Sleep Apnea

What is Sleep Apnea?

Sleep apnea is the condition where a person stops breathing for ten seconds or longer while they are sleeping. As their body senses the drop in oxygen in the blood, it briefly awakens them to breathe. It is sometimes noticed as gasping or choking. This cycle occurs repeatedly throughout the night. The repeated awakenings rob a person of a restful night’s sleep, because they do not maintain deep sleep.

This lack of deep sleep causes many dangerous health problems, including artery disease and high blood pressure. There is also an alarming increase in auto accidents in people with untreated apnea.

How Does Apnea Differ From Snoring?

Snoring is the loud, rasping noise made by the vibration of the soft palate, uvula, tonsils or other soft tissues of the airway during sleep. It is estimated that over 60 million Americans snore.

And, the number of people affected by snoring nearly doubles, since the bed partner’s sleep is also affected. (And sometimes, even family members in other rooms.)

Although snoring was once thought to be a physically harmless condition, recent studies indicate the vibration causes atherosclerotic plaques in the carotid artery (Lee, et al., Sleep. 2008 September 1; 31(9): 1207–1213)This is artery disease which leads to diminished blood flow to the brain, and possible stroke.

Although people with apnea snore, it is the stoppage
of breathing that differentiates snoring from apnea.

How is Sleep Apnea Diagnosed?

Sleep apnea is diagnosed with a sleep study, called a polysomnograph or PSG. The patient will sleep in a sleep center and be monitored for one night.

What Treatment is Available?

Treatment falls into 3 categories.

  1. Oral Devices: These are retainer-type devices that open the airway by moving the lower jaw forward.
  2. CPAP (Continuous Positive Air Pressure) Machine: A mask is worn over the nose, or nose and mouth, and delivers air under pressure into the throat and lungs.
  3. Surgical Intervention: There are many differing interventions, discussed in further detail below.

Oral Devices

This is the treatment we provide at our office. The same device is used for both snoring and apnea. It works by moving the lower jaw forward. This opens the airway at the base of the tongue, where the majority of obstructions occur. The device is removable and fits over the teeth like an orthodontic retainer.

If apnea has been diagnosed, a second PSG study is needed to determine if the device is effective. If the patient did not have apnea, but is a snorer, no follow-up sleep study is needed.

CPAP

CPAP is considered the “gold standard” of apnea treatment. It is almost 100% effective when used. The problem is the bulky equipment that must be worn. A fan/humidifier box sits on the nightstand, connecting to a hose, which then connects to a mask that is worn over the nose or face.

This presents problems for people who travel because it is bulky, and for campers, who do not generally have an electric source. Studies have shown that the compliance rate (the number of people using the device) after one year is about 60%. This means 4 out of 10 people who initially used a CPAP, are untreated for their apnea.

Some of our apnea patients, who have a CPAP, will have us make them an oral device to
have as an alternative for nights when using the CPAP is not practical.

Surgery

There are various types of surgery that can be helpful with snoring and apnea. The least invasive, used for snoring, is removal of the uvula (the tissue that resembles a punching bag, hanging off the soft palate).

For apnea, other “soft tissue” surgery includes a “PPP” – a pharyngopalatalplasty. This surgery is performed by an ENT and includes the removal of the uvula as well as thinning and removal of excess tissue of the throat at the tonsil and base of the tongue area. The effectiveness of these surgeries is generally about 70%.

The other general class of surgery is orthognathic (jaw) surgery. It is common in patients who have a jaw imbalance to have diminished airway due to the position, shape and relationship of the jaws to each other and to the airway.

In patients who are candidates for orthognathic surgery, there is benefit far beyond treatment of their apnea, as they also get enhanced function and esthetics of their teeth and jaws. These patients require braces for optimal results and we work closely with the oral surgeon.

(See our section Jaw Surgery and Orthodontics for more information.)

What to Expect At Your Snoring/Sleep Apnea Appointment At Our Office

Your apnea evaluation appointment includes taking a history of symptoms, a physical evaluation, and x-rays to determine both the nature of the problem and if an oral appliance would be successful.

If we determine there is a good chance of success with an oral appliance, we can then start the process of fabrication of the device. We will also refer you for a sleep study, if we suspect you have apnea.

If we determine that an oral appliance will not be successful, we will refer you to an appropriate specialist.

As with all of our exams, Dr. Lawrence sets aside time, just for you, to review all of our findings and recommendations. We want you to be fully comfortable with our recommendations and to feel comfortable asking any questions.