Sleep Apnea is a serious medical condition that can be life-threatening where people experience repeated breathing pauses during sleep due to an obstructed airway. The obstruction occurs when the soft tissues of the tongue, soft palate, and uvula collapse in the back of the throat and block the airway so that air cannot flow into the lungs. This blockage will continue until the brain sensing a lack of oxygen partially awakens the person, and after a gasp or snort begins to breathe again. These unintentional breathing pauses may occur many times per hour and continue throughout the night. These people rarely reach a deep level of sleep enabling them to feel refreshed upon awakening. Consequently, daytime sleepiness and a chronic lack of energy are common complaints.
What are the signs and symptoms?
There are 3 cardinal symptoms of sleep apnea:
Snoring, daytime sleepiness, and spousal witnessed breathing pauses. There are also several other signs that sleep apnea patients often complain about:
- Waking up tired and un-refreshed no matter how many hours of sleep
- Morning headaches
- Short term memory loss
- Chronic lack of energy
- Inability to concentrate or think clearly
- Frequent night time restroom visits
- Irritability or depression
- Acid reflux
- Restless and unrefreshed sleep
- Dozing off while reading, watching television, or driving
How is it diagnosed?
The only definitive test that exists is the Polysomnogram, or sleep study. This is performed overnight in a sleep lab in a hospital. It will record a great deal of information including EEG, eye movement, muscle activity, heart rate, respiratory effort and rate, air flow and blood oxygen levels. From this test the physician can tell you if you have sleep apnea and how severe it is.
In some cases changing behavior is all a person needs to do to control his/her sleep apnea. A person can learn to sleep on their sides or stomach instead of their back. They can limit the use and/or consumption of alcohol, tobacco, and sleeping pills since all of these make the airway more likely to collapse during sleep and extend the breathing pauses. People who are overweight can profit from a weight loss, even a 10% drop in weight can reduce the severity of the disease.
CPAP- (Continuous Positive Airway Pressure) – This is the most common and effective treatment for sleep apnea. It acts as a pneumonic splint using forced air to remove the obstruction in the throat, and drive air into the lungs. The biggest problem with CPAP is that even though it is very effective, it is not well tolerated by many patients for a number of different reasons.
Oral Appliance – Oral appliance therapy is a conservative alternative to CPAP. It provides a non-invasive form of treatment that has a high level of compliance as it is small, comfortable, portable, and effective. According to the American Academy of Sleep Medicine oral appliances are an appropriate treatment option for sleep apnea patients “with mild-moderate sleep apnea who prefer them to CPAP, or who do not respond to, are not appropriate candidates for, or who fail attempts with CPAP.” Oral appliances are also the next best option for
severe sleep apnea patients who cannot and will not tolerate CPAP. These appliances would remind you of teeth protectors worn by athletes, only these hold your lower jaw forward to keep the airway open by preventing the collapse of the tongue, soft palate, and uvula into the back of the throat.
Although CPAP is considered the “gold star” standard for patients with severe sleep apnea, it fails 100% of the time if it is not worn, and only 43% of CPAP users actually wear their masks. Therefore, patients with severe sleep apnea that need to wear their CPAP find comfort in combining therapies. They include oral appliance therapy in conjunction with their CPAP. The forward repositioning of the lower jaw will help open the airway, allowing CPAP users to turn down the pressure on their masks resulting in higher tolerance and usage.