| SLEEP APNEA | ||||
| Sleep Apnea Information Sleep Apnea Causes What is Sleep Apnea? |
Sleep Disorders Snoring |
Symptoms Upper Airway Resistance Syndrome (UARS) |
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Sleep Apnea Information Drowsiness during the day coupled with morning headaches, a dry or sore throat in the mornings, nighttime snoring, frequent waking's during the night or waking feeling as though one were choking or gasping could be signals of a more serious illness. If these or other symptoms are presented to a doctor or dentist, he may recommend further testing for sleep apnea. The only way to know for sure is to spend a night at a sleep clinic under the watchful eye of a sleep doctor who will administer tests for facial movements, breathing rate, and snoring. These tests, called polysomnography (PSA) or a sleep test, are done by placing electrodes on the face, belts around the chest and stomach and finger to record breathing and oxygen intake and a snore microphone to capture any night music made. Using the results of the polysomnography a diagnosis as to whether or not the patient has sleep apnea can be given. One of the main complaints that leads people to treatment is nighttime snoring. Often it is the spouse who advises the patient to talk to their dentist or doctor about the problem. Snoring is often associated with sleep apnea. If snoring is heard at night with lapses in breathing and choking or gagging sounds, it could be a sign of sleep apnea. Not everyone who snores suffers from sleep apnea. In order to be diagnosed, the patient must have several episodes where breathing is stopped during the night. Snoring is not the only symptom, thought, and some sleep apnea sufferers never snore. The two main types of sleep apnea depend on the cause. The most prevalent of the two is Obstructive Sleep Apnea (OSA). This occurs when soft tissue in the back of the throat falls in on itself during sleep, blocking the airway. Many dentists have successfully treated this form, usually through obstructive sleep apnea surgery – such as tracheostomy or orthognathic surgery. A dentist might also fit a sleep apnea oral appliance in the patient's mouth to open up the airway at night. The other type is known as Central Sleep Apnea (CSA). This is not as common and results from the brain failing to send the proper signals to breathe during sleep due to problems in the breathing control center of the brain. The patient is more likely to need a continuous positive airway pressure (CPAP) breathing mask to help him sleep if he suffers from this form. The treatment options for sleep apnea depend on the symptoms and diagnosis of the type suffered. Discussion with ones dentist or doctor if sleep apnea or snoring is suspected. The sooner a dentist can begin treatment, the sooner the patient can get a restful night's sleep. Causes
Unlike obstructive sleep apnea, central sleep apnea (CSA) has no known physical deformity at its root. The basis of this affliction lies in the brain. With CSA, the patient's brain does not send the proper signals to the lungs to breathe enough or with regularity at night. Many believe that one cause of this sleep apnea is heart disease or hypertension, as these can both affect blood flow to the brain, which in turn slows brain function. Another possible cause of sleep apnea of this form is drug use, since drugs, especially sleeping medicines and opiates, greatly affect the brain chemistry and function. Due to the fact that a physical problem is not a cause of sleep apnea of the central type, surgery is unlikely to help, but a dentist might fit the patient with a continuous positive airway pressure (CPAP) mask to force air into the lungs during sleep. The goal is to have a constant flow of oxygen to the lungs, so that the patient does not continually awaken at night. The causes of sleep apnea will differ depending upon the type, but once a diagnosis is made, a dentist, oral surgeon, or orthodontist is likely to be the physician the patient turns to for treatment. The experience of the dentist in treating sleep apnea will likely determine the speed in which the patient receives relief from his symptoms What is Sleep Apnea? Imagine spending half of your night under water. Similar to the effects of not being able to breathe under water, apnea is defined as cessation of airflow for more than 10 seconds, which means that patients can go for periods of 10 seconds or more without sending the necessary oxygen they need to their brains. Commonly a side effect to snoring, these periods of cessation repeat themselves as much as 20 times per hour during sleep, increasing the likelihood of serious complications, however snoring is not necessarily an implication of sleep apnea. There are two common types: Central Sleep Apnea (CSA) and Obstructive Sleep Apnea (OSA), each with its own specific symptoms, implications and treatment. This is why it is crucial for your physician to perform the necessary tests to correctly diagnose your sleep disorder as one of the two specific types of apnea before developing a sleep treatment regimen. Central Sleep Apnea is sleep disorder where there is a loss of breathing effort resulting in episodes of apnea, and is common in patients with heart failure, cerebrovascular disease, or in newborns. CSA occurs when the brain fails to send the appropriate signals to the muscles which initiate breathing, which essentially stops the patient from breathing. This interruption of breathing may be due to the immaturity of the respiratory centers of the brain, as in pediatric cases, or due to the presence of drugs, seizures, brain injury or neuromuscular disorders. Obstructive Sleep Apnea (OSA) is the repeated obstruction of breathing during sleep, caused by the collapse of the throat air passage and is common among approximately 17% of middle aged men and women, and also among children. OSA occurs when breathing is obstructed during sleep because of the collapse of the throat and breathing passage. Medical health, age and other factors may contribute to OSA including obesity, abnormality of the facial bones, smoking cigarettes or consuming alcohol. OSA has an even greater impact on co-existing illnesses such as heart failure and stroke, and should be taken seriously by both patient and physician. In addition to CSA and OSA, a small percentage of infants and adults may suffer from “mixed apnea,” showing symptoms of both forms of the sleep disorder. Patients who snore, or are at risk for any form of sleep disorder should look at some of the most common Sleep Apnea Symptoms, or consult their physician or dentist about a treatment option. Sleep Disorders There are several types of sleep disorders, the most common of which are restless leg syndrome, insomnia, sleep apnea, and narcolepsy. With narcolepsy, a person feels extremely drowsy during the day and may even involuntarily fall asleep doing mundane tasks, including driving and reading. In the case of restless leg syndrome, the patient feels that he must move his legs because of an "itching" or "crawling" feeling in the limbs. Both this and narcolepsy have been successfully treated with medications available from ones physician. Other forms of sleep disorders can be helped by a dentist or orthodontist. These include sleep apnea and sometimes insomnia. The underlying causes of these sleep disorders will determine the ability of the dentist to help the patient. Insomnia is often the result of lifestyle factors such as smoking, too much caffeine or other stimulants, and stress. While a dentist cannot change the patient's lifestyle, if stress is causing insomnia, it could have an unwanted side effect – bruxism also known as tooth grinding. Most often the patient himself might not notice a problem aside from daytime sleepiness or some jaw pain, but his spouse will usually hear his tooth grinding at night and beg for treatment. This sleep disorder is a result of stress, the same sort of stress that might lead to insomnia in the first place. If left untreated, bruxism – or tooth grinding – can lead to the wearing away of the tooth surfaces or the enamel. A dentist might even spot the worn surfaces, and ask the patient if he has any sleep disorders. In order to treat bruxism, the dentist will fit the patient with a night guard that is worn at night to prevent the teeth from grinding against each other. These night guards are specially molded by the dentist to fit the patient, and it is the only way to ensure that the night guard will properly work. Over the counter remedies for bruxism are not recommended as they often do not fit properly and may do more harm than good. If a patient exhibits snoring, repeatedly awakening during the night, or stopping breathing several times at night, the dentist might suspect that sleep apnea is the cause. If there is any physical abnormality that blocks the airway, a diagnosis of obstructive sleep apnea might be made. This form of sleep disorder is best treated by a dentist, oral surgeon, or orthodontist with experience in this field. Usually the treatment for obstructive sleep apnea is some form of oral surgery, which requires an experienced expert to conduct. While there are procedures that can be done in the dentist's office such as radio frequency tissue ablation (RFTA) also known as Somnoplasty, most obstructive sleep apnea surgery options will require an overnight stay to ensure that the patient does not have an adverse reaction to the anesthetic or procedure. Depending upon the type of surgery required, a patient may have to follow up several times with his dentist to verify effectiveness. A close relationship with the dentist will help determine the outcome of the treatment of this sleep disorder. Snoring If a patient is only snoring, his physician might recommend an overnight sleep study, called a polysomnography. The results of the tests run during the study will tell if sleep apnea snoring is the problem. Unlike simple snoring, sleep apnea snoring disrupts breathing for 10 seconds or more sometimes up to 100 times a night. During each of these episodes, the patient briefly wakes up, although he may not remember it the following day. Constantly awakening at night can cause daytime fatigue and impaired function. Sleep apnea snoring is a serious condition that requires experienced treatment for the sake of the patient and his family. Once diagnosed, the patient can begin to seek treatment. He will need to consult with his dentist who will discuss the treatment options, many of which he can offer. Often the root of sleep apnea snoring is some sort of obstruction of the airway, usually from the muscles at the back of the throat relaxing and allowing the soft tissues there to sag, when those tissues vibrate, sleep apnea snoring results. This is called obstructive sleep apnea. Depending on the physiology of the patient, the dentist might recommend several options. To alleviate sleep apnea snoring, the dentist might fit the patient with a sleep apnea oral appliance. This device is worn at night to keep the airway open and to prevent the tissue vibrations heard as sleep apnea snoring. Some patients do not respond well to the sleep apnea oral appliance. In those cases, surgery might be an option. As with any surgery, the patient must find an experienced oral surgeon or orthodontist, depending on the procedure. Obstructive sleep apnea surgery options vary from the simple in-office radio frequency tissue ablation (RFTA), also known as somnoplasty, procedure to the more complex Maxillomandibular advancement that involves surgery to move the position of the upper and lower jaw. A dentist or oral surgeon is likely to try the simplest first, perhaps coupled with other treatments to ensure success with the least amount of invasiveness. An experienced oral surgeon will also increase the likelihood for success and the quickest relief of symptoms. Sleep apnea snoring can lead to more serious conditions. Prompt addressing of this sleep disorder is critical to keep the increased risks of heart heart, stroke, and auto accidents to a minimum. The best treatment can be found from an experienced oral surgeon, dentist or orthodontist. His professional knowledge will guide the patient through the optimal course of action, with the least amount of invasiveness. By closely working with ones dentist, oral surgeon, or orthodontist, sleep apnea snoring can be cured or at the very least, reduced to a manageable condition. There is hope but only if help is sought promptly. Symptoms Medical dictionaries define snoring as a rough, rattling noise made while breathing during sleep, caused by the vibration of the back of the roof of the mouth and the uvula (dangling structure at the back of the mouth). When a person inhales and exhales, air is on its way to the lungs, traveling past the tongue, through the soft palate, uvula, and tonsils. When awake, the muscles in the back of the throat tighten, holding these structures in place, which prevents them from collapsing and vibrating in the airway. For a patient who experiences sleep apnea symptoms, the soft palate and uvula may collapse during sleep, resulting in snoring, cessation of breath or choking. More important than damaging personal relationships, the act of persistent snoring can be a symptom of a sleep-breathing disorder that narrows the airway and decreases oxygen flow to the brain. Often one of the leading sleep apnea symptoms, snoring can also contribute to the development of high blood pressure, as well as heart and lung complications, and thus, should be taken very seriously. Frequent snoring is one of many sleep apnea symptoms, which include partial or complete cessation during sleep, reductions in blood oxygen levels, severe sleep fragmentation, or excessive daytime sleepiness. One of the more severe sleep apnea symptoms involves the complete cessation of breathing during sleep, which is a sign of moderate to severe sleep apnea. In this instance, patients experience a pattern of snoring where the patient snores loudly up to a certain point where, for a period of time—about 10 seconds or longer—they’ll stop breathing completely. Then all of a sudden, the sleeping patient will open their mouth and gasp for air, sometimes experiencing a choking sensation. This vicious cycle can repeat itself several times an hour, during a single night. Loud snoring, or periods of sleep where the patient does not receive air for 10 seconds or more are two obstructive sleep apnea symptoms that lead to two significant, but treatable medical problems: 1) Neuropsychiatric problems--patients are frequently significantly sleep deprived, which can lead to depression, cognitive changes, anxiety, or personality changes. 2) Cardiovascular problems such as hypertension, congestive heart failure, coronary artery disease, or even cerebral vascular disease including stroke. Sleep apnea symptoms and signs are often overlooked, because most people discount snoring to gender, age or genetics, however the lack of restful sleep can contribute to a variety of medical conditions and disorders unrelated to sleep including weight gain, muscle fatigue and pain, acid reflux disease, or more. This is why it is necessary to speak with your dentist about treatment options if you or your loved ones experience any sleep apnea symptoms or snoring, so you and your family can improve the quality of your health—one night at a time. Upper Airway Resistance Syndrome When a patient is referred for a polysomnography, they will undergo a painless, drug-free procedure that lasts for at least one entire night, and sometimes two. During the study, electrodes are placed around the face and head to measure facial movements and brain waves. Bands are fitted around the abdomen and tubes are placed near the nose and mouth to measure breathing, and sensors on the chest show heart rate. For a diagnosis of Upper Airway Resistance Syndrome (UARS) the breathing rate is the most important. The sleep doctor will see if the patient wakes up during the night because his airway relaxes and constricts. This narrows the airway, thereby reducing the amount of oxygen that can get to the lungs. The patient will feel this in his sleep as a difficulty in breathing and wake up as a result. Several episodes will happen a night, as the airway opens back up once the patient awakens but constricts again when he relaxes in sleep. In its repetitiveness and sleep disruption, it is similar to sleep apnea, but the two differ in key ways. Unlike sleep apnea, Upper Airway Resistance Syndrome (UARS) does not cause a complete stoppage of breathing. Instead, of the airway being blocked - as it is with sleep apnea, muscles that support it relax too much during sleep, and the airway does not hold itself open fully. The result is the patient awakening because he has a sensation of breathing through a straw. This can happen several times a night and severely disrupt sleep patterns. Like sleep apnea, the consequences of untreated Upper Airway Resistance Syndrome (UARS) can be serious. Due to daytime sleepiness, accident rates increase, and productivity decreases. Once a diagnosis of Upper Airway Resistance Syndrome (UARS) is made, the patient may be referred to a dentist or orthodontist for treatment. Surgery is not often performed for Upper Airway Resistance Syndrome (UARS), rather, the patient will likely be fitted with an oral appliance. These are the same oral appliances that are designed for those suffering from sleep apnea. This is because the treatment for Upper Airway Resistance Syndrome (UARS) is the same as it is for mild to moderate sleep apnea. For the best fit of the custom-made oral appliance, the patient should seek out a qualified, experienced orthodontist. A professional who has previously made these devices will be able to craft the it for the patient with the least amount of discomfort and the fewest return visits for refitting. The proper fit for an oral appliances is essential in treating Upper Airway Resistance Syndrome (UARS), since this appliance is the only thing that is keeping the airway from constricting at night. If the device is not molded properly to the patient, it will not work and troubling symptoms will continue.
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Occasional daytime sleepiness or snoring are often problems for most Americans, but some people find that it is a more chronic condition. Too rarely do they consult their dentists or doctors. While there are many sleep disorders suffered by Americans, what many mistake for being tired during the day, or just a loud snorer at night, could be caused by sleep apnea, and left untreated, studies have shown that it could lead to an increased likelihood for car accidents, high blood pressure, stroke, diabetes, pregnancy complications, or heart failure. Daytime sleepiness and snoring are serious issues that should always be discussed with a dentist or a physician, both of whom can treat them, since it can influence so many aspects of ones life. 
Obstructive sleep apnea is the most commonly seen form, and many dentists and oral surgeons have many years' worth of experience treating it. Several factors could be causes of sleep apnea of the obstructive kind. Occasionally in people, the muscles at the back of the throat relax too much. This leads to the soft tissues such as the tonsils, tongue, and uvula to sag down and temporarily block the airway. Usually, this occurs more often when the patient is asleep on his back. Alcohol, tranquillizers, and sleeping pills are designed to relax the entire body, and as a result these can lead to sleep apnea, disrupting the patient's slumber rather than aiding it. It is not just a matter of the muscles relaxing. Anything that constricts the airway can cause sleep apnea. A naturally narrow neck or throat or swollen tonsils or adenoids could be a risk factor since all of these could block the airway and cause sleep apnea.