What is Sleep Apnea?
Sleep apnea, a potentially life-threatening condition, is one of the
most underdiagnosed sleep disorders. Sleep apnea is a treatable disorder
in which a person stops breathing, often hundreds of times, during
the night. Snoring is a cardinal sign that sleep apnea may be present.
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Snoring and Obstructive sleep apnea
The most common form of sleep apnea is associated with obstructions of
airflow to the lungs during sleep due to a collapse of the upper airway
at the back of the throat. During normal breathing in people who do
not snore or have apnea, the airway remains open during sleep. Air
flows freely through the nose past the flexible structures in the throat
and into the lungs.
During snoring however, the muscles relax in the back of the throat, narrowing the airway to a smaller opening. As air is forced through this smaller opening, it causes vibrations known as snoring. Although snoring may be harmless (benign snoring), it can also be a sign of a more serious medical condition which progresses from Upper Airway Resistance Syndrome (UARS) to Obstructive Sleep Apnea (OSA).
Obstructive Sleep Apnea (OSA)
During an apnea event, the muscles in the throat relax and the tongue is sucked against the throat, totally blocking the airway. The entire upper airway is blocked, causing air flow to stop and preventing oxygen from flowing into the lungs. When the oxygen level in the brain becomes low enough, the sleeper partially awakens, the obstruction in the throat clears, and the flow of air starts again – usually with a loud gasp or snort. People with untreated apnea are generally not aware of the awakenings but only of being sleepy during the day.
Obstructive sleep apnea is a life-threatening and life-altering condition
that causes a person to stop breathing repeatedly during sleep. The
oxygen deprivation that results can trigger severe health problems.
The restless sleep that also results from OSA affects the quality of
life of individuals.
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Oral Appliance Therapy
Oral appliances are prescribed as an excellent therapeutic approach
to Obstructive Sleep Apnea. The treatment is simple, reversible,
cost-effective, and is endorsed by the American Academy of Sleep Medicine. Additionally, the appliance has been approved by the Food
and Drug Administration, and has been classified as a medical
device.
The oral appliance is fabricated with an acrylic polymer. It secures
to both the upper and lower dental arches and has a mechanism for adjustment.
Each turn or activation gradually advances the lower jaw, which in
turn gently eases the tongue forward. Therefore, the three-dimensional
size of the airway increases and improves the patient’s ability
to breathe comfortably.
This form of treatment is performed by a dentist. The dentist must not only be expert in assessing
the viability of the teeth and their ability to support the oral appliance, but must be very knowledgeable in the care of the temporomandibular
joints and associated oral structures. Once the physician recommends the oral appliance, a referral is sent to the dentist who proceeds with the fabrication of the oral appliance and the follow-up care relating directly to the appliance.
Follow-up visits by the dentist are necessary to evaluate the health of the oral structures and integrity of the occlusion while using the oral appliance. The patient’s physician will do post treatment testing and follow-up care regarding the patient’s medical progress.
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Sleep Apnea FAQ’s
Click on a question to view the answer
What causes sleep apnea?
The exact cause of obstructive sleep apnea (OSA) remains unclear;
however, there are well documented contributing factors. A primary
risk factor is excessive weight gain with the accumulation of fat on
the sides of the upper airway causing it to become narrow and predisposed
to closure when the muscles relax. Other risk factors may include gender
(males seem to have a greater predisposition), age, enlarged tonsils
and adenoids, or an enlarged tongue. Use of alcohol or sedative drugs
which relax the musculature, and smoking, which may cause inflammation
and swelling can all lead to narrowing of the upper airway. A short,
thick neck is often correlated to obstruction. Studies suggest that
2 percent of women and 4 percent of men over the age of 50 years have
symptomatic obstructive sleep apnea.
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What exactly occurs during obstructive sleep apnea?
When obstructive sleep apnea occurs, the tongue and soft tissues fall
back toward the throat during sleep, totally blocking the airway, causing
a cessation in breathing. The airway obstruction will not clear until
the brain’s oxygen level falls low enough to partially awaken
the sleeper. The tongue then returns to a more normal position, and
the airway seal is broken - usually with a loud gasp. Sleep is extremely
fragmented and of poor quality. People with untreated sleep apnea are
generally not aware of the awakenings. Mild to moderate apneic events
may range from 20 to 40 or more per hour, and increase in severe cases.
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How do I know if I have obstructive sleep apnea—what
are the effects?
People with sleep apnea often feel very sleepy during the day (excessive
daytime somnolence) noticing that their concentration and performance
is suffering. They may be depressed, irritable, have learning and
memory difficulties, and may somewhat frequently fall asleep while
at work, on the phone, driving, or watching a movie. Their bed partners
may complain of hearing heavy snoring from them with an apparent
struggle to breathe.
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How is snoring involved and what causes it?
Snoring is the turbulent sound of partially obstructed breathing during
sleep. When the airway is sufficiently reduced and the flow of air
is partially obstructed, snoring may occur. Large tonsils, a long
soft palate, a large uvula and excess fat deposits, all contribute
to airway narrowing. As air tries to pass through these obstructions,
the throat structures vibrate causing the sound we recognize as snoring.
Loud snoring is a common presenting complaint of those diagnosed
with obstructive sleep apnea. Although, loud snoring does not in
itself mean that one has obstructive sleep apnea.
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How is sleep apnea diagnosed?
The primary care physician may be the first to consult, followed by
other physicians with special training in sleep disorders (usually
a pulmonologist). An overnight sleep study (polysomnograph)
is often recommended. Polysomnography is a test that records a variety
of body functions during sleep: electrical activity of the brain,
eye movement, muscle activity, heart rate, respiratory effort, air
flow, and blood oxygen levels. This test is used both to diagnose
sleep apnea and to determine its severity. Another diagnostic test
is the Multiple Sleep Latency Test which measures the speed of falling
asleep. People without sleep problems usually take more time to fall
asleep than those with sleep disorders. These diagnostic tests are usually performed in a hospital sleep center.
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How can an oral appliance help me if I have obstructive sleep apnea?
Oral appliances are designed to advance the lower jaw and base of the tongue thereby
preventing obstruction of the airway during sleep. Oral appliances vary
in design; however, their function is basically the same. Dentists
with special training in the use of sleep appliances will recommend
an appliance best suited for your medical and dental needs.
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