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What Causes SLEEP APNEA? |
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The exact cause of obstructive sleep apnea (OSA) remains unclear; however, there are well documented contributing factors. The primary risk factor is excessive weight gain with the accumulation of fat on the sides of the upper airway causing it to become narrow and predisposed to closure when the muscles relax. Other risk factors may include gender (males seem to have a greater predisposition), age, enlarged tonsils and adenoids, or an enlarged tongue. Use of alcohol or sedative drugs which relax the musculature, and smoking, which may cause inflammation and swelling can all lead to narrowing of the upper airway. A short, thick neck is often correlated to obstruction. Studies suggest that 2 percent of women and 4 percent of men over the age of 50 years have symptomatic obstructive sleep apnea.
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| Q |
What Exactly occurs during OBSTRUCTIVE SLEEP APNEA? |
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When obstructive sleep apnea occurs, the tongue and soft tissues fall back toward the throat during sleep, totally blocking the airway, causing a cessation in breathing. The airway obstruction will not clear until the brain's oxygen level falls low enough to partially awaken the sleeper. The tongue then returns to a more normal position, and the airway seal is broken - usually with a loud gasp. Sleep is extremely fragmented and of poor quality. People with untreated sleep apnea are generally not aware of the awakenings. Mild to moderate apneic events may range from 20 to 40 or more per hour, and increase in severe cases.
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How do I know if I have OBSTRUCTIVE SLEEP APNEA - What are the effects? |
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People with sleep apnea often feel very sleepy during the day (excessive daytime somnolence) noticing that their concentration and performance is suffering. They may be depressed, irritable, have learning and memory difficulties, and may somewhat frequently fall asleep while at work, on the phone, driving, or watching a movie. Their bed partners may complain of hearing heavy snoring from them with an apparent struggle to breathe.
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Epworth Sleepiness Scale Self Test |
| Q |
How is Snoring involved and what causes it? |
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Snoring is the turbulent sound of partially obstructed breathing during sleep. When the airway is sufficiently reduced and the flow of air is partially obstructed, snoring may occur. Large tonsils, a long soft palate, a large uvula and excess fat deposits, all contribute to airway narrowing. As air tries to pass through these obstructions, the throat structures vibrate causing the sound we recognize as snoring. Loud snoring is a common presenting complaint of those diagnosed with obstructive sleep apnea. Although, loud snoring does not in itself mean that one has obstructive sleep apnea.
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How is SLEEP APNEA diagnosed? |
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The primary care physician may be the first to consult, followed by other physicians with special training in sleep disorders (usually a pulmonologist). An overnight sleep study (polysomnograph - PSG) is often recommended. Polysomnography is a test that records a variety of body functions during sleep: electrical activity of the brain, eye movement, muscle activity, heart rate, respiratory effort, air flow, and blood oxygen levels. This test is used both to diagnose sleep apnea and to determine its severity. Another diagnostic test is the Multiple Sleep Latency Test which measures the speed of falling asleep. People without sleep problems usually take more time to fall asleep than those with sleep disorders. These diagnostic tests are usually performed in a sleep center.
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How is mild to moderate SLEEP APNEA treated? |
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Nasal continuous positive airway pressure (CPAP) is the most common treatment for obstructive sleep apnea. With this procedure, the patient wears a mask over the nose during sleep, and pressure from an air blower forces air through the nasal passages. Straps hold the mask firmly over the nose, and the machine that generates the positive airway pressure sits on a table next to the bed. Perhaps the biggest problem with CPAP therapy is noncompliance. Many patients feel claustrophobic in addition to experiencing nasal dryness or discharge. Lack of a good fit of the nasal mask is also a common complaint. Compliance is greater in patients with more severe apnea.
Several surgical procedures are available for those who cannot tolerate the CPAP; however; surgery is invasive and not always effective.
For patients who snore, or snore with mild to moderate sleep apnea, an oral appliance is a conservative and often very successful alternative.
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| Q |
How can an ORAL APPLIANCE help me if I have OBSTRUCTIVE SLEEP APNEA? |
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Oral appliances are designed to advance the base of the tongue thereby avoiding or preventing obstruction of the airway during sleep. They work to reposition the lower jaw and tongue. Oral appliances vary in design; however, their function is basically the same. Dentists with special training in the use of sleep appliances will recommend an appliance best suited for your medical and dental needs.
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| Q |
What does the appliance look like? |
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An oral appliance to treat obstructive sleep apnea and snoring is relatively small and easy to wear. Because of its size, the appliance is easy to travel with. The oral appliance looks somewhat similar to an athletic mouth guard or a dental retainer. Appliances that may be considered the most comfortable allow lateral and vertical jaw movement. Some appliances are adjustable by the patient under the supervision of the dentist.
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Are Oral Appliances to treat OBSTRUCTIVE SLEEP APNEA and SNORING approved by the FOOD AND DRUG ADMINISTRATION? |
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Yes. Oral appliances for the treatment of snoring and obstructive sleep apnea require FDA clearance before they may be marketed. As such, they are considered to be medical devices under the definition of the Food, Drug and Cosmetic Act, Sec. 201 (h) of the Act.
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| Q |
How effective is the appliance - What is the success rate? |
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The appliance will not cure the obstructive sleep apnea and/or snoring. Its intention is to prevent the apnea and/or snoring from occurring; consequently, it must be worn every night to produce the desired effect. Physicians and dentists who have researched the effects of appliances have found that in a majority of patients, a well-made, well-fitted oral appliance will effectively reduce or eliminate snoring, and significantly relieve symptoms of mild to moderate obstructive sleep apnea. Although the success rate is very good, there is no guarantee that an appliance will be successful for every individual.
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| Q |
Are there any side effects to wearing the ORAL APPLIANCE? |
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In some patients, slight movement of the teeth may occur, and they may experience some minor changes in their dental bite. In prior studies, some patients (3 of 14) reported a sense of altered occlusion (dental bite), but severity was not specified. Other reports suggest that occlusal changes are relatively uncommon occurrences. Additional complaints have been excessive salivation, sore jaw joints or jaw muscles, or sore teeth.
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| Q |
What happens at my first appointment? |
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Before your appointment, paperwork will be sent to you which will contain the Epworth Sleepiness Scale, an excellent diagnostic tool. You will be requested to provide a copy of your sleep study if one has been completed (obtained from your medical doctor). Your first appointment will take approximately 1 hour. The examination will include your medical/dental history, an intraoral assessment, an evaluation of your dentition and periodontal condition, and a temporomandibular joint examination. Radiographs are usually taken to help with the doctor's assessment, and finally, an impression of your upper and lower teeth.
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| Q |
Will I need follow-up visits after getting the appliance? |
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Follow-up visits (3 to 4) are necessary to evaluate the health of the oral structures and integrity of the occlusion while using the oral appliance. As well, the health of the temporomandibular joints (TMJs) must be maintained as the mandibular condyle is advanced and kept in a forward position. You will be referred back to your physician and/or sleep specialist for a follow-up sleep study and/or re-evaluation of the effectiveness of the appliance.
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| Q |
Will my insurance cover the cost of an oral appliance? |
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Oral appliances have been ruled as medical devices by the Food and Drug Administration; consequently, more and more medical insurance companies are considering payment. You may very likely expect coverage from your medical insurance company once they have determined that your treatment is medically necessary. You can help your dentist by providing a prescription and a referral from your medical doctor or sleep specialist along with a copy of your sleep study.
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