Snoring & Sleep Apnea
If you snore loudly, you know of the social implications of your problem. It's bad enough when your spouse can't sleep in the same room with you, but when your travel companions stop inviting you places because they can't get a decent night's sleep, it may be time for you to do something about it.
Snoring is no laughing matter. It is a signal that something is wrong with your breathing during sleep. It means that the airway is not fully open and the noise you make comes from efforts to force air through the narrowed passageways.
For many people who snore, the problem has no significant medical consequences. However, for others, snoring is the first sign of a potentially life threatening disorder called Obstructive Sleep Apnea.
What Causes Snoring?
During sleep, the muscles and soft tissues in the throat and mouth relax making the breathing airway smaller. This decrease in space increases the velocity of air flowing through the airway during a breathing cycle. As the velocity increases in the constricted space, the soft tissues vibrate producing the classic snoring sound.
What is Obstructive Sleep Apnea?
An apnea episode is defined as the absence of breath for 10 seconds or more. Someone is considered to suffer from Obstructive Sleep Apnea if they stop breathing like this for 5 or more times an hour while sleeping. In severe cases of Obstructive Sleep Apnea a patient can suffer from 30 or more apnea events per hour. When these interruptions of breathing occur, oxygen in the blood drops causing your blood pressure to rise and your heart to work harder. It also disrupts normal sleep cycles causing you to suffer from excessive daytime sleepiness (EDS). That is why some people are chronically tired or sleepy even after "sleeping" for 7 to 8 hours. Over time, these episodes of apnea can be associated with high blood pressure and other cardiovascular diseases, risk for heart attack, risk for stroke, pulmonary hypertension, migraine headaches, hyperactivity in children, memory problems, depression and anxiety, job impairment, and motor vehicle crashes. Bottom line is that Obstructive Sleep Apnea is an extremely serious sleep disorder that can decrease quality of life and significantly decrease life expectancy.
How do I know if I suffer from Obstructive Sleep Apnea?
The only way to know if you have OSA is to be seen by a sleep specialist and be tested. These tests can be performed at a sleep center or at your home and will provide the necessary information to make a diagnosis. The following screening questions are a good start to determine if you need to be evaluated by a sleep specialist:
Do you snore?
Do you have high blood pressure?
Has anyone reported that you choke or gasp for air while sleeping?
What is your neck size? (>17 for men or >15 for women is a concern)
Do you wake refreshed?
Are you excessively tired during the day?
Dr. Johansen is not a sleep specialist and therefore cannot make a medical diagnosis of OSA. He does however work in close collaboration with multiple sleep specialists in the Salt Lake Valley and can help you get in contact with the proper medical professionals.
Treament options for Obstructive Sleep Apnea
A CPAP is a medical device that delivers continuous positive air pressure through a face mask or nasal tube attached to a pump. It is the gold standard of treatment due to the fact that if tolerated it is the most effective treatment of OSA. Unfortunately, approximately 50% of people who need CPAP are unable or unwilling to tolerate it and are therefore required to seek alternative therapy.
Over the years several surgical procedures have been used to address snoring and sleep apnea. These surgeries can be to the soft palate, uvula, and tongue to eliminate the tissue that collapses during sleep. Many of these procedures have not had a high level of success and have therefore decreased in popularity. More complex surgery can reposition the bones of the mouth and face in order to permanently increase the size of the upper airway. This surgery called MMA (maxillomandibular advancement) has proven to be extremely successful in treating OSA for those who qualify for it. As with all surgeries, there is always a risk of complications.
Oral Appliance Therapy (OAT)
OAT is often a viable alternative to CPAP therapy. A specially designed oral appliance repositions the jaw and tongue in a forward position which keeps the airway from collapsing. Dentists who are trained in dental sleep medicine are qualified to fabricate oral appliances.
More information about Oral Appliance Therapy (OAT):
There are many dental appliances that either hold the tongue or lower jaw in a forward position. With your tongue or lower jaw in a forward position, the airway stays open and prevents soft tissue vibrations which cause snoring.
Dental appliances have also been proven effective in treating cases of mild to moderate Obstructive Sleep Apnea. In February 2006 the American Academy of Sleep Medicine stated that oral appliances are the first treatment option for patients who are diagnosed with mild or moderate Obstructive Sleep Apnea. It also stated that: "Oral appliances are indicated for use in patients with mild to moderate OSA who prefer them to CPAP therapy, or who do not respond to, are not appropriate candidates for, or who fail treatment attempts with CPAP."
Since dental appliances are made to fit your teeth with a high level of precision, all necessary dental work should be performed prior to fabricating the appliance.
What is your next step?
If you snore and are interested in Oral Appliance Therapy you need to call and make an appointment to be screened. Dr. Johansen will not make an appliance for someone who snores until they have been screened and tested for Obstructive Sleep Apnea.
If you have been diagnosed with Obstructive Sleep Apnea and you either don't want or cannot tolerate CPAP, Dr. Johansen will work with your physician in order for you to receive any medical benefits that are applicable. Medical insurance companies generally do pay for Oral Appliance Therapy when a sleep specialist is involved in recommending it as treatment.
Children and Sleep Apnea
Does your child snore? 20% do and it is not normal. Of those that do snore 2-3% suffer from sleep apnea. If your child has any of the following symptoms they should be seen by an ENT or sleep specialist.
Continuous loud snoring
Episodes of not breathing at night
Failure to thrive (weight loss or poor weight gain)
Chronic mouth breathing
Enlarged tonsils and adenoids (with frequent sore throat infections)
Bed wetting and restless sleep
Excessive daytime sleepiness
Behavior problems, including problems paying attention, aggressive behavior, ADHD, and hyperactivity.
Facts about snoring and sleep apnea:
An estimated 30 million - or one in eight - Americans snore.
Individuals who snore have a high likelihood of having (or developing) obstructive sleep apnea.
Approximately 18 million Americans suffer from sleep apnea.
Some 28 percent of men over the age of 65 suffer from sleep apnea.
Up to 50 percent of sleep apnea patients have high blood pressure.
Risk for heart attack and stroke also may increase among those who have sleep apnea.
Nearly 60 percent of Americans suffer from daytime sleepiness, a side effect of sleep apnea.
Snoring and mild-moderate apnea is improved and often eliminated in many patients who use oral appliances.
Each year, sleep disorders add an estimated $15.9 billion to the national heathcare bill.
Sources: American Academy of Sleep Medicine, American Sleep Apnea Association and the National Sleep Foundation.
The SomnoDentMAS holds the lower jaw in a forward position so that it does not fall back during sleep, causing the airway to collapse. This appliance has been proven effective in treating snoring and mild to moderate sleep apnea.
The SUAD DeviceThe SUAD Device is a premium oral appliance used in the treatment of snoring and Obstructive Sleep Apnea.
Dr. Johansen is a member of the AADSM. Please click the AADSM logo to learn more about this organization. Their website contains extensive information on snoring, obstructive sleep apnea, and other various treatments that are available to patients.