People are becoming more aware of problems related to their sleep, sleep breathing, snoring,
sleep apnea and upper airway resistance syndrome, excessive daytime sleepiness, being tired
and constantly fatigued. These are all signs and symptoms of sleep breathing disorders and
where indicated can comfortably be treated without medication. This can be done with using a
Mandibular advancement device or positive airway pressure treatment.
Treatment of Sleep disordered Breathing Problems
Obstructive Sleep apnea (OSA)
Upper airways resistance syndrome (UARS)
Sleep-related breathing disorders
Sleep-disordered breathing (SDB) spans a continuum from snoring over upper airway resistance syndrome (UARS) to obstructive sleep apnea syndrome (OSA). SDB is characterized by normal muscle relaxation with repetitive collapse of the pharyngeal airway during sleep. These are diseases that affect men and women equally and can start from a very young age, sometimes only to be diagnosed later in life. It is estimated that 80-90 percent of adults with OSA remain undiagnosed and untreated. Unfortunately, OSA is a growing problem, with overweight and obese people making up one of the highest risk groups for this disease.
Snoring is the most common indication of a sleep breathing disorder. Snoring is what people hear but they usually have no idea of the severity of their sleep breathing disorder and the impact that it has on their day to day life and general wellbeing. So often one hears of people complaining about snoring, forcing them to sleep elsewhere. Often you hear people talking about their partner stopping breathing completely (10-60 seconds), lying awake, waiting for them to start breathing again or they shake them to start breathing again. These are all signs and symptoms of sleep apnea. Sleep apnea can lead too many physiological, cardiovascular and other problems, there is debate on whether SBD is the cause of the problems or is caused by some of the problems (What came first, the chicken or the egg). The treatment of sleep breathing disorder is therefore multidisciplinary as patients can have many different illnesses, signs and symptoms.
SDB, Obstructive sleep apnea occur when the muscles in the airway relax during sleep, the muscles lose rigidity, these include the muscles in the back of the airway, the muscles of the tongue and the muscles that regulate position and movement of the mandibula. This allow collapse of the soft tissue and blockage of the airway. The result of the closure lead to development of apnea and hypopnea, which lead to stoppage of breathing up to hundreds of times per night. This stoppage of breathing can last from a few second to more than a minute causing hypoxemia.
Snoring, excessive daytime sleepiness, mood, irritability, memory problems, fatigue, feeling that that you aren’t sleeping well at night, even though you cannot remember tossing and turning and insomnia are all signs of lack of sleep and sleep apnea.
Left untreated it can increase the risk of high blood pressure, stroke, heart disease, obesity, diabetes, depression and impotence.
Sleep apnea is a common problem that effect people of any age and body type. Although sleep apnea can occur at any age, there is an increased risk with age. It is estimated that 18-25 million Americans are affected by sleep apnea. While the sleep disorder is common in men, it occur in women too, especially during and after menopause. Excess body weight, a narrow airway, a recessed chin and misaligned jaw can increase the risk of sleep apnea.
How do we know if we suffer from sleep apnea?
Are you getting a good night sleep?
If not, try recording yourself sleeping or ask your bed partner, they usually have a good idea.
Listen for: Loud and frequent snoring which is a common symptom.
Sleep apnea is characterized by breathing pauses throughout the night.
Your bed partner may hear you gasp for breath in your sleep or may wait for you to start breathing again.
Snorers never wake themselves snoring but sometimes awake, gasping for a breath, thinking that their snoring woke them.
Watch for: Excessive daytime sleepiness (the ability to fall asleep anywhere at any time)
Moodiness and irritability
Signs and symptoms of acid reflux, indigestion, heart burn or chest pain.
The American Academy of Dental Sleep Medicine conducted a survey that revealed what may be causing relationship woes. Here are some of the results:
Forty percent of women claimed that snoring in the opposite sex is a turn-off.
More than forty percent confessed that a snoring bed partner makes them annoyed or
One in five said a snoring partner could drive them out of bed.
One in 10 Americans admitted that snoring has hurt at least one romantic relationship.
The traditional prescribed treatment for SDB, OSA is continuous positive airway pressure (CPAP) therapy. It involves sleeping with a face mask connected via tubing to a positive air pressure machine. Although CPAP is effective a very high percentage of patients do not adhere to the treatment. Oral appliance therapy provide an alternative solution to the treatment of OSA. Oral appliance can be used in conjunction with CPAP or as an independent treatment.
Oral appliance therapy (OAT) is an effective, non-invasive option for snoring and OSA. It support the jaw in a forward position to help maintain an open upper airway. Compared with a CPAP machine and mask, oral appliances are less cumbersome and more discreet for both the snorer and their partner. The survey revealed that single adults are twice as likely to prefer oral appliance therapy over CPAP therapy. When compared with CPAP, oral appliances can feel less burdensome, making it less embarrassing choice than a bulky CPAP machine and mask. Oral appliances has added advantage of being silent, portable and easy to clean.
OAT involve the customized fabrication, fitting, adjustment and long term follow-up care of a specially designed oral device, worn during sleep, which reposition the lower jaw and tongue forward to maintain a more open upper airway.
Treating snoring or sleep apnea with oral appliance therapy can help you feel like a new person. You will find that your symptoms, and your quality of life, can improve when you remain committed to your treatment and use it nightly, improving your sleep, restore your alertness and revitalize your health.
OAT is recommended for people with mild to moderate obstructive sleep apnea and for severe sleep apnea patients if they are unable to tolerate CPAP.
With oral appliance therapy, travellers can seamlessly continue their sleep apnea treatment while on the journey. Consistently wearing your oral appliance will ensure you get better sleep and have a more enjoyable journey.
Symptoms and quality of life can improve dramatically for patients who remain committed to their treatment and abide by it nightly.
Loud and frequent snoring is not just a nighttime annoyance; it is often a red flag for larger health problems. Understanding the impact of snoring on health and the treatment options available, help snorers make smarter, healthier lifestyle choices that are sure to positively impact them and their families in the long term.
Side effects of OAT are generally minor, including excessive salivation, muscle and tooth discomfort and occasionally joint discomfort, and most improve within a few weeks. Major adverse effects of OAT are uncommon but can include slight tooth movement, changes in the patient’s bite and ongoing muscle soreness.
Sleep breathing disorders
Cephalometric radiographs of patient without and with the intra oral device in position.
Changes in measurements
H-C3 4.5mm increase V-LPW 3.8mm increase H-MP 8.1mm decrease
ANB 6 decrease PAS 4.3mm increase SNB 4 increase