Snoring and Sleep Apnea

Airway, Snoring and Sleep Apnea

Dr. G. Lecours has been closely mentored by Dr. Steven Olmos of the TMJ & Sleep Therapy Centre’s International. Dr. Olmos graduated from the University of Southern California’s School of Dentistry and has dedicated the past 25 years to the fields of craniofacial pain, TMD and sleep disordered breathing. He has extensive post graduate education and board certifications in both craniofacial pain and dental sleep medicine. Dr. Olmos is an adjunct professor at the University of Tennesse College of Dentistry, where his system diagnosis and treatment are utilized at the school’s Craniofacial Pain Center. He is currently directing research in these fields through data collection at 21 TMJ & sleep Therapy Centre’s spanning 5 countries including the Craniofacial Pain Center at the University of Tennesse – making him an ideal mentor for Dr. Lecours.


What is sleep apnea and how common is it?

Sleep apnea is a type of sleeping disorder that involves pauses, instances of shallow or irregular breathing during sleep. Each pause, or apnea, can last from several seconds to several minutes and may occur 5 to 30 times or more per hour. These pauses affect a person’s quality of life both asleep and awake. A recent study has identified sleep apnea as common as 1 in 5 people having at least mild obstructive sleep apnea. 9 out of 10 people living with sleep apnea don’t know they have it. Usually sleep apnea is first detected by a bed partner noticing the person is having difficulty breathing while asleep. If left untreated, sleep apnea can be dangerous to your health. One of the most important things about this disorder is that sleep apnea can be successfully treated.


Is all sleep apnea the same?

No, there are 3 main types:

  1. Cental Sleep Apnea (CSA) – Is a rare type of sleep apnea which occurs when the brain signal that instructs the body to breathe is delayed. This central nervous system form of the disorder can be caused by a disease or injury involving the brainstem such as stroke, brain tumor or aneurism, a viral brain infection or a chronic respiratory disease.

  2. Obstructive Sleep Apnea (OSA) – Is the most common type of sleep apnea. This form of the disorder is caused by a breathing obstruction. Normally, your throat muscles keep your throat airway open while you sleep but with OSA your throat collapses during sleep blocking the airway and preventing air from getting to your lungs.

  3. Mixed sleep apnea – Is a combination of the two other types of sleep apnea, CSA and OSA.


What are the most common causes of sleep apnea?

  • An irregular shape of your head and/or neck (bony structure) may cause a smaller airway size in the mouth and throat area.

  • Throat muscles and tongue relax more than normal during sleep. (This may, but not necessarily, be due to alcohol or sedative use before bed)

  • Large tonsils and/or tongue, adenoids or other anatomical differences such as a deviated septum, enlarged tongue, or receding chin

  • A weakened brain signal to your throat muscles may allow them to result in your loosen therefore narrowing or collapsing your airway


 

Other risk factors include:

  • Irregular sleep hours

  • Being overweight or obese. Soft fat tissue can thicken the wall of the windpipe resulting in a narrow windpipe – making it harder to keep open

  • Snoring - Snoring can cause the soft palate to lengthen, which in turn can obstruct the airway

  • Smoking or secondhand smoke exposure

  • Nasal congestion, nasal blockages, and nasal irritation

  • Family history of sleep apnea - No genetic marker for sleep apnea has been identified, but obstructive sleep apnea seems to run in families.

  • Other disorders and syndromes - Hypothyroidism, acromegaly, amyloidosis, vocal cord paralysis, post-polio syndrome, neuromuscular disorders, Marfan's syndrome, and Down syndrome.

  • Other physical conditions, such as immune system abnormalities, severe heartburn or acid reflux and high blood pressure. It isn’t clear whether the conditions are the cause or the result of sleep apnea.


What are the signs and symptoms of sleep apnea?

  • Recurrent pauses in breathing. Perhaps frequent silences from your side of the bed noticed by your sleep partner.

  • Choking or gasping during sleep to get air into the lungs

  • Loud snoring

  • Abrupt awakenings to restart breathing

  • Waking up in a sweat during the night

  • Feeling unrefreshed in the morning after a night’s sleep

  • Headaches, sore throat, or dry mouth in the mornings after waking up

Daytime sleepiness, including falling asleep at inappropriate times, such as during driving or at work


Is snoring the same as sleep apnea?

No, sleep apnea and snoring are not the same. Snoring is simply a loud sound that you make during breathing while asleep. Although sleep apnea is commonly accompanied by snoring, snoring does not mean you have sleep apnea.


How can I get diagnosed for sleep apnea?

Before you talk to your doctor for possible diagnosis, ask your sleep partner to keep a diary for a few nights for you to record whether you are asleep or not, whether it sounds like you are having a hard time sleeping (choking or gasping), and how loud you are snoring. If you are without a sleep partner you can try to record yourself sleep with a sound activated device. If you do not have a recording device try asking a friend or family member to monitor your sleep pattern for a few nights, or you can visit a sleep center for observation.

With your sleep diary in hand, visit a knowledgeable doctor or dentist. The possibility of sleep apnea will then be assessed by the doctor or dentist by:

  • Performing a physical examination of your nose, mouth and throat for obstructions

  • Possibly doing an endoscopy of your nose and throat, and x-rays or a CT scan of the head and neck

  • Recommending an overnight sleep study


How does sleep apnea affect my health?
What happens when I stop breathing during sleep?


When you stop breathing during sleep your body receives less oxygen. The blood imbalance between oxygen and carbon dioxide stimulate the brain to restart the breathing process – often signaling you to wake up so that the muscles of the tongue and throat can increase the size of the airway. Then, carbon dioxide can escape, and oxygen can enter the airway. These waking episodes are necessary to restart breathing and to save your life however, you become sleep-deprived.

The main effects of sleep apnea are:

  • sleep deprivation, and

  • oxygen deprivation



Sleep deprivation

Sleep apnea not only reduces the quality of sleep you’re having but the bed partner also typically suffers from sleep deprivation as well. A bed partner may lose an hour or more of sleep each night from sleeping next to a person with sleep apnea.

Other implications of sleep deprivation are:

  • Low energy

  • A negative mood, irritability

  • Daytime sleepiness

  • Poor mental and emotional health

  • Decreased productivity

  • Unclear thinking, lack of concentration

  • Slower reaction time

  • A compromised immune system and slower healing

  • Oxygen deprivation



Oxygen deprivation

When you stop breathing your brain does not get enough oxygen to function efficiently. Severe problems can arise from oxygen deprivation resulting from sleep apnea which include:

  • Insomnia, restless sleep

  • Sexual dysfunction such as impotence or reduced libido

  • Heart disease, heart failure, or heart abnormalities such as arrhythmia (irregular heart beat)

  • Type II diabetes

  • Stroke, high blood pressure (hypertension), and other cardiovascular system problems

  • Memory problems, learning difficulties, and lack of attention

  • Increased involvement in auto accidents

  • Changes in weight

  • Morning headaches

  • Premature death, such as Sudden Infant Death Syndrome (SIDS)

  • Major Depressive Disorder (MDD)

Other, non-serious effects of sleep apnea are:

  • Loud snoring

  • Dry mouth in the morning

  • Frequent bathroom visits to urinate during the night

  • Heartburn

  • Heavy sweating during sleep

  • In children, a concave chest during sleep


What are the treatments for sleep apnea?

Luckily sleep apnea can be easily treated. The type of sleep apnea determines which type of treatment works best for you. Treatments include:

  • Behavioral treatments for sleep apnea (self-help)

  • Physical or mechanical therapy or treatment for sleep apnea, including surgery

Medication is generally ineffective at treating sleep apnea. However, may wish to try several treatments, either in succession or simultaneously to determine which works best.

 

What can I do to help with mild sleep apnea?


Weight loss – Overweight or obese individuals that lose as little as 10% of their body weight can significantly improve their quality of sleep and reduce their sleep apnea.

Avoid sedative/depressants – Avoid the use of alcohol, tobacco, and sedatives such as sleeping pills – eliminating the use of alcohol, tobacco, and sleeping pills can reduce the likelihood of airway closure during the night.

Sleep on your side – Typically people only experience sleep apnea when they sleep on their backs. Therefore, it may be beneficial to use special pillows or folk remedies that encourage side-sleeping, such as the golf ball trick.
Regular sleep hours – Irregular sleep hours can throw off your circadian sleep cycles and lead to breathing problems during the most important sleep stages. Stabilizing bedtime hours and eliminating disturbances to your sleep can help reduce sleep apnea.

What are the treatment options for sleep apnea?

Snoring and obstructive sleep apnea (OSA) can be treated with lifestyle changes (such as weight loss, change of sleeping position, avoidance of alcohol or smoking, relief of nasal obstruction), CPAP therapy (a medical device that blows air into your nose and opens your airway), oral appliances (small, plastic devices that are worn in your mouth to hold your tongue and jaw forward), surgery or by a combination of these treatments. Physical devices and mechanical therapies are often effective in treating sleep apnea. These treatments for sleep apnea are:

  • Continuous Positive Airway Pressure (CPAP)

  • Dental appliances or jaw adjustment devices

  • Oxygen administration

  • Surgery

Continuous Positive Airway Pressure (CPAP) - To keep your airway open during sleep, a machine at your bedside blows pressurized air into a mask that you wear over your nose or face. Very common long-term treatment for severe sleep apnea.

Dental appliances, oral devices, and lower jaw adjustment devices - Opens your airway by bringing your lower jaw or your tongue forward during sleep. Most dental devices are acrylic and fit inside your mouth, much like a mouth guard or orthodontic appliance. Some others fit around your head and chin to adjust the position of your lower jaw. Two most common oral devices are the Mandibular Repositioning Device and the Tongue Retaining Device.

Oxygen administration – is rarely used but may be used in addition to CPAP. A narrow tube runs from an oxygen source to your nose, where the tube ends in small plastic prongs that fit into your nose ensuring that you get enough oxygen during sleep.

Surgery - Increases the size of your airway by surgically removing tissues. The surgeon may remove tonsils, excessive fat, adenoids, or excess tissue at the back of the throat or inside the nose. In some instances the surgeon may even reconstruct the jaw. The surgeon operates with a scalpel, a laser, or a microwaving probe (radiofrequency energy).

Oral Appliance Approach

A traditional treatment is to have a dental appliance made to wear during sleep which gently slides the lower jaw forward causing a positive change in tongue position – opening the airway. Advantages of an oral appliance over other therapies include:

  • Reversible

  • Inexpensive cost

  • Non-invasive

  • Easily received by patients

As a specialized member of the health professional sleep apnea team, a trained dentist will complete a medical and dental history and perform an intra-oral exam to determine where the blockage is and what is causing the obstruction, including:

  • tonsil exam

  • intra-oral habit assessment

  • airway evaluation

  • periodontal health exam

  • x-rays and diagnostic model

  • gag reflex check

  • TMJ and occlusal exam

  • orthopedic exam

If oral evaluation reveals an airway restriction due to chronically enlarged tonsils, an enlarged tongue or soft palate abnormality, a dental appliance can be a successful treatment for snoring and/or obstructive sleep apnea.

Studies have shown that appliances are very effective when choosing a treatment modality - especially as an alternative treatment to Continuous Positive Airway Pressure (CPAP) or surgery.

Oral appliances worn during sleep create extra space and prevent the airway from collapsing. While many models of appliances are available to treat snoring and obstructive sleep apnea (OSA), only a specialized dentist can properly select and fit the type of appliance that is necessary.

Most dentists who treat TMJ (temporomandibular joint disorders) are an excellent choice, because they are very much familiar of the jaw position, which is crucial, when making an effective device. TMJ appliances can often be modified to work for sleep apnea. Appliances are light and easy to wear. Most patients become comfortable wearing an oral appliance in as little as a few weeks.


 

About Snoring

Moderate to severe levels of snoring may really be obstructive sleep apnea (OSA) otherwise termed "sleep disordered breathing." To correctly identify the disorder, there are simple, cost-effective sleep screening tools used by a trained sleep dentist.

Snoring is a noise that may occur while someone is sleeping. The actual snoring sound is produced from the vibration of the soft palate and sides of the throat when air rushes against them.

The sound of snoring occurs when the airway collapses and the muscles fail to maintain their normal function. Some factors that may contribute to snoring are:

  • overweight

  • a small retruded jaw

  • sedatives before bed

  • allergies

  • alcohol before bed

  • airway obstruction

Recently, snoring has been acknowledged as a warning sign that normal breathing is not taking place. For the majority of adults, snoring does not involve a serious medical disorder. Nevertheless, snoring may be the first sign of obstructive sleep apnea (OSA).


Understanding Sleep Apnea

A person is considered to have sleep apnea when they stop breathing for at least 10 seconds up to thirty times or more a night.

Snoring may be indicative of sleep apnea, a cessation of breathing during sleep, which can put a great strain on the cardiovascular system. This is why sleep apnea, left untreated, increases risk of heart attack and stroke.

Aside from snoring, other common symptoms of sleep apnea include:

  • morning headaches

  • dry mouth and throat

  • excessive daytime sleepiness

  • sudden short-of-breath awakenings, choking or gasping

  • sexual dysfunction

  • lowered energy levels

A lack of sleep affects our day-to-day lives in addition to those around us.