Snoring and Obstructive Sleep Apnea

What is snoring?

Snoring is a noise created by the partial or total closure of the airway and may often be no more problematic than the nose itself. The sounds of snoring originate in the collapsible part of the airway where there is no rigid support; that is, from the epiglottis to the choanae. It involves the soft palate, uvula, tonsils, tonsillar pillars, base of tongue, and pharyngeal muscles and mucosa. Snoring is a warning that the sleeper may be a victim of obstructive sleep apnea.

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What is Obstructive Sleep Apnea?

Obstructive Sleep Apnea is a serious condition. The airway closes many times during the night significantly reducing oxygen levels in the body disrupting sleep. In varying degrees, this can result in excessive daytime sleepiness, irregular heartbeat, high blood pressure, reflux, depression, heart attack, stroke, and death. Sleep apnea causes a significant drop of oxygen levels in the bloodstream. This raises blood pressure and causes heart rhythm disturbances.

According to findings of a Mayo Clinic study published in the New England Journal of Medicine, approximately 20 million Americans suffer from obstructive sleep apnea (OSA.) They are more likely to die suddenly of cardiac causes between 10 p.m. and 6 a.m. than during the other 16 hours of the day combined. Apoor Gami, M.D., lead author of the study, examined over a hundred death certificates of patients who died of cardiac arrest. More than half (54 %) of the OSA patients died between 10 p.m. and 6 a.m., while only 24% of the 34 cardiac deaths among non-OSA patients occurred during that period.

Apneic episodes can last anywhere between 10 to 20 seconds each, ending with at least a partial awakening when the person can no longer breath. A person experiencing obstructive sleep apnea may have as many as 300 episodes per night.

If a person experiences 30 or more apnea episodes during a seven-hour sleep period, they may be suffering from Sleep Apnea.

Levels of Severity

• Mild – 5-15 episodes per hour
• Moderate – 15-25 episodes per hour
• Severe – 30 or more episodes per hour

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What are some of the signs and symptoms?

Adults

• Heavy Snoring
• Gasping or choking during the night
• Excessive daytime sleepiness
• Frequent arousals during sleep
• Non-refreshed sleep
• Restless sleep
• Morning headaches
• Nausea
• Personality changes such as becoming irritable or temperamental
• Severe anxiety or depression
• Poor job performance
• Clouded memory
• Intellectual deterioration
• Occupational accidents
• Impotence
• Decreased sex drive
• Bruxing
• Dry mouth when you awaken
• Scratchy throat

Children

• Hyperactivity
• Poor concentration
• Developmental delay
• Hyponasal quality to their voice
• Noisy breathers
• Obesity
• Frequent upper airway infections
• Earaches
• Bedwetting
• Nocturnal mouth breathing
• Snoring
• Restless sleep
• Nightmares
• Night terrors
• Headaches
• Chronic nose running

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How is obstructive sleep apnea diagnosed?

A definitive diagnosis of OSA can only be accomplished by a sleep test called a polysomnogram.

During sleep a polysomnogram machine measures ventilation, gas exchange, cardiac rhythm, the number and length of apneic episodes, assesses oxygen saturation, determines sleep stages, and detects arousals. With new mobile sleep technology, this test can be taken in the comfort of your own home. Most medical insurers will require a patient to undergo a full blown PSG (Polysomnography) study in a sleep lab for primary diagnosis prior to paying for treatment. However, patients with a high insurance deductible or with no medical insurance may prefer the relatively low cost of diagnosis with a mobile PSG device.

How is obstructive sleep apnea treated?

There are many treatments for sleep apnea including surgical procedures, Continuous Positive Airway Pressure (CPAP) machines, and oral appliances that keep the jaw in place during sleep.

Practical Measures

1. Lose weight. People with severe sleep apnea are almost always overweight. Losing weight will reduce excess tissue volume in the upper airway, decrease the load in the chest wall and abdomen, and improve respiratory muscular efficiency. In mild cases, weight loss alone may result in a cure. In other cases it enhances the effects of other treatments.
2. Sleep on your side. Many studies have shown that patients who sleep on their back have a significantly higher level of sleep disturbance. It’s believed that sleeping on your back causes the tongue to come in contact with the pharyngeal wall.
3. Avoid alcohol within two to three hours of bedtime. Alcohol is a central nervous system (CNS) depressant and relaxes the muscles that control normal breathing causing the airway to collapse.
4. Avoid certain pharmacological agents. Benzodiazepines, narcotics, barbiturates, and testosterone have all been reported to affect the occurrence of sleep apnea episodes. For example, Flurazepam has been shown to worsen apnea episodes in patients who already suffer from this disease and triggers apnea in patients who have no history of a problem.

Surgeries

Uvulopalatopharyngoplasty (UPPP) was first introduced in 1964 and later in 1981. This surgical procedure enlarges the air space by removing tissue from the palate, uvula, tonsils and pharyngeal walls. Most clinical investigations indicate that the success rate of this surgical approach is less than 50%. This is due to the level and cause of obstruction often being misdiagnosed. Removing some of the vibrating tissues may resolve snoring, but it does not prevent an obstruction by the base of the tongue when the jaw rotates backward during sleep. This is a very serious, expensive, and invasive surgery that is not without complications. Post-operative stenosis (an abnormal constriction or narrowing of the airway), significant post-operative pain, and infection are all possible complications.

A Laser Assisted Uvulectomy (LAUP) is a modification of UPPP surgery. It is accomplished using lasers and is considered a less invasive procedure. It is constantly being used to remove soft tissue of the palate believed to cause snoring.

A Somnoplasty is a procedure which utilizes radio frequencies to heat the tissues of the airway to a very precise temperature creating a finely controlled lesion of coagulation within the tissue. Over a period of four to six weeks, the injured tissue heals and in the process the tissue shrinks and tightens. This technique can be used to reduce excess tissue in the soft palate, the nasal turbinates and the tongue. The procedure generally takes two to three treatments to shrink the tissue enough to have an effect. Patients seem to have minimal side effects making it one of the more promising procedures for treating snoring and sleep apnea.

Continuous Positive Airway Pressure (CPAP)

This technique involves wearing a mask tightly over the nose during sleep. Pressure from an air compressor is used to force air through the nasal passages and into the airway. The forced air keeps the airway open. This treatment is effective but it’s not for everyone. The mask and straps are uncomfortable, it’s inconvenient, it restricts movement and it dries out the airway and can dry out the nose and eyes. One patient described the machine as “blowing air out of every orifice of her head.” Daily compliance by users of the CPAP is less than 50% due to these problems.

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How do dental appliances treat sleep apnea?

Numerous appliances are available to treat snoring and obstructive sleep apnea. Research has shown that many dental appliances are quite effective and can now be considered as an alternative to other treatments. Dental appliances offer several advantages over other treatments. They’re inexpensive compared with other treatments, they’re non-invasive and non-surgical, they're easy to fabricate, and they're custom fitted to your mouth making them comfortable.

Dental appliances work by stabilizing the lower jaw, tongue, soft palate, and hyoid bone into a position to help create a more open airway. The appliance also gives the tongue muscles muscle tone. This increased muscle tone makes the tongue less likely to relax and cover the airway during sleep.

There are many variants of dental appliances that are effective. The Thornton Adjustable Positioner (TAP) appliance, invented by Dr. Keith Thornton, is one of the best designed and is the best researched of them all and therefore our choice for treating snoring and sleep apnea. Dr. Jeff Rouse was personally trained by Dr. Thornton with this treatment method.

The TAP is small plastic device similar to a retainer that’s custom molded from a cast of your teeth. By adjusting the appliance to reposition the jaw, soft throat tissue is prevented from obstructing the airway, thus eliminating snoring and improving breathing. It provides the sleeper with restful uninterrupted sleep, and probably even more important in some cases, allows a bed partner to get a restful night’s sleep as well.

The TAP is custom designed to provide the patient with a comfortable fit. Patients simply have an impression of their teeth made and return in a few weeks to try on their TAP device and take it home. With proper use, the TAP may eliminate snoring and improve nighttime breathing resulting in a great night’s sleep and the start of a healthier lifestyle.

The TAP device may not reduce all sleep apnea symptoms. It may be used in conjunction with a CPAP at a greatly reduced air flow.

If you would like more information about how we can treat OSA, please call us today at 210-828-3334 or email us.

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