Obstructive Sleep Apnea

OSA is characterized by complete airway obstruction.  It is often found, but not limited to, older, overweight men and affects significant percentages of women and children as well. If someone in your family has OSA, you will be more likely to have it also.  The serious and life-threatening problems start when sleepers begin experiencing apneas, where breathing stops, and hypopneas, where breathing is shallow due to an obstruction. Breathing is usually blocked in the back of the throat because:

  • The tongue and muscles relax during sleep.
  • The lower jaw falls back toward the throat.
  • The airway becomes blocked.

Why Sleep Apnea Occurs

A typical sequence of OSA occurs when a person stops snoring and is silent for seconds, or minutes.  The body’s oxygen level drops and the blood pressure rises.  The heart is forced to beat faster, causing the pulse rate to increase.  The brain may cause the arms, legs or whole body to jerk in an attempt to wake the sleeper so breathing will resume.  The silence may end with a loud snort, cough or gasp.  This causes the sleeper to wake briefly and begin breathing.  Once asleep again, the muscles relax and the airway becomes blocked, cutting off the airway again.  This cycle can occur hundreds of times per night.  Obstructive Sleep Apnea is the most common form of sleep apnea.  It ranges in severity from mild to moderate, to severe.  Other forms of sleep apnea include Central and Mixed Sleep Apnea.

 

What Causes Snoring?

Snoring occurs when the soft tissue structures of the upper airway collapse onto themselves and vibrate against each other as we attempt to move air through them. This produces the sound we know as snoring. Large tonsils, a long soft palate, a large tongue, the uvula, and excess fat deposits in the throat all contribute to airway narrowing and snoring. Usually, the more narrow the airway space, the louder or more habitual the snoring.

 

 

Snoring Relation to Sleep Apnea

Snoring is the sound of partially obstructed breathing during sleep. While snoring can be harmless, it can also be the sign of a more serious medical condition known as Obstructive Sleep Apnea (OSA).When Obstructive Sleep Apnea occurs, the tongue and soft palate collapse onto the back of the throat and completely block the airway, which restricts the flow of oxygen. The condition known as Upper Airway Resistance Syndrome (UARS), is midway between primary snoring and true obstructive sleep apnea. People with UARS suffer many of the symptoms of OSA but require special sleep testing techniques.

Sleep apnea can reveal its presence in a number of ways, and each patient may have a unique combination of symptoms. If you experience any of the following recurring:
  • Excessive daytime sleepiness
  • Morning Headaches / Migraines
  • Snoring
  • Weight Gain
  • Short Term Memory Problems
  • Acid Reflux
  • High Blood Pressure
  • Depression
  • Severe Anxiety
  • ADD & ADHD Symptoms
  • Choking/Gasping sensation that wakes you up
  • Insomnia / Inability to sleep through the night
  • Diabetes
  • Sore Throat / Dry Mouth
  • Slow Metablism/ Inability to lose weight
  • Poor job performance or problems in school
  • Mouth Breathing /Difficult Nose Breathing
  • Restless and tossing and turning during sleep
  • Impotence and/or Decreased Sex Drive
  • Mood Swings / Temperamental Behavior

Since OSA is a serious medical condition, it must be diagnosed by a physician. Once a diagnosis of sleep apnea is made, the severity of the dysfunction can be classified and treatment options will be given.

Sleep Studies

A sleep study gives the best picture of how you breathe when you sleep. It provides information regarding apneas (when breathing stops) and hypopneas (when breathing is shallow due to an obstruction) as well as pulse, blood pressure and other physiological processes such as REM sleep, EEG and leg or arm jerking. Depending on your circumstances, Dr. Willey will recommend either a PSG or a HST.

Polysomnogram (PSG)

A PSG is a sleep study that is done in a sleep lab overnight and monitored by a trained sleep lab technician. The patient is hooked up with wires via sticky electrodes to the apparatus that will monitor their sleep channels. The physician associated with the sleep lab will examine the results and interpret the data collected.

Home Sleep Test (HST)

Home Sleep TestAn ambulatory sleep study, or HST, is a convenient monitoring system that the patient can use in the comfort of his own bed. The HST is a small, portable unit that utilizes wireless technology. The data recorded during sleep is then downloaded to a computer the next day. This data is analyzed by a board certified sleep physician.

 

 

Cone Beam Volumetric Tomography (CBVT)

Dental CatscanLike a Medical Cat Scan, but emitting dramatically less radiation, the Cone Beam is a powerhouse of technology used to view and analyze airway passages, tissues, structure and anomalies from the neck up. A board certified oral and maxillofacial radiologist performs the CBVT read and provides an exhaustive report of all findings. IIDSM uses this information to provide optimal treatment for patients as well as shares the findings with the patient’s physician to partner in patient care.

Good sleep hygiene, weight loss, and exercise are some helpful OSA treatments a patient can practice on their own. However, medical and dental treatments include Oral Appliance Therapy, Continuous Positive Airway Pressure and surgery.

Oral Appliance Therapy

Herbst 3Oral appliances are worn during sleep to treat snoring and Obstructive Sleep Apnea. These devices are similar to orthodontic retainers or sports mouth guards. Oral Appliance Therapy involves the selection, design, fitting and use, and professional titration of a custom designed oral sleep appliance that is worn during sleep. The job of the oral appliance is to prevent the obstruction which occurs when the lower jaw, tongue and tissues in the back of the throat become relaxed during sleep and collapse into the narrow airway space.

 

Oral Appliances are indicated for use in patients with:

  • Mild to moderate OSA who prefer then to CPAP (Continuous Positive Airway Pressure)
  • Severe OSA who do not respond to, are not appropriate candidates for, or who fail treatment attempts with CPAP

Oral appliances may be used alone or in combination with other means of treating OSA. These means include general health, weight management, surgery, or CPAP. Oral appliances work in several ways:

  • Repositioning the lower jaw, tongue, soft palate and uvula
  • Stabilizing the lower jaw and tongue
  • Increasing the muscle tone of the tongue

Oral Appliances should be fitted by qualified dental personnel who are trained and experienced in sleep apnea and the overall care of oral health, the temporomandibular joint, dental occlusion and associated structures.  We will work with your physician as part of the medical team in your diagnosis, treatment, and on-going care.  Initiation of oral appliance therapy can take from several weeks to several months to complete. Once maximum medical improvement is reached, a follow up sleep study with the oral appliance is place is done to determine medical efficacy.  Dr. Willey will continue to monitor patient adherence, evaluate device deterioration or maladjustment, and to evaluate the health of the oral structures and integrity of the bite every six months the first year, and then yearly thereafter.

Advantages of Oral Appliance Therapy

  • Most people acclimate quickly to wearing Oral Appliances
  • Patients who cannot tolerate or refuse to use CPAP now have a non-surgical alternative
  • Oral Appliances are small, convenient and easy to carry when traveling and require no electricity
  • Bed partner approved, discreet and quiet
  • Easy to clean, low maintenance
  • Denture friendly

Follow Up Care

On-going care, including short- and long-term follow-up is an essential step in the treatment of snoring and Obstructive Sleep Apnea 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.

Continuous Positive Airway Presure (CPAP)

Patient wearing Oral Sleep Appliance vs CPAP

Continuous Positive Airway Pressure (CPAP) is pressurized air generated from a bedside machine. The air is delivered through a tube, connected to a mask, covering the nose. The force of the pressurized air splints the airway open. The CPAP opens the airway like air into a balloon; when air is blown into the balloon, it opens and gets wider. This is exactly how CPAP clears the airway.

Surgical Procedures

In addition to Oral Appliance Therapy, dentists who are oral and maxillofacial surgeons may consider a variety of methods to evaluate, diagnose and treat upper airway obstruction. These dental specialists treat upper airway obstructive disorders by utilizing both minimally invasive procedures as well as more complex surgery, including jaw advancement. Additionally, an ENT specialist may evaluate you for other types of surgery, mainly the removal of the excess tissues in the throat. It may be necessary to remove tonsils and adenoids (especially in children), the uvula, or even parts of the soft palate and the throat.

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