Obstructive Sleep Apnea
What Causes Snoring?
Snoring is the sound made by the vibration of upper respiratory structures (the soft palate, tongue, and uvula – the little “thing” that hangs down) caused by obstructed air movement during breathing while sleeping. The sound may be soft or loud and unpleasant. The cause may be any of the following: the tongue, soft palate, or uvula falling back into the airway, relaxed muscle tone in the structures of the upper airway, allergies (causing swelling), obstruction in the nasal airway, or fat build-up around the throat.
What is Obstructive Sleep Apnea (OSA)?
Obstructive sleep apnea (OSA) is a debilitating sleep and breathing disorder defined as the cessation of breathing for at least 10 seconds or more (an apnea). During sleep, muscles relax, allowing the tongue and soft palate to collapse into the upper airway (back of the mouth and throat), resulting in blocked breathing. When this blockage occurs, the brain reacts by disrupting deep sleep just enough to start breathing again. These arousals of sleep may occur hundreds of times each night. A sleep apnea sufferer never fully awakens and remains unaware of their loud snoring, choking, and gasping for air typically associated with OSA. OSA sufferers never get “a good night’s sleep” because repeated apneas and arousals deprive patients of REM and deep-stage restorative sleep, leading to chronic daytime exhaustion, mood alteration, and long-term cardiovascular stress.
What Are the Health Implications of OSA?
OSA has a profound impact on an individual’s health. Over the long term, OSA is associated with the following symptoms: snoring, silence followed by a snort and jerk, not feeling rested upon awakening, daytime sleepiness, unclear thinking, emotional instability and depression, GERD (esophageal acid reflux disease), high blood pressure (hypertension), diabetes, heart disease and irregular heartbeat (arrhythmias), stroke, and congestive heart failure. A major risk is deadly motor vehicle accidents; in fact, OSA has been implicated in the Exxon Valdez oil spill in Alaska.
Who Suffers from OSA?
Some studies say that more than 50% of Americans with OSA are undiagnosed. Because of the trend towards increased weight in the US, OSA cases are increasing at an alarming rate. If you or your partner wake up in the morning not feeling rested, you or your partner may have OSA. Many times it is a sleep-deprived bed partner who convinces the apneic patient to seek treatment, but often the apnea goes undetected by the patient and their partner. Some common associations/risk factors with sleep apnea are:
- Neck size in men greater than 17 inches
- Neck size in women greater than 15 inches
- Hypertension and/or diabetes
- Acid reflux disease
- Endocrine or neuromuscular disorders
- Snoring and/or tooth grinding (nocturnal bruxism) at night
OSA is typically medically diagnosed by having an overnight sleep study (polysomnagraphy) done at a sleep clinic where they record breathing, heart rate, oximetry, and brain waves.
Treatment of OSA
The type of OSA treatment depends on the severity of the problem. Treatment can be life-saving for moderate to severe cases. Lifestyle changes can help reduce OSA.
- Weight loss – even small reductions in weight is beneficial.
- Change sleep habits – for some, sleeping on their side instead of their back reduces apnea.
- Alcohol and drug use – Avoid alcohol within 4 hours of sleep, and avoid drugs and sleeping pills that cause relaxation and decreased muscle tone.
- Nasal strips – over-the-counter nasal strips to open the nasal airway are helpful, but it does not affect the mouth or tongue.
- Surgery – painful, 40% successful, but loses effectiveness with time.
- CPAP – a machine that pumps air via a mask worn at night that keeps the airway open is the most effective treatment and has saved many severe OSA patients’ lives. But CPAP compliance is typically low (only 40-55% compliance,) so this leaves many severe apneics at risk.
- Oral appliances – adjustable dental appliances made by a dentist with training in sleep dentistry are effective and approved treatments for moderate sleep apnea as an alternative to CPAP. These appliances are called Mandibular Advancement Splints or Mandibular Advancement Appliances and advance the position of the lower jaw at night and thus keep the airway open at night. These appliances need to be “titrated” by a dentist to find an effective yet comfortable position for a patient. Although sleep partners typically report the cessation of snoring, another sleep study is repeated to verify whether the appliance therapy is successful.