Sleep Apnea

Apnea is a Greek word which literally means “without breath.” There are three types of apnea: obstructive, central, and mixed. Out of the three, obstructive is the most widespread. Regardless of the differences in the root cause of each type, in all three, people with untreated sleep apnea will stop breathing repeatedly during their sleep, sometimes hundreds of times during the night and often for a minute or even longer.

Obstructive sleep apnea (OSA) is caused by a blockage of the airway, usually when the soft tissue in the rear of the throat collapses and closes during sleep. In central sleep apnea, the airway is not actually blocked; however the brain fails to signal the muscles to breathe. Mixed apnea, as the name implies, is a combination of the other two. With each apnea event, the brain briefly arouses the person with sleep apnea in order for them to resume breathing, but accordingly sleep is extremely fragmented and of very poor quality.

Sleep apnea is very common, and it is estimated to affect more than twelve million Americans, according to the National Institute of Health. Some risk factors include being male, overweight, and over the age of forty, and having a short neck, however sleep apnea can strike anyone at any age, even children. Several treatment options exist, and research into additional options continues. The link to dental issues has proven to be significant, and we will be looking further into those treatment areas in this and future articles.

The person suffering with sleep apnea may be unaware of these events, even though they may happen as many as hundreds of times a night, however if snoring is involved, their family is almost certainly aware of the problem!. Unaware or not, these airless episodes last 10 to 30 seconds and may cause the patient lots of trouble, especially in the daytime, having been robbed of a restful nights sleep.

Some Symptoms of Obstructive Sleep Apnea (OSA)

• Severe snoring. Most people with obstructive apnea are likely to snore between episodes. Of course, not everyone who snores has OSA, but severe snoring combined with one or more of the following symptoms is a good suggestion that that person should see their physician and request a sleep study.
• Dry, sore throat and nasal passages in the morning upon awakening. A look in the mirror may expose a swollen and red uvula.
• Sore jaws, headaches, neck aches and ear aches when arising in the morning. These are symptoms of TemperoMandibular Dysfunction which is mentioned in our articles covered on TMJ disorder, also.
• Multiple sudden awakenings during sleep. When a person ceases to breathe during sleep, they may wake up, often with a gasp, several times during the night. This may happen literally hundreds of times a night, or perhaps just a few dozen. Not everyone with severe OSA experiences sudden awakenings since many sufferers are simply brought to a lighter level of sleep in which they regain the muscle tone in their throat so that breathing may begin properly again.
• Excessive daytime sleepiness. (hypersomnia) Even if a person with sleep apnea does not completely awaken many times a night, he or she must continuously rise to a lighter level of sleep in order to regain enough control of the throat muscles to relieve the obstruction. This severely reduces the quality of the sleep. Patients with OSA often complain of waking up feeling like they had never slept at all. They often feel worse after taking a nap than they did before napping.
• Sleepiness leads to traffic accidents. Long distance drivers, such as truck drivers, must be especially cautious, and seek treatment if they suspect they may suffer from OSA.
• Restless muscles during sleep. A lack of oxygen in the blood causes muscles to become restless. Persons who suffer with sleep apnea often find their legs in nearly continuous motion during the night, or they may notice themselves kicking during the night.
• Impotence, and/or decreased interest in sex. Sleep apnea has wide ranging physiological and psychological effects, including high blood pressure, slowed heart rate, changes in appetite and diminished sexual arousal.
• Morning headache
• Difficulty staying asleep (insomnia)
• Impaired memory
• Irritability
• Personality changes
• Depression
• Impaired concentration
• Poor job performance
• Sudden death from heart attack or stroke.

Diagnosis of Obstructive Sleep Apnea
Since OSA is potentially a very serious medical condition, it should be diagnosed by a physician. Diagnosis is usually based on the results of an overnight sleep study, called a Polysomnogram (PSG). Other factors of determining OSA are patient evaluation and history.

Treatment Options
Practice good sleep hygiene, meaning no television in the bedroom, no working on the computer the last hour before bed, no alcohol at bedtime, et. Weight loss if necessary and sensible exercises are some helpful OSA treatments a sufferer can practice on their own. However, medical and dental treatments include Continuous Positive Airway Pressure, Oral Appliance Therapy, and surgery.

Continuous Positive Airway Pressure (CPAP)
The Continuous Positive Airway Pressure (CPAP) is pressurized air generated from a bedside machine. The air is delivered through a tube, connected to a mask, which covers the nose. The force of the pressurized air splints the airway open. The CPAP, pronounced C-Pap, opens the airway like blowing air into a balloon; when air is blown into the balloon, it opens and gets wider. This is how the CPAP clears the airway.

Oral Appliance Therapy
Oral appliances are worn in the mouth to treat snoring and OSA. These devices are comparable to orthodontic retainers or sports mouth guards. Oral Appliance Therapy involves the choice, design, shaping and use of a custom designed oral appliance that is worn during sleep. This appliance then attempts to maintain an opened, unobstructed airway in the throat. There are several different oral appliances available. Approximately 40 appliances have been approved through the FDA for treatment of snoring and/or sleep apnea. Oral appliances can be used alone or in combination with other ways of treating OSA. These means include general health, weight management, surgery, or a CPAP unit. Oral appliances work in several ways:

• Repositioning the lower jaw, tongue, soft palate and uvula
• Stabilizing the lower jaw and tongue
• Increasing the muscle tone of the tongue

Dentists with specialized training in Oral Appliance Therapy are familiar with the numerous designs of appliances available. They can decide which one is best suited for your specific needs. The dentist will work with your physician as part of the medical team in your diagnosis, treatment plan, and on-going care. Determination of appropriate therapy can be best made by joint consultation of your dentist and physician. Initiation of oral appliance therapy can take from several weeks to several months to complete. Your dentist will continue to monitor your treatment and evaluate the response of your teeth and jaws.

Surgical Procedures
In addition to Oral Appliance Therapy, dentists who are oral and maxillofacial surgeons may consider a mixture of methods to evaluate, diagnose and care for your upper airway obstruction. These dental specialists treat upper airway obstructive disorders by utilizing both minimally invasive procedures as well as more complex surgery, including jaw advancement. Additionally, an ENT specialist may evaluate you for other types of surgery, primarily the removal of the excess tissues in the throat. It may be required to remove tonsils and adenoids (especially in children), the uvula, or even parts of the soft palate and the throat.

Who treats OSA?
While a dentist may be the first practitioner to identify patients who have sleep apnea, they seldom treat these patients without medical guidance. Pulmonologists and sleep specialists are qualified to certify and treat the disorder; however dentists are becoming more and more accepted by the medical profession as qualified OSA treatment providers.

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