If you snore loudly and often, you may be accustomed to middle of the night elbow thrusts and lots of bad jokes. But snoring is no laughing matter. That log-sawing noise that keeps everyone awake comes from efforts to force air through an airway that is not fully open.
Perhaps one in every ten adults snores and although for most people snoring has no serious medical consequences, for an estimated one in 100 snorers, habitual snoring is the first indication of a potentially life threatening disorder called “Obstructive Sleep Apnea.”
It has been estimated that the indirect costs of sleep disorders is over 41 billion dollars a year from lost productivity 17 to 27 billion dollars a year from motor vehicle accidents, 7 billion dollars a year in work-related accidents and 2 to 4 billion dollars a year in home and public accidents. Clearly there is a major national problem that needs to be dealt with in an appropriate fashion.
Unfortunately, most physicians have not been trained to deal with these common problems. It has been estimated that on the average, only two hours are spent during the four years of medical school teaching medical students anything about sleep. This has created a significant deficit in our current medical system.
Dentists can provide a role in the recognition and treatment of Snoring and Obstructive Sleep Apnea. To provide optimal care, the dentist must have an overview of the architecture of sleep and sleep disorders. Although most dentists limit their practice to the treatment of teeth and gums, Dr Hernandez’s passion for continuing education has allowed him to understand the complex process of facial development in order to present a comprehensive wellness plan that will best improve his patients overall health. At Biscayne Dental Group, Dr. Julio Hernandez and his staff also work closely with sleep specialists to provide optimal treatment for their patients.
Although many treatment methods exist, most people will benefit by following a few general measures:
1. Lose Weight– People with severe sleep apnea are almost always over weight. Losing eight will reduce redundant tissue volume in the upper airway, decrease the load on the chest wall and abdomen and improve respiratory muscular efficiency. In mild cases, weight reduction alone may result in a cure. In other cases, it enhances the effects of additional therapy.
2. Sleep on your side– Many studies have shown that patients who sleep on their back have a significantly higher level of sleep disturbance. It is believed that sleeping in the supine position causes a gravitational pull on the tongue forcing it to come in contact with the posterior pharyngeal wall. therefore any technique that keeps you sleeping on your side could be beneficial.
3. Avoid alcohol within two to three hours of bedtime. Alcohol is a central nervous system depressant and changes motor activity to the muscles that control normal inspiration. These changes create unfavorable forces in the upper airway causing it to collapse.
4. Avoid certain pharmacological agents– Benzodiazepines, narcotics, barbiturates, and testosterone have all been reported to affect the occurrence of apnea episodes. For example, Flurazepam has been shown to worsen apnea episodes in patients who already suffer from this disease and trigger apnea in patients who have no history of a problem.
What is Sleep Apnea? Steadman’s Medical Dictionary defines “apnea” as the absence of breathing or the want of breath. Where there is a cessation of airflow at the mouth and nose for more than 10 seconds and apnea episode has occurred. If a person experiences 30 or more apnea episodes during a seven-hour sleep period, then they are believed to be suffering from Sleep Apnea.
Apnea severity is usually categorized by the frequency of apnea episodes:
5-15 episodes per hour————————————-mild
15-25 episodes per hour———————————–moderate
>30 episodes per hour————————————–severe
These episodes can last anywhere between 10 to 20 seconds each, terminating with at least a partial wakening. patient may have as many as 300 apneic episodes per night.
What is Snoring?
Many people think that snoring and apnea are the same thing. This is not true. Snoring, which is caused by a change in airflow through the nasal and pharyngeal tissues, is only a sign that a patient may be suffering from apnea. It’s basically like water running through a pipe. If the water runs abnormally through a pipe, the pipe will vibrate. The same thing happens with airflow when it is partially obstructed.
Snoring can be categorized by its severity. On one side of the spectrum, you have the benign snorer, who snores but experiences no physical problems. On the other side, of the spectrum, you have the snorer who suffers from apnea, and in the middle you have the snorer who suffers from what we call Upper Airway Residence Syndrome. In these people, though they may not actually experience apnea episodes, their snoring is so loud and their breathing is so labored, that it still wakes them up numerous times throughout the night. This leaves them unrefreshed and tired in the morning.
The following are some of the signs and symptoms that are indicative of a person who is suffering from apnea:
- Heavy snoring
- Gasping or choking during the night
- Excessive day time sleepiness
- Frequent arousals during sleep (fragmented sleep)
- Non-refreshed sleep • Restless sleep
- Morning headaches • Nausea
- Dry mouth when you awaken
- Personality changes such as becoming irritable or temperamental
- Severe anxiety or depression
- Poor job performance
- Clouded memory
- Intellectual deterioration
- Occupational accidents
- Decreased sex drive
- Scratchy throat
Children can suffer from sleep apnea as well. Typically these children suffer from growth and development problems. A lot of them have under developed maxillas, narrow upper arches, and retruded mandibles. Often they are highly allergic with their airway completely blocked due to tonsillar hypertrophy. If they are already having snoring and breathing problems, do not ignore them. An evaluation for early orthodontic intervention should be done as soon as possible.
Here are some of the signs and symptoms seen in children.
- Poor concentration
- Developmental delay
- Hyponasal quality to their voice
- Noisy breathers
- Frequent upper airway infections
- Nocturnal mouth breathing
- Restless sleep
- Night terrors
- Chronic nose running
Several treatments are available to help stop snoring and treat sleep apnea if present. specific. This means that not all treatments work on all patients. This is due to the fact that the causes of sleep apnea are multifactorial. Because the apnea or the snoring can be caused from a variety of factors, understanding which factors affect each patient is important in determining the best treatment option for that patient.
Therefore, to determine which treatment option is best suited for you, Dr. Hernandez and the staff at Biscayne Dental Group go through a detailed and comprehensive examination and records. This information is evaluated and if sleep apnea is suspected, the patient is referred for a sleep study. The sleep study will determine the severity of the apnea in order to determine the best treatment options.
Treatment options available include:
1. Continuous Positive Airway Pressure (CPAP): This technique involves wearing a mask tightly over the nose during sleep. Pressure from an air compressor is used to force air through the nasal passages and into the airway. When accepted by the patient, this treatment is highly effective. Unfortunately, daily compliance by patients using CPAP is less than 50%. This is due to the fact that the machine is inconvenient, restricts patient’s movements and it dries out the airway mucosa.
2. Surgical Approaches: There are various surgical approaches used to address sleep apnea. The most beneficial of all is the nasal reconstruction. This is done when an obstruction exists in the nasal passage. These could include deviated septum, enlarged turbinates or polyps in the nose. Other surgical procedures include the UPPP, LAUP and the Somnoplasty. These have very limited long term benefit and should be considered only in very specific cases. Finally, orthognathic surgical procedures used to advance the mandible and/or the maxilla have been used in order to create more room for the tongue and reposition the muscles to a more favorable position.
3. Dental sleep appliances: Many different appliance designs exist. The objective of the appliance is to stop snoring to an acceptable level, resolve the patients apnea, allow for higher amount of oxygen flow, and eliminate excessive daytime sleepiness allowing patients to function normally. The appliances work by repositioning the mandible and the soft palate, bringing the tongue forward and opening the airway. Dental sleep appliances offer several advantages over other therapy choices. They are inexpensive, non-invasive, easy to fabricate, reversible and quite well accepted by patients. These appliances are particularly appropriate for those patients who cannot handle CPAP or when surgery is contraindicated.