It has been estimated that 60% of men and 40% of women between the ages of 40 and 60 years of age snore. Snoring occurs when there is a partial obstruction of the airway which causes the palatal tissues to vibrate. Obstructive sleep apnea occurs when the airway is completely blocked for certain periods of time. Snoring is a social problem, particularly for the spouse, but obstructive sleep apnea poses a significant health risk for the patient. It can lead to irregular heartbeat, high blood pressure, heart attacks and strokes.
what is Sleep Apnea?
Sleep apnea is a type of breathing disorder which is a serious, potentially life-threatening condition characterized by brief interruptions of breathing during sleep. As many as 20 million people in North America may have sleep apnea. There are basically three types of apnea:
The upper airway is open, but no oxygen is getting into the system. This occurs because the patient is not getting a chemical response from the brain to stimulate the lungs and the diaphragm to assist with breathing.
Obstructive Sleep Apnea
The lungs and the diaphragm are functioning normally, but no oxygen is entering the system because there is an obstruction in the upper airway.
This is a combination of central and obstructive sleep apnea.
Sleep Apnea Symptoms
The signs and symptoms for obstructive sleep apnea include the following:
- Excessive daytime sleepiness
- Gasping or choking during the night
- Non-refreshed sleep
- Fragmented sleep
- Clouded memory
- Personality changes
- Decreased sex drive
- Morning headaches.
Common Causes of Sleep Apnea
Factors that affect obstructive sleep apnea are as follows:
- Sedative Hypnotics (sleeping pills)
Signs My Child Could Have Sleep Apnea
Children can also snore and suffer from obstructive sleep apnea. An airway blockage can occur due to enlarged adenoids, tonsils or swollen nasal mucosa. Clinical signs would indicate a:
- Turned up nose
- Allergic shiners under the eyes
- Mucous draining out of the nose
- Mouth breathing
- A nasal sound to the voice
- Bed wetting
- Difficulty in concentrating at school
How do We test for sleep apnea?
Most hospitals have sleep diagnostic centers in which sleep technicians work directly with physicians. Sleep centers have sophisticated equipment in an adjoining room where an intercom and video camera allow communication between the technician and the patient. The patient comes in at night to allow a number of machines to monitor the activities of the brain, the eyes and the muscles. The recordings are done in a private room and there is no discomfort to the patient. The patient is not confined to a fixed position and can turn freely. Recordings are done during the night in a seven hour sleep period and the patient is discharged in the morning.
Obstructive Sleep Apnea Treatment Options
- Oral Appliance Therapy
- Continuous Positive Air pressure (CPAP)
- Surgical Removal of Excess Palatal Tissue (UPPP) or the Laser Assisted Removal of the Uvula (LAUP)
Types of Oral Appliances
Despite the fact that treatment with the CPAP unit is extremely successful, there are a number of patients who cannot or choose not to wear the face mask with the attached air compressor. These patients are excellent candidates for oral appliances. Some patients either do not want surgery or have had surgery and the procedure has been unsuccessful in solving the problem of obstructive sleep apnea. These patients prefer a non-surgical, non-invasive plastic intra-oral appliance that can be worn at night only to help solve their problem.
A prefabricated appliance constructed by the clinician at the chair. It is a relatively inexpensive, good diagnostic, temporary appliance and is used if the patient breaks or loses the permanent snoring appliance.
This two piece appliance is consists of two plastic parts which cover the upper and lower teeth and are joined together with a plastic plunger. The advantage of this appliance is that it is extremely comfortable.
This removable appliance is highly effective. The upper and lower acrylic components are held together by a plunger mechanism which holds the mandible forward in both the open and closed positions. The Modified Herbst has the advantage of allowing the patient to open and close as well as providing some limited side to side jaw movement.
Nocturnal Airway Patency Appliance (NAPA)
This is a rigid appliance which stabilizes the jaw in the horizontal and vertical dimension.
This is a two piece appliance held together with a special titanium hinge. This is one of the most comfortable appliances since it allows for jaw movements.
After the oral appliance has been used for a few months and the treatment appears to be working, then a second polysomnogram must be taken to confirm that the snoring and obstructive sleep apnea have been corrected. If the polysomnogram reveals that there is still a problem, then it is advantageous to have an adjustable appliance.
This is an effective, custom-fit device that is worn while sleeping. This device moves the lower jaw into a comfortable position, which allows the tissues in the back of your throat to relax. The base of your tongue is supported, which prevents it from collapsing back and blocking your airway, leaving you with safe and comfortable sleep.
The current gold standard utilized by the medical profession for the treatment of OSA is continuous positive airway pressure (CPAP). The patient wears a tightly fitting nose mask which is strapped to the head and connected by a hose to an air compressor pump. The air is forced into the airway through the nasal passages in order to open up the airway.
Complaints about the use of this air blower include pump noise, voice changes, skin irritations from the mask, nose and throat dryness, headaches from the strap around the head, tinnitus, difficulty getting to sleep, sinus infections, and difficulty breathing out against the air being forced through the nose.
The patients who should use CPAP are the severe cases of obstructive sleep apnea as the device may indeed be a life saver. In cases of mild to moderate OSA, or in cases where patients refuse to wear the CPAP, perhaps oral appliances may be the treatment of choice.
Sleep Apnea Treatment Before and After
Sleep Apnea Surgery Options
Laser Assisted Uvulaplasty (LAUP)
This is a very popular form of surgery now being performed. The purpose is to surgically remove the uvula when it is excessive and deemed to be causing the problem.
This is the surgical removal of excess palatal tissue which is thought to be causing the problem.
The disadvantage is that these surgeries can be quite painful during the healing period. Following the surgery, patients report voice changes and difficulty in swallowing their food.
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