Sleep Apnea and Snoring

Snoring and Sleep Apnea - Your Dentist Can Help...

If you snore loudly and often, you know 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. Even if you have become accustomed to middle of the night elbow thrusts and lots of bad jokes, 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 log-sawing noise that you make comes from efforts to force air through narrowed passageways. Perhaps 1 in every 10 adults snores and for most, snoring has no serious medical consequences. However, for an estimated 1 in 100 persons, habitual snoring is the first indication of a potentially life threatening disorder called "Obstructive Sleep Apnea." Both snoring and sleep apnea are gaining greater recognition among health professionals and the lay public. Your dentist can play a role in the recognition and treatment of both snoring and sleep apnea.

What is Sleep Apnea?

An apnea episode is defined as the absence of breath for 10 seconds or more. Simply put, someone is considered to suffer from sleep apnea if they stop breathing like this for 30 or more times during a normal seven hour sleep period. Typically a person may have as many as 300 apneic episodes per night and some of them may last up to 120 seconds at a t!me.

There are three basic classifications of sleep apnea: Central, Obstructive and Mixed.

Central Apnea

In central apnea, the trouble seems to lie in the part of the brain that controls breathing during sleep. The brain appears to forget to send the necessary instructions to the breathing muscles. In this type of apnea the airway stays open, while the chest muscles and diaphragm stop working. Falling levels of oxygen sound the alarm in the brain, causing the sleeper to awaken and start breathing. Since the airway remains open, the sleeper may not snore.

Obstructive Sleep Apnea

During sleep, muscles, including muscles necessary for breathing, relax much more than they ever do during waking hours. In most people, this normal process causes no problems; sleep is a time of rest. However, for some people, muscles relax excessively, compromising breathing and making sleep a time of danger. Specifically, in obstructive sleep apnea, the muscles of the throat and tongue relax and sag obstructing the airway and making breathing labored and noisy. As pressure to breathe builds, muscles of the diaphragm and chest work harder. The effort is akin' to sipping a drink through a floppy straw, the greater the effort the more the walls collapse. Collapse of the airway walls eventually blocks breathing entirely. When breathing stops, a listener hears the snoring broken by a pause until the sleeper gasps for air and awaken,s, but so briefly and incompletely, that he/she usually does not remember doing so in the morning. When these interruptions of breathing occur, oxygen in the blood drops causing your blood pressure to rise and your heart to work harder. Over time, these episodes of apnea can even be associated with hypertension, stroke, initiation of a gastroesophageal reflex, frequent nocturnal voiding,'susceptibility to atherosclerosis, and stroke or cardiopulmonary problems that can lead to sudden death.

Mixed Apnea

Mixed Apnea is a combination of central and obstructive apnea usually beginning with a central episode being immediately followed by an obstructive one. When this is seen, the obstructive component is treated first. This usually eliminates the problem but when it does not, re-evaluating the patient for a central component will have to be done. People who have mixed apnea generally snore.

Snoring

Many people think that snoring and apnea are the same thing. This is not true. Snoring, which is caused by vibration of the tissues due to air turbulence as the airway narrows, may be a sign that a patient is suffering from apnea. But not all snorers are apneics. Snoring can be categorized by its severity. On one side of the spectrum is the benign snorer who snores but experiences no physical problems. On the other side of the spectrum lies the snorer who suffers from apnea, and in the middle is the snorer who suffers from Upper Airway Resistance Syndrome. These people, they may not actually experience apnea episodes; their snoring is so loud and their breathing is so labored that it can still wake them up numerous times throughout the night. This leaves them unrefreshed and tired throughout the day.

Social Implications

There are also many social reasons to actively treat those who suffer from sleep breathing disorders. These range from husbands and wives who can no longer sleep in the same room, to professional truck drivers who are seeing an increase in accidents and citations for moving violations caused by excessive daytime sleepiness. On-the-job accident rates are also related to sleep apnea.

It has been estimated that the indirect costs of sleep disorders is over 41 billion dollars a year from lost productivity alone; 17 to 27 billion dollars a year from motor vehicle accidents; 7 billion dollars a year in work-related accidents and 2 to 4 billion dollars a year in home and public accidents. Clearly there is a major national problem that needs to be addressed in an appropriate fashion.

Treatment Options - How To Beat The Problem

Many treatment methods have been tried over the years to treat snoring and obstructive sleep apnea. Regardless of the 'technique used, most people benefit by following a few general measures. Some of these guidelines are:

Diet if you are overweight Get regular exercise.
Avoid alcohol prior to going to sleep.
Avoid sleeping pills. Only take over-the-counter medications that have been approved by your physician.
Sleep on your side.

Specific Treatments Nasal CPAP (Continuous Positive Airway Pressure)
The patient wears a mask over his/her nose and the airway is kept open by using a compressor that gently forces air through the nasal passages.

Surgery

Sometimes physical abnormalities like enlarged tonsils, nasal polyps, a deviated nasal septum, and malformations of the jaw or palate can be responsible for snoring and apnea. There are numerous surgical techniques, which are available to help correct these defects.

Dental Appliance Therapy

A dental appliance is a small device similar to a mouthguard or an orthodontic retainer. When worn during sleep, it will help prevent the airway from collapsing by bringing the jaw forward, elevating the soft palate, or retaining the tongue.

Dental Appliances

Dental appliances have been shown to be very successful in the treatment of snoring and are also regularly used in both the diagnosis and treatment of obstructive apnea. Dental appliances offer several advantages over other therapy choices. They are inexpensive, non-invasive, easy to fabricate, reversible, and quite well accepted by patients. The basic indications for dental sleep appliances are to treat primary snoring and mild to moderate obstructive sleep apnea. Appliances are particularly appropriate for those patients who cannot tolerate CPAP. When surgery is contraindicated or the patient is unwilling to go through a surgical procedure, appliance therapy may also be appropriate. Only a specially trained dentist can properly select the appliance that is right for you.

Sleep Quiz - The First Step Answering these simple questions may be the first step to a restful night's sleep for you and your family. The problems listed here may appear suddenly or emerge over many years. It is possible that you are not even aware of them.

We recommend that you discuss these questions with your family members and coworkers, as they may be the first to recognize these signs.

- I have been told that I snore.
- I have been told that I snore loudly, every night, in all positions.
- I have been told that I stop breathing while I sleep.
- I have jolted awake gasping for breath during the night.
- After a full night's sleep, I still wake up feeling tired.
- I fall asleep at inappropriate times, for example, at work or behind the wheel of a car.
- I have trouble concentrating.
- I have become unusually forgetful. - People say, or I feel, I have become uncharacteristically irritable, anxious or depressed.
- I often wake up with a headache.
- I have high blood pressure.
- I am overweight.
- I seem to have lost my sex drive.

IF YOU CAN ANSWER YES TO ANY OF THESE STATEMENTS YOU SHOULD ASK YOUR DENTIST OR PHYSICIAN ABOUT SNORING AND SLEEP APNEA. THE EDUCATIONAL DIVISION OF SPACE MAINTAINERS LABORATORY Copyright@1998 Space Maintainers Laboratory