for diagnosis and treatment.