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Sleep Apnea

 What is Sleep Apnea?
Obstructive Sleep Apnea (OSA) is a sleep breathing disorder in which a person stops breathing while they sleep. The tissues in the throat collapse, cutting off the airway despite efforts to breathe. Apnea is defined as "a cessation of airflow for 10 seconds or more." This can occur dozens and sometimes even hundreds of times an hour.

Typically, someone with sleep apnea snores heavily, and then stops breathing while still sleeping. A sleeping partner would observe that the person is struggling to breathe but there is no snoring sound. These periods of stopped breathing are followed by a gasping or choking sound. The person with sleep apnea will partially awaken in order to breathe, leading to fragmented, non-refreshing sleep which can be the cause of excessive daytime sleepiness.

The even greater concern is that when the airway collapses and oxygen is cut off, the body goes into a fight-or-flight response, putting a strain on the heart and increasing blood pressure. Over time, this can wear out the heart and lead to heart disease or a stroke.

Sleep Apnea Statistics

  • 9% of middle-aged women and 25% of middle-aged men suffer from OSA.
  • 1 in 5 adults has at least mild OSA.
  • That translates to 18-25 million Americans (1 in every 15) living with sleep apnea.
  • Possibly as few as 5% have been diagnosed, or have taken a sleep study.
  • A person afflicted with untreated obstructive sleep apnea is up to 4 times more likely to have a stroke, as well as 3 times more likely to have heart disease.
  • Approximately 50% of all patients who have hypertension, or high blood pressure, are also afflicted with obstructive sleep apnea.
  • People suffering from OSA are as much as 6 times more likely to be involved in a car crash than those without sleep disorders. This is due to the fact that they are drowsy from lack of sleep.

Who is at Risk for Sleep Apnea?

Even though sleep apnea can affect anyone regardless of age, weight, and gender, these factors indicate a higher likelihood of having sleep apnea:

  • Mouth breathing: Sleeping with the mouth open is a sign that the nasal airway is obstructed. Nasal obstruction causes the jaw to drop, reducing the diameter of the pharyngeal airway and increasing the likelihood of obstructive sleep apnea. If you know a sleeping mouth breather, they may be suffering from obstructive sleep apnea.
  • Excess weight: Fat deposits around the neck and chin may obstruct your breathing. Keep in mind though, not everyone who has sleep apnea is overweight. Thin people suffer from OSA as well.
  • Neck size (circumference): People with large neck circumferences tend to have narrowed airways as a result. Men with a 17 inch neck size and women with a 16 inch neck size are at higher risk. Another risk factor is excess skin from the chin to the neck, often referred to as a turkey neck.
  • Family history: If you have family members who suffer from OSA or snoring, you may be at increased risk. There is a hereditary link associated with sleep apnea.
  • Use of alcohol or other sedatives: These substances cause the muscles in your throat to relax, exacerbating sleep breathing issues such as OSA.
  • Smoking: Smokers are three times more likely to suffer from OSA than their non-smoking counterparts. Smoking tends to cause inflammation and fluid retention in the airway, resulting in less space for air to pass through the airway.
  • Being a male: Men are projected to be twice as likely to have sleep apnea. This gap narrows as age increases. Once women reach menopause, the ratio is almost equal.
  • Age: OSA occurs significantly more often in adults that are older than 40.
  • A narrowed airway: You may have a naturally narrowed airway. This is more common in women than in men, and could be a strong indicator of sleep apnea in women.
  • Enlarged tonsils and/or adenoids: Your tonsils and/or adenoids may become enlarged, which lessens the amount of room for air to pass through your airway. In children, this is the most common cause of sleep apnea, in which removal is the most effective solution.
  • Jaw structure: A lower jaw that is undersized compared to the upper jaw (retrognathia).

Often the person with sleep apnea is totally unaware of the problem and will often deny the fact that he / she snores, but the bed partner will observe:

  • Loud snoring followed by cessation of breathing
  • Gasping and choking during sleep
  • Excessive daytime sleepiness
  • Morning headaches
  • More sleep apnea symptoms

Snoring


 Snoring
Snoring: A Common Problem For Many Adults It's estimated that nearly 45% of normal adults snore at least occasionally, and 25% are habitual snorers. It's undeniable that snoring can disrupt a good night’s sleep, impact relationships, and affect the quality of life for both you and your partner. Estimates show that about 80 million people in North America snore. Snoring ranges from the occasional snorer to the chronic snorer. Dental Associates of Arlington of Arlington, MA, is concerned about the chronic snorer – the individual who suffers from chronic snoring. A chronic snorer snores whenever they sleep and is usually tired after what seemed like a good night's rest. Chronic snoring affects about 25 percent of the adult population, putting them at risk for developing serious health problems. What Causes Snoring? Snoring occurs in the throat area when the soft tissue...

Oral appliance therapy


Oral Appliances Oral appliances (OA) are a front-line treatment for patients with mild to moderate Obstructive Sleep Apnea (OSA) who prefer OAs to continuous positive airway pressure (CPAP), or who do not respond to CPAP, are not appropriate candidates for CPAP, or who 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. Standards of Care Patients with primary snoring or mild OSA who do...
 Oral appliance therapy

Other treatment options


 Other treatment options
While positive airway pressure therapy is the first line of treatment for moderate to severe sleep apnea, patient compliance represents a clear problem. Studies have shown that even in compliant patients, the actual usage of PAP is only approximately 50 percent of the time. Patients often complain of difficulty in being able to wear a tight mask throughout the night and dealing with the high pressure of air blown into their nose. For the noncompliant, surgery for sleep apnea may be a feasible alternative. While there are many surgical options, surgery should be tailored to the area of obstruction in each particular patient. The sites of obstruction could be anywhere in the upper respiratory tract including the nose, tongue, and throat. Below are the most common and effective surgical methods to address these potential sites of obstruction. Graphic 1 Nasal surgery Both daytime nasal...