Snoring Sleep Apnea
Sleep Apnea, Symptoms, Causes, Diagnosis & Treatment
Author: | Posted: 2007-08-06
90% of people who have sleep apnea don't know that they have it. Usually it is the bed partner who first notices that the person is struggling to breathe during sleep. Diagnosis and treatment can dramatically improve quality of life, asleep and awake and sleep apnea can be life-threatening.
What is sleep apnea?
One Couple's Struggle with Sleep Apnea
Mark’s wife was always bothered by his snoring, but she became more troubled when she noticed that throughout the night he would stop breathing periodically, seeming to wake up and fall back asleep again to restart his breathing. Mark occasionally remembered waking up during the night, but for the most part, he did not remember the gaps in breathing. He did, however, know that he was always tired during the day. He fought to stay awake at work and even though he was good at disguising the problem, he knew his work was suffering from his inability to concentrate. He realized he had to do something about the situation and made an appointment to talk with his doctor.
Do you or your sleep partner notice that you stop breathing periodically during sleep or awaken gasping for air? If so, you may have sleep apnea. You may not remember anything at all about the awakenings. However, if you sleep with someone else, your sleep partner probably will remember.
If left untreated, sleep apnea can be dangerous to your life and relationships, but also to your health. The most important thing to know about sleep apnea is that it can be successfully treated.
Is snoring the same as sleep apnea?
Snoring and sleep apnea are not the same thing. Snoring is simply a loud sound that you make during breathing while asleep. Snoring may accompany sleep apnea, but snoring by itself does not mean that breathing has stopped.
What are the signs and symptoms of sleep apnea?
Warning signs and symptoms of sleep apnea are:
- Frequent cessation of breathing (apnea) during sleep. Your sleep partner may notice repeated silences from your side of the bed.
- Choking or gasping during sleep to get air into the lungs
- Loud snoring
- Sudden awakenings to restart breathing
- Waking up in a sweat during the night
- Feeling unrefreshed in the morning after a night’s sleep
- Headaches, sore throat, or dry mouth in the mornings after waking up
- Daytime sleepiness, including falling asleep at inappropriate times, such as during driving or at work
What are the types of sleep apnea?
There are three types of sleep apnea
- Obstructive Sleep Apnea (OSA) - The most common type of sleep apnea. Caused by a breathing obstruction, which stops the air flow in the nose and mouth.
- Central Sleep Apnea (CSA) - A rare type of sleep apnea which occurs when the brain signal that instructs the body to breathe is delayed. This central nervous system disorder can be caused by disease or injury involving the brainstem, such as a stroke, a brain tumor, a viral brain infection, or a chronic respiratory disease.
- Mixed sleep apnea - A combination of the two other types of sleep apnea, Obstructive Sleep Apnea and Central Sleep Apnea.
What are the causes of sleep apnea?
When you have obstructive sleep apnea, your throat collapses during sleep, blocking the airway and preventing air from getting to the lungs. Generally, your throat muscles keep the throat and airway open. Causes of an obstructed airway include:
- Shape of head and neck may create a smaller than normal airway.
- Large tonsils or adenoids or other anatomical differences. (A deviated septum, enlarged tongue, or receding chin can also create difficulties breathing during sleep.)
- Being overweight or obese (although almost 50% of people with sleep apnea are not obese).
- Throat muscles and tongue relax more than normal during sleep. (This can be due to alcohol or sedative use before bedtime, but not necessarily.)
Other risk factors for sleep apnea include:
- Irregular sleep hours
- Snoring - Snoring can cause the soft palate to lengthen, which in turn can obstruct the airway.
- Smoking or exposure to secondhand smoke
- Nasal congestion, nasal blockages, and nasal irritants
- Family history of sleep apnea - No specific genetic marker for sleep apnea has been discovered, but obstructive sleep apnea seems to run in families. This may be a result of anatomic abnormalities that run in the family.
- Other disorders and syndromes - Hypothyroidism, acromegaly, amyloidosis, vocal cord paralysis, post-polio syndrome, neuromuscular disorders, Marfan's syndrome, and Down Syndrome.
- Other physical conditions, such as immune system abnormalities, severe heartburn or acid reflux and high blood pressure. It isn’t clear whether the conditions are the cause or the result of sleep apnea.
How can I get diagnosed for sleep apnea?
Before you visit a doctor for a possible diagnosis of sleep apnea, ask your spouse or sleeping partner to keep a sleep diary for you. For a few nights, a willing sleep partner can record:
- how loud your snoring is
- whether you are asleep or not, and
- whether you are having trouble breathing (that is, choking or gasping).
If you don’t have someone to record your sleep patterns, try taping yourself. You can use a sound-activated audio recorder or a software program that turns your computer into a recorder. If you don’t have access to recording equipment, it may be worthwhile to ask a friend or loved one to monitor your sleep pattern for a few nights, or visit a sleep center for observation.
With your sleep record in hand, consult a knowledgeable dentist or doctor. To diagnose for sleep apnea, the dentist or doctor will:
- perform a physical examination of your mouth and nose to look for obstructions,
- possibly do an endoscopy of your nose and throat, and x-rays or a CT scan of the head and neck, and
- recommend an overnight sleep study.
What are the results or effects of sleep apnea on health?
What Happens When You Stop Breathing During Sleep?
If you have sleep apnea, you stop breathing during sleep, and the balance of oxygen and carbon dioxide in the blood is upset. This imbalance stimulates the brain to restart the breathing process. The brain signals you to wake up so that the muscles of the tongue and throat can increase the size of the airway. Then, carbon dioxide can escape, and oxygen can enter the airway. These waking episodes are necessary to restart breathing (and to save your life), but you become sleep-deprived.
Sleep apnea has serious health consequences and can even be life-threatening. The main effects of sleep apnea are:
- sleep deprivation, and
- oxygen deprivation.
Sleep deprivation
Both the person with sleep apnea and the bed partner suffer from sleep deprivation. A bed partner may lose an hour or more of sleep each night from sleeping next to a person with sleep apnea.
Some trickle-down effects of sleep deprivation are:
- Daytime sleepiness
- A compromised immune system and slower healing
- Poor mental and emotional health
- Lack of smooth functioning of the body
- Decreased productivity
- A negative mood, irritability
- Low energy
- Unclear thinking, lack of concentration
- Slower reaction time
- Oxygen deprivation
Oxygen deprivation
When you stop breathing, your brain does not get enough oxygen. Drastic problems can result from the oxygen deprivation of sleep apnea:
- Insomnia, restless sleep
- Heart disease, heart failure, or heart abnormalities such as arrhythmia (irregular heart beat)
- Stroke, high blood pressure (hypertension), and other cardiovascular system problems
- Type II diabetes
- Memory problems, learning difficulties, and lack of attention
- Rapid weight gain and obesity
- Impotence, sexual dysfunction, or reduced libido
- Morning headaches
- Depression
- Sevenfold increase in involvement in auto accidents
- Premature death, such as Sudden Infant Death Syndrome (SIDS)
Other, more mild effects of sleep apnea
Some other consequences of sleep apnea are:
- Frequent bathroom visits to urinate during the night
- Heartburn
- Excessive sweating during sleep
- Dry mouth in the morning
- Loud snoring
- In children, a concave chest during sleep
What are the treatments for sleep apnea?
Sleep apnea responds well to treatment. Your specific sleep apnea characteristics determine which treatment will work best for you. Treatments include:
- Behavioral treatments for sleep apnea (self-help)
- Physical or mechanical therapy or treatment for sleep apnea, including surgery
Medication is not usually an effective treatment for sleep apnea.
You may wish to try several treatments, either in succession or simultaneously.
What self-help remedies are there for sleep apnea?
Minor sleep apnea is responsive to self-help remedies, or “behavioral treatments.” Some of the following self-help treatments for sleep apnea may work for you.
Lose weight - Overweight individuals who lose even 10% of their weight can reduce sleep apnea during the night and dramatically improve the quality of their sleep.
Eliminate the use of alcohol, tobacco, and sedatives such as sleeping pills - Avoiding the use of alcohol, tobacco, and sleeping pills can reduce the likelihood of airway closure during the night.
Sleep on your side - People who experience sleep apnea only when they sleep on their backs can benefit from special pillows or folk remedies that encourage side-sleeping, such as the tennis ball trick.
Regularize your sleep hours - Irregular sleep hours can throw off your sleep cycles and lead to breathing problems during the most important sleep stages. Stabilizing bedtime hours and eliminating disturbances to your sleep can reduce sleep apnea.
Learn to play the didgeridoo - Swiss medical scientists found that regular playing of the didgeridoo (an Australian wind instrument) improved snoring, sleep apnea, and daytime sleepiness, and reduced sleep disturbances to bedroom partners. The reason for this improvement may be that training to play the didgeridoo decreased the collapsibility of the upper airways.
What physical or mechanical treatments can cure sleep apnea?
Physical devices and mechanical therapies are effective in treating many cases of sleep apnea. These treatments for sleep apnea are:
- Continuous Positive Airway Pressure (CPAP)
- Dental appliances or jaw adjustment devices
- Surgery
- Oxygen administration
Continuous Positive Airway Pressure (CPAP) - To keep your airway open during sleep, a machine at your bedside blows pressurized air into a mask that you wear over your nose or face. Very common long-term treatment for severe sleep apnea.
Dental appliances, oral devices, and lower jaw adjustment devices - Opens your airway by bringing your lower jaw or your tongue forward during sleep.
Most dental devices are acrylic and fit inside your mouth, much like an athletic mouth guard or orthodontic appliance. Some others fit around your head and chin to adjust the position of your lower jaw. Two common oral devices are the Mandibular Repositioning Device and the Tongue Retaining Device.
Surgery - Increases the size of your airway by surgically removing tissues. The surgeon may remove tonsils, adenoids, or excess tissue at the back of the throat or inside the nose. Or the surgeon may reconstruct the jaw.
The surgeon operates with a scalpel, a laser, or a microwaving probe (radiofrequency energy).
Oxygen administration - A narrow tube runs from an oxygen source to your nose, where the tube ends in small plastic prongs that fit into your nose.
Ensures that you get enough oxygen during sleep.
Rarely used. May be used in conjunction with CPAP.
About Snoring
Moderate to severe levels of snoring may really be obstructive sleep apnea (OSA) otherwise termed "sleep disordered breathing." Sleep apnea is associated with cardiovascular disease, daytime sleepiness and even increased mortality. To correctly identify the disorder, there are simple, cost-effective sleep screening tools used by a trained sleep dentist.
Snoring is a breathing noise that occurs while someeone is sleeping. The actual snoring sound is produced from the vibration of the soft palate and sides of the throat when air rushes against them.
The sound of snoring occurs when the airway collapses and the muscles fail to maintain their normal function. A few of the medical and dental conditions that can lead to snoring are:
- overweight
- a small retruded jaw
- sedatives
- allergies
- alcohol before retiring
- airway obstruction
In recent years, snoring has been acknowledged as a warning sign that normal breathing is not taking place. For the majority of adults, snoring does not involve a serious medical disorder. However, snoring may be the first sign of obstructive sleep apnea (OSA).
Understanding Sleep Apnea
Apnea is a Greek word that means "want of breath." A person is considered to be a sleep apnea sufferer when they stop breathing for at least 10 seconds up to thirty times or more a night.
Snoring may be indicative of sleep apnea, a cessation of breathing during sleep, which can put a great strain on the cardiovascular system. This is why sleep apnea, left untreated, increases risk of heart attack and stroke.
Besides snoring, other common symptoms of sleep apnea include:
- morning headaches
- dry mouth and throat
- excessive daytime sleepiness
- sudden short-of-breath awakenings, choking or gasping
- lost interest in sex
- low energy levels
A lack of sleep effects our waking lives and those around us.
What are the Treatment Options?
Snoring and obstructive sleep apnea can be treated with lifestyle changes (weight loss, regular sleep routines, change of sleeping position, avoidance of alcohol or smoking, relief of nasal obstruction), CPAP therapy (a medical device that blows air into your nose and opens your airway), oral appliances (small, plastic devices that are worn in your mouth to hold your tongue and jaw forward), surgery or by a combination of these approaches.
Oral Appliance Approach
A conservative treatment is to have a dental appliance made to wear during sleep which gently moves the lower jaw forward causing a positive change in tongue position. Advantages of an appliance - also known as an orthotic device or mouthguard - over other therapies include:
- Inexpensive cost Non-invasive
- Easily accepted by patients
- Reversible
As a special member of the sleep apnea team of health professionals, a trained dentist will complete a medical and dental history and perform an intra-oral exam to determine where the blockage is and what is causing the obstruction, including:
- intra-oral habit assessment
- evaluating periodontal health
- x-rays and diagnostic model
- TMJ and occlusal exam
- checking gag reflex
- tonsil exam
- orthopedic exam
- airway evaluation with ecovision
When oral evaluation reveals an airway restriction due to chronically enlarged tonsils, an enlarged tongue or soft palate abnormality, a dental appliance can be a successful treatment for snoring and/or obstructive sleep apnea.
Research has shown that appliances are very effective when choosing a treatment modality - especially as an alternative treatment to Continuous Positive Airway Pressure Pressure (CPAP) or surgery.
An appliance worn during sleep prevents the .airway from collapsing by creating extra space. While many models of appliances are available to treat snoring and obstructive sleep apnea, only a specially trained dentist can properly select and fit the type of appliance that is needed.
Most dentists who treat TMJ - temporomandibular joint disorders - are an excellent choice, because they are very much aware of the jaw position when making the device. This is an important consideration. In fact, TMJ appliances can often be adapted to work for sleep apnea. Appliances are light and easy to wear. In only a few weeks, most patients are comfortable.
TAP 3
The TAP 3 is the latest addition to the TAP family
The Thornton Adjustable Positioner 3 (TAP 3) is a mandibular advancement device for the treatment of snoring and sleep apnea. Developed with advanced dental technology, the TAP 3 improves breathing and eliminates snoring in over 95% of all patients. The TAP 3 effectively treats sleep apnea and reduces the impact of associated health risks without the need for surgery, CPAP, or medication.
The TAP 3 offers the same results as the TAP and TAP II and fits more comfortably in the mouth. The smaller hardware provides more room for the tongue and allows the lips to close. Interchangeable hooks can accomodate Class I, II, and III bites and increase the vertical distance between upper and lower teeth. The TAP 3 gives dentists numerous options to create the best, customized treatment solution for their patients.
- Patient-friendly
- Superior results
- Easy to fit
- Infinitely adjustable
- Precise control of acvancement
- Interchangeable hooks
- Freedom for lateral movement
- More room for tongue
- Allows lips to close