Obstructive Sleep Apnea (OSA)
Obstructive sleep apnea is a very common and potentially life-threatening medical disorder that prevents airflow during sleep. More than 18 million Americans have sleep apnea, and many are not receiving treatment.
Sleep apnea occurs when tissue in the back of the throat collapses and blocks the airway, reducing the amount of oxygen delivered to all of your organs, including your heart and brain. People with sleep apnea may snore loudly and stop breathing for short periods of time. When the blood-oxygen level drops low enough, the body momentarily wakes up. It can happen so fast that you may not be aware you woke up. This can happen hundreds of times a night, and you may wake up in the morning feeling un-refreshed.
In addition to snoring and excessive daytime sleepiness, sleep apnea can cause:
Decreased sex drive
Sleep apnea patients have a much higher risk of stroke and heart problems, such as heart attack, congestive heart failure and hypertension.
Sleep apnea patients are also more likely to be involved in an accident at the workplace or while driving.
Signs of Sleep Apnea
Sleep apnea patients are often older, obese and have thick necks, but men and women of any age or body type can have sleep apnea. This sleep disorder progressively worsens with age and weight gain. Common signs of sleep apnea include:
Unintentionally falling asleep during the day
General daytime sleepiness
Waking from sleep with a choking sound or gasping for breath
Diagnosing Sleep Apnea
A physician is required to perform an overnight sleep study to properly diagnose obstructive sleep apnea. The test, also known as a Polysomnogram, will chart your brain waves, heartbeat and breathing, during sleep. It also records arm and leg movement.
A sleep specialist will look for other conditions that may mimic or worsen the symptoms of OSA, such as:
Another sleep disorder
A medical condition
A mental health disorder
A sleep specialist will consider your symptoms during diagnosis. Prior to the appointment, ask your partner if you snore loudly, stop breathing or gasp for breath during the night.
The sleep specialist will also want to know if you gained weight or stopped exercising before your symptoms began.
Snoring is extremely common and, in many cases, relatively harmless. Nearly everyone snores at one time or another. Occasional light snoring, at worst, is a minor annoyance. Loud and habitual snoring can disrupt your sleep and may be a sign of obstructive sleep apnea.
Snoring is a sound that occurs in the upper airway as you breathe in air. The unmistakable sound is a sign that your airway is partially blocked, usually by soft tissue in your throat. The flow of air causes the soft tissue to vibrate, generating the noise, which comes out of your nose, mouth or both.
The volume of snoring depends on the person. You may snore so loudly you wake yourself up. Snoring may also cause you to have a dry mouth or to wake up with a dry mouth and a sore throat.
Snoring can affect almost anyone.
Habitual snoring has been found in an estimated 24% of adult women and 40% of adult men.
Both men and women are more likely to snore as they age. Men become less likely to snore after the age of 70.
Alcohol, drugs, muscle relaxers and tobacco products contribute to snoring for both men and women.
Obese or overweight people tend to snore because there is more fat tissue in the back of their throats.
Pregnancy can increase a woman's chance of snoring.
An estimated 10 to 12% of children snore.
Snoring appears to run in families.
Is it Snoring or Obstructive Sleep Apnea?
Obstructive sleep apnea frequently goes undiagnosed because people often mistake the serious sleep disorder for snoring. About half of loud snorers have some form of sleep apnea.
Snorers who suffer from sleep apnea may make gasping, choking or snorting sounds as they try to breath in their sleep and feel drained of energy during the day. If you or someone you love experiences habitual, loud snoring like this, it’s time to get tested for OSA.
Oral Appliance Therapy
Oral appliances (OA) are a front-line treatment for patients with mild to moderate OSA who:
Prefer OAs to continuous positive airway pressure (CPAP)
Do not respond to a CPAP
Are not appropriate candidates for CPAP
Fail treatment attempts with CPAP or treatment with behavioral measures such as weight loss or sleep position change
This small plastic device fits in the mouth during sleep like a sports mouth guard or orthodontic retainer. Oral appliances help prevent the collapse of the tongue and soft tissues in the back of the throat, keeping the airway open during sleep and promoting adequate air intake. Oral appliances may be used alone or in combination with other treatments for sleep-related breathing disorders, such as weight management, surgery or CPAP.
Custom-made oral appliances are proven to be more effective than over-the-counter devices, which are not recommended as a screening tool or as a therapeutic option.
Dentists with training in oral appliance therapy are familiar with the various designs of appliances and can help determine which is best suited for your specific needs. A board certified sleep medicine physician must first provide a diagnosis and recommend the most effective treatment approach. A dental sleep medicine specialist may then provide treatment and follow-up.
The initial evaluation phase of oral appliance therapy can take several weeks or months to complete. This includes examination, evaluation to determine the most appropriate oral appliance, fitting, maximizing adaptation of the appliance and the function.
Ongoing care, including short- and long-term follow-up, is an essential step in the treatment of snoring and OSA with oral appliance therapy. Follow-up care serves to assess the treatment of your sleep disorder, the condition of your appliance, your physical response to your appliance and to ensure that it is comfortable and effective.
Advantages of Oral Appliance Therapy
Oral appliances are comfortable and easy to wear. Most people find that it only takes a couple of weeks to become acclimated to wearing the appliance.
Oral appliances are small and convenient, making them easy to carry when traveling.
Treatment with oral appliances is reversible and non-invasive.
How Oral Appliances Work
Reposition the lower jaw, tongue, soft palate and uvula
Stabilize the lower jaw and tongue
Increase the muscle tone of the tongue
Other Treatment Options
There are three primary ways to treat snoring and sleep apnea, in addition to lifestyle changes such as good sleep hygiene, exercise and weight loss.
The most common treatment is Continuous Positive Air Pressure (CPAP). CPAP keeps your airway open by providing a steady stream of air through a tube connected to a mask that you wear as you sleep.
Another option is a surgery performed by an American Academy of Dental Sleep Medicine member who is trained as an oral and maxillofacial surgeon. The surgeon can prevent airway collapses by eliminating tissue in the soft palate, uvula and tongue. More complex surgical procedures can reposition the anatomic structure of your mouth and facial bones.
This information is adapted from the American Academy of Dental Sleep Medicine.