Sleep Apnea – Frequently Asked Questions

How Do I Determine If I Have a Problem?
The standard sleep study is done in a sleep lab or center, a technician is watching you sleep. The team at Nelson Dental Exceptional Smiles together with a sleep physician can help you understand the results of your physician reviewed study. We offer our guests a method of doing a sleep study in the comfort of their own home. By taking home a monitor you are able to receive a report on the severity of your OSA and the results are back within 48 hours. This home device is a screening tool and not meant to replace a formal sleep study. A sleep physician will review your report to make recommendations for treatments such as an oral appliance (made by a dentist) or CPAP. Only with a sleep physician’s recommendation will we recommend an oral appliance.

What Will The Report Tell Me?
The report will give you the following information:
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• Number of hours spent sleeping
• Number of times you woke up
• The decibel level of your snoring
• Your body positioning and how that relates to snoring
• Your oxygen saturation level
• Your average pulse rate
• The amount of REM vs. non-REM sleep
• The number of apnic and hypopnic events

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Schedule a consultation to find out if this comfortable alternative to CPAP is right for you.

What can the dentist do for me?
We custom fit a sleep appliance for you. This device is worn on your upper and lower teeth. The reason it works is because it pulls the bottom jaw forward. When the jaw is positioned forward, so is the tongue. The tongue is the largest obstacle to airway flow. We are simply opening the airway to provide you with the oxygen you need for a restful sleep.

What are the dangers of sleep apnea?
Having sleep apnea puts your health in jeopardy in several ways. When you stop breathing, your body actually wakes itself up—without you consciously knowing it. One huge detrimental effect of this is you can never get into a deep sleep, so your body never gets the rejuvenating effect of deep sleep. Your body needs two things during the night; REM sleep and NREM sleep. Both are essential to a thriving functional person.

How can you tell if your partner really has sleep apnea?
Your partner’s buzz saw-like snoring might make you want to pull your hair out, but restrain yourself and use the unwanted wakefulness to see if sleep apnea may indeed be their problem. The most critical thing to look for is a pause in breathing for more than 10 seconds. Be careful, breathing can be an illusion. When the lawn mower mouth suddenly falls silent, you may think he or she is breathing, but in fact the breathing and oxygen flow may have stopped! Gasping for air after a quiet spell often means there was no air exchange. Tossing and turning can also indicate sleep apnea. This movement is often to open the airway.

What are the big risk factors for sleep apnea?
If you don’t have a bedmate who can personally witness your breathing breaks during the night, you can still gauge your risk of sleep apnea. These are all big risk factors:

1. Being overweight
2. Being excessively sleepy during the day. For example, if you can fall asleep anywhere during the day (and you do not work or play all night long)
3. Having a neck that’s over 17 inches in circumference.
4. Tonsils and adenoids that are still present and often infected.
5. A severely retruded chin, from a profile the chin appears further back toward the neck than desirable.

More about sleep apnea:
Sleep apnea is a serious sleep disorder that occurs when a person’s breathing is interrupted during sleep. People with untreated sleep apnea stop breathing repeatedly during their sleep, sometimes hundreds of times during the night. There are two types of sleep apnea: obstructive and central. Obstructive sleep apnea is the more common of the two. Obstructive sleep apnea occurs when repetitive episodes of complete or partial upper airway blockage happens during sleep. During the apnea episode, the diaphragm and chest muscles work harder as the pressure increases to open the airway. Breathing usually resumes with a loud gasp or body jerk. These episodes can interfere with sound sleep, reduce the flow of oxygen to vital organs, and cause heart rhythm irregularities.

In central sleep apnea, the airway is not blocked but the brain fails to signal the muscles to breathe due to instability in the respiratory control center. Central apnea is named as such because it is related to the function of the central nervous system.

What are the treatments for sleep apnea?
People who suffer from sleep apnea can choose a number of treatment options, although none are perfect. The most popular being a C-PAP mask (or continuous positive airway pressure mask) that’s worn when the person sleeps. The mask, which looks like a traditional oxygen mask hooked up to a machine with tubes, gauges levels of the airway resistance and pushes air past the swollen tissue so oxygen is delivered. A Mandibular Repositioning Device (MRD) is made by a trained dentist and positions the jaw forward. It has no bells and whistles like the CPAP and may be more highly tolerated. The compliance or continued use of the CPAP after one year is only 33%.

How common is obstructive sleep apnea?
Obstructive sleep apnea (OSA) is very common. Research has shown that about one in every five adults has enough sleep apnea to be considered abnormal. This makes OSA about twice as common as asthma. Most individuals with OSA have only mild disease when defined by the frequency of the abnormal breathing events during sleep and most of them don’t have daytime symptoms. About one in 20 adults has the Obstructive Sleep Apnea Syndrome, which is OSA associated with excessive daytime sleepiness. That is a lot of people with OSA, about 23 million in the United States with at least mild disease, and 16 million with moderate to severe disease. So it is very likely you know someone with OSA, although they may not tell you. If you travel by plane on a Boeing 747 with 451 uncomfortable fellow passengers, you have a one in 25 chance of sitting next to one who has significant OSA. If that person is a male, overweight, and a snorer, the chances that he has OSA are even higher. OSA is distributed in the population unequally. It is more common in males (24%) than females (9%), and in those who are obese. One out of every 10 habitual snorers has symptomatic OSA. Because OSA is strongly linked to obesity and age, and on average our population is growing older and more overweight, OSA is becoming more common all the time.

You will probably see someone with OSA today. It might be your bed-partner.

What causes obstructive sleep apnea?
Obstructive sleep apnea is a uniquely human problem and can be considered a price we pay for our ability to talk. We use our throat in at least three different ways. We use it to form words when we speak, to propel food when we swallow, and to serve as a passageway for air when we breathe. We are stuck with a single tube that must be flexible and collapsible so we can talk and swallow, but must stiffen up to resist collapse when we suck air into our lungs. The solution to this design problem is a complex group of muscles that change the shape of our throat when we talk and swallow, but also stiffen and dilate the passageway when we breathe in. These muscles work well when we are awake, but like all muscles they relax – become less active – when we are asleep. If our airway is abnormal in its size or shape or “stiffness”, for example if it is too small because of excess tissue in or around it, then the muscles responsible for holding it open during sleep are unable to do their job. The airway collapses so no air (or not enough air) gets to the lungs.

So OSA is caused by conditions that narrow this passageway, the upper airway, or make it more collapsible. Chief among these is obesity, especially obesity with a large neck, although other conditions such as having “kissing” tonsils or a relatively small jaw (this gives one a relatively large tongue) also can promote upper airway collapse. Certain diseases such as hypothyroidism (low thyroid hormone levels) are also associated with OSA. The effect of gravity on the tongue and other structures surrounding the upper airway can narrow it when sleeping on your back. Drinking alcohol near bedtime can make the airway more collapsible.

Is surgery a good therapy option for obstructive sleep apnea?
For some carefully selected people the answer is yes, surgery is a good therapy option for their obstructive sleep apnea (OSA). However, the majority of patients with OSA are best treated medically. Placing a breathing tube in the windpipe (tracheostomy) was the first treatment perscribed for OSA. It was always successful, but was poorly accepted and is seldom used today. The removal of pharyngeal tissue to open the airway may be indicated for a small percentage of people. As a dental office we always look in the throat to see if this could be a contributing factor toward someone’s OSA. If these tissues are present we will discuss the possible referral to an ENT (Ear , Nose and Throat Physician) for evaluation for surgery.

Is obstructive sleep apnea a chronic disease or can it be cured?
For the vast majority of people with obstructive sleep apnea (OSA) their condition is a chronic disease. If you have OSA it will likely last your lifetime. It can be successfully managed, but it will not be cured. OSA is like other chronic diseases such as diabetes or high blood pressure. In highly selected patients surgical cures of OSA have been reported. Management of OSA with changes in lifestyle and the addition of a medical device have proven to be very effective. Loss of weight and neck size is very important as a first lifestyle change. Use of a medical device like a MRD (mandibular repositioning device) with a dentist, or with a CPAP from a sleep physician will likely help.