Obstructive Sleep Apnea/Snoring

Do you sleep well? Would you know if you didn’t?

We try to make wise decisions while we are awake. We try to eat well and exercise when we can. When necessary we take medication to control our blood pressure, our heart rhythm and our blood sugar because we know how important those factors can play in our longevity and potentially our quality of life. We even visit our dental team twice a year to help keep our mouth’s healthy. So we do the right thing while we can, while we are in control of our bodies.

What about when we aren’t in the driver’s seat? We spend a third of our lives sleeping. Most of us assume that when we are sleeping we allow our bodies to recuperate rest and heal. In many people that is exactly what sleep does. For others however, the opposite is true. Even worse, 85% of these people have no idea that they aren’t getting a restful night’s sleep.

The American Academy of Sleep Medicine is the authoritative body that classifies sleep pathologies from Restless Leg Syndrome to Obstructive Sleep Apnea and Snoring. It is the latter two that pertain to Dental Sleep Medicine and will be discussed further here.

Snoring

Snoring can be a completely harmless event resulting from the relaxation of your throat muscles as you fall deeper into sleep. Primary or ‘benign’ snoring sounds like a regular and continuous purring as you inhale. This type of snoring, while potentially distracting to other sleepers, has no detrimental effect to your health.

In some snorers however, as the muscles of the throat relax and the throat closes as a result, the flow of air does become restricted. The purring sound becomes higher pitched as airflow becomes more obstructed and the sounds have more of a crescendo (increasingly louder) quality rather than a consistent rhythm. This is a pathological snore and clinically is called Upper Airway Resistance Syndrome. As the oxygen decreases in the bloodstream due to the air restriction, your body actually wakes up slightly (called a micro arousal) to allow for the muscles in your throat to flex a bit to reopen the collapsed airway. This happens repeatedly throughout the night and every time this occurs you have compromised your quality of sleep and you will be less rested in the morning. Think about what that means for everyday of your life if you are less rested than you could be!

That is what happens in sleep apnea.

Sleep Apnea (Obstructive Sleep Apnea or OSA)

It is estimated that 30-50% of snorers actually suffer from sleep apnea. The difference between a snorer and someone who suffers from sleep apnea is that with sleep apnea the entire airway actually collapses so that there is absolutely no flow of air into your body. As this happens, the oxygen level in your blood stream decreases and you essentially suffocate while you sleep. As your oxygen levels drop, the brain is forced to wake you up enough so that the muscles in your throat flex. This opens the airway and allows you to gasp for air to recover from the suffocation (we rarely wake up enough to actually realize this is happening). This chronic activity while you’re sleeping has an enormous impact on the overall health of your body and mind. Imagine if you spend the whole day holding your breath until you had to gasp for air, over and over again?!?!? That is what happens in sleep apnea.

How dangerous is this? Here are the sobering facts about what suffocating in your sleep really means:

• The blood vessels of the heart become more prone to taking on plaque deposits leading to a much higher likelihood of having a heart attack-especially in your sleep.
• You are 26x more likely to have a stroke.
• Having high blood pressure becomes much more difficult to control and becomes more severe.
• Diabetic complications are more likely because your body has a much harder time regulating blood sugar levels.
• All the above circumstances make losing weight more difficult (which is a terrible predicament because weight loss is critical in treating sleep apnea)

This ends up creating or contributing to a cycle of problems where you have high blood pressure and high blood sugar, increased coronary artery disease and a much more difficult time treating and improving these problems. This phenomenon is called the Metabolic Syndrome; a common disease in industrialized nations where the obesity epidemic is on the rise.

Obstructive sleep apnea affects an estimated 9% of men and 4% of woman in North America. These rates are on the rise and the most frightening statistic is that about 85% of people suffering from sleep apnea aren’t aware they have it. The overall burden on the people with apnea, their family and colleagues and society as a whole is staggering. Here are some of the issues that sleep apnea can cause:

• Increased rate of motor vehicle accidents
• Increased work related accidents
• Poor job performance
• Marital and family discord
• Depression
• Decreased quality of life

Here are the most common signs and symptoms of OSA:

• Snoring intermittently with pauses
• Excessive daytime sleepiness
• Awakenings with gasping or choking
• Fragmented, non refreshing light sleep
• Poor memory, clouded intellect
• Irritability, personality changes
• Decreased sex drive, impotence
• Morning headaches
• Gastro-esophageal reflux (GERD)

Obstructive sleep apnea can only be tested for and diagnosed by a sleep physician. At Retter Dental Care we have joined a network of health professionals to effectively screen for and refer patients who need to be tested and treated for sleep apnea.

The primary treatment for OSA is the CPAP (continuous positive air pressure) machine. This device uses a mask that flows air with enough pressure to reopen the airway while you sleep.

In instances of mild to moderate sleep apnea (as determined by your sleep physician) there is another alternative for patients who cannot tolerate the CPAP machine. The OAD (oral advancement device) is a dental device that patients wear when they sleep. It causes the patient to close their lower jaw into a more forward position while they sleep. As the lower jaw is advanced into a more forward position, it has the natural effect of opening the airway enough to allow proper airflow. This can also be used to treat snoring. In certain cases a CPAP and an OAD are worn together.

Our primary concern at Retter Dental Care is to ensure that our patient community is in their best attainable overall health. If you, a loved one or a colleague is snoring, suffering from someone who snores or is not feeling well rested, we are always here to take a look and refer you in the right direction.