Sleep Apnea

Snore Prevention Therapy

If you’ve been told that you’re snoring too much, you’re not alone. Studies show that one in every 10 adults snores. Snoring comes from efforts to force air through an airway that is not fully open. Unfortunately, it often has serious medical consequences. It usually has beginnings in our younger years and evolves into a potentially life threatening disorder called “obstructive sleep apnea” (OSA). Sleep Apnea was listed as the cause of death for football player Reggie White and former supreme court justice Antonin Scalia. There are solutions to reduce your risk of the comorbidities of sleep apnea that are significant health issues.

Is It Snoring, Sleep Apnea or Something Else?

Snoring can be categorized by its severity. Least severe is the benign snorer who snores but experiences no physical problems. Next is the snorer who suffers from Upper Airway Resistance Syndrome (UARS) – they may not experience apnea, but their sleep is non-refreshing, leaving them tired in the morning and late afternoon. The UARS patient will also be told that they grind their teeth a lot. Finally, and most severe classification is the snorer who suffers from sleep apnea.

Stedman’s Medical Dictionary defines “apnea” as the absence of breathing or the want of breath. Apnea occurs when there is a cessation of airflow at the mouth and nose for more than 10 seconds. That means no air for more than ten seconds.

When breathing stops, a listener hears the snoring broken by a pause until the sleeper gasps for air and awakens briefly, though incompletely. The apnea events occur with some regularity even though the patient usually doesn’t remember any of this in the morning. Having five to fifteen such events per hour would be classified as mild sleep apnea. Fifteen to thirty results in moderate apnea and would you believe there are thousands of patients who exhibit more than thirty apnea events per hour. That’s almost one per minute. These patients are classified as having severe sleep apnea.

In addition to excessive daytime sleepiness, studies show that sleep apnea patients are much more likely to suffer from heart problems (heart attack, congestive heart failure, hypertension), strokes, as well as other systemic disease problems like diabetes. Sleep apnea has been shown to speed up the progression of Alzheimer’s disease and Parkinson’s disease. Of course, it also makes sense that apnea patients have a higher incidence of work related and driving related accidents.

Some of the signs of sleep apnea among adults include:

• Heavy snoring
• Gasping or choking during the night
• Excessive daytime sleepiness
• Personality changes or Irritability
  
• Dry mouth when you awaken
• Scratchy throat

What Causes Apnea?

Apneas have long been wrongly considered a factor of weight. The classic OSA patient was a barrel chested, short necked middle-aged men. The thought was that the weight of our body would collapse the airway. More recently it was found that inflammation narrowed the airway and created a more collapseable situation. Now, some of the most current thinking revolves around the body actually holding its breath in an attempt to correct the levels of CO₂. This new thinking has revolutionized the treatment in medicine and dentistry for sleep apnea patients.

Snore Prevention Is Within Reach

Proper diagnosis and treatment of sleep apnea should be handled by a team of healthcare providers that includes a sleep specialist, an ENT, along with Dr. Sharifi. And even after thorough evaluations by our office and your physician, a definitive diagnosis of OSA can only be accomplished by a sleep study called a polysomnogram (PSG). The sleep study is usually performed in a hospital sleep clinic, but can also be completed in the comforts of your own home. The polysomnogram measures ventilation, gas exchange, cardiac rhythm, the number and length of apneic episodes, and more.

Prior to taking a PSG, we offer two levels of screening in our office to evaluate those patients who feel they may indeed be at risk for OSA or its precursor, UARS. These screening levels include a questionnaire that, if supportive of those risks, is followed by an overnight evaluation of your heart rate and oxygen saturation levels as well as movement. While these are a part of the overall polysomnography, this amount of information can be obtained by wearing a small wristwatch while you sleep in your own bed. Interpretation of the data is completed with the aid of a physician and reports are generated to support the divergent pathway of treatment toward sleep apnea or upper airway resistance syndrome.

Treatment of UARS can be done without a PSG and doesn’t often require medical interaction. Instead, there are many personal improvements that can have a dramatic impact on our sleep and our health that we can institute on our own. Reducing inflammation, maintaining an open airway and, most importantly, retraining the process of breathing are all simple procedures that will have an impact on your sleep and health within a matter of weeks rather than months. Download this patient information sheet on Nasal Breathing to learn more.

If you are diagnosed with OSA, we can provide a number of treatment options. There are many surgical procedures that can be done, their success is dependent upon the specific anatomic reason you may exhibit for the many causes for snoring and OSA. Surgical correction should always be considered because it is a 24 hour a day, 365 day of the year treatment to an airway problem. We know these are airway disorders, not sleep disorders. The referral to an ENT is often indicated to consider these surgical solutions.

An old tried and true method of treating OSA that is still prescribed today is Continuous Positive Airway Pressure (CPAP). This treatment involves wearing a tightly fit mask over the nose during sleep. An air compressor forces air through the nose and keeps the airway open. CPAP is effective, but uncomfortable and compliance tends to be low. Clinical research at the VA showed that veterans who used CPAP had the greatest reduction of their OSA, but still had the shortest lifespan because of non-compliance of wearing the device.

Instead, dental appliances have been shown to be an effective method of controlling snoring and OSA. They are desirable because they are non-invasive, inexpensive, reversible, and accepted well by patients. We use numerous appliances in our office – sometimes providing our patients with more than one solution.

It is important to also consult with your physician because OSA has been linked to many other medical conditions. These include increased hypertension, elevated protein levels, initiation of gastric reflux, hypercapnia (elevated blood CO₂), cardiac changes and hypothyroidism. We will work with you – and your physicians – to ensure proper, effective, and comfortable treatment for your condition.

You Can Make A Difference

As with many medical conditions, you can help improve your chances for a better recovery by following these general measures:

• Lose weight (today’s treatment shows that improving apnea results in weight loss)
  
• Sleep on your side
• Eliminate caffeine after 6 pm
• Create a go-to-sleep routine to avoid falling asleep on the couch
• Include a consistent time, dark room, cool temperatures and comfortable bedclothes
• Avoid alcohol within two to three hours of bedtime
• Avoid certain medications including benzodiazepines, narcotics and barbiturates

Following your sleep study, your dental treatment will include an exam and diagnostic models of your mouth. We’ll also may fabricate a diagnostic sleep appliance that same day. The appliance will be modified and adjusted at a follow up visit. A sleep study with your appliance in place confirms the success of our treatment and leads us to fabricate your definitive sleep appliance for long-term use. There is no anesthetic, no drilling. It’s easy.

We look forward to helping you – or your loved one – get a better night’s sleep.