What is Obstructive Sleep Apnea (OSA)?
Apnea literally means “cessation of breath”. In other words, apnea is when you stop breathing. Obstructive Sleep Apnea (OSA) is simply when your airway becomes obstructed during sleep, causing you to stop breathing. The human upper airway is surrounded by muscles. The largest of these muscles is the tongue. When we are awake we have tightness, or tonicity, in our upper airway muscles, but during sleep these muscles relax.
As we breathe during sleep, the throat and upper airway muscles relax and may begin to vibrate (this vibration is what causes snoring). Eventually these muscles relax even more and can collapse into the airway, effectively closing your throat and prohibiting air from flowing into your lungs. When you airway collapses and you stop breathing, your body responds as if you are suffocating. Your brain realizes that you are not receiving oxygen from your lungs, and arouses you from deeper stages of sleep (where rest occurs) to a lighter stage of sleep. By moving to a lighter stage of sleep your brain is able to contract your throat and upper airways muscles to open your airway and help you resume breathing. This tightening of your upper airways muscles helps force open your airway and allow air and oxygen to flow into your lungs so you do not suffocate. This cycle of suffocation (apnea) and arousal to breath can happen hundreds of times a night. In most cases you do not fully awake, so you may not even realize this is happening to you every night! Obstructive Sleep Apnea (OSA) can cause excessive daytime sleepiness, mental impairment, cardiovascular problems, heart attack, stroke, diabetes, impotence, acid reflux, and a multitude of other undesirable side effects. Obstructive Sleep Apnea is a serious and progressive condition that can lead to serious health problems and even death if left untreated.
Recent studies have shown that 1 in 4 adults in the United States (31% of all men and 21% of all women over 18) are at “high risk” for Obstructive Sleep Apnea (based on analysis of the National Sleep Foundation’s 2005 Sleep in America survey). It is estimated that the American public spends over $3 billion every year on the diagnosis and treatment of sleep apnea! This is a serious health issue affecting millions of Americans.
How can Dental Sleep Solutions® dentists help?
Snoring and Obstructive Sleep Apnea (OSA) are both caused by a collapse of the upper airway when the muscles relax during sleep, causing the patient to stop breathing during the night. The largest muscle, and most likely culprit for this problem of airway collapse, is the tongue. The tongue muscle is much larger than most people realize. The tongue is present in the oral cavity (mouth) but it also extends down the throat and beyond throughout most of the length of the collapsible upper airway.
Dental Sleep Solutions® dentists have obtained specialty training in oral appliance therapy, allowing us to fit custom FDA-approved dental devices (sometime called mandibular advancement devices or dental sleep devices) that help control the collapsing of the tongue into the airway, allowing patients to stop snoring and sleep and breath easier throughout the night. A dental sleep device looks similar to a sports mouth guard and can be comfortably worn in the mouth during sleep. The dental devices help prevent snoring and Obstructive Sleep Apnea (OSA).
Dental Sleep Solutions® dentists have the specialized knowledge and training to choose and fit an oral appliance that works perfectly for you. Many dentists claim they can provide treatment for Obstructive Sleep Apnea (OSA), but only Dental Sleep Solutions® dentists have received the rigorous training necessary to ensure that you are treated properly. Don’t trust your health to a non-specialist – make sure that you receive treatment from a qualified dentist with advanced training in sleep medicine. All Dental Sleep Solutions® dentists are here to help you with the knowledge and clinical experience you deserve.
What other treatments for snoring and Obstructive Sleep Apnea (OSA) are available?
TREATMENT options for a patient suffering from sleep apnea include Dental Device Therapy (learn about dental device therapy here), CPAP, Surgery, Positional Therapy, and Weight Loss.
CPAP (Continuous Positive Airway Pressure)
CPAP was developed in the early 1980’s and was the first viable solution for treating the insidious disease of Obstructive Sleep Apnea (OSA). Most physicians prescribe CPAP as a first treatment option, though many physicians now utilize dental devices as a first line of therapy for mild to moderate disease OSA. CPAP treatment consists of a pump that delivers positive air pressure to a mask that is fitted over the nose and/or the mouth. The air pressure is adjusted until the airway is forced open, much like blowing up a balloon.
CPAP is a very effective therapy WHEN it is used. If you’ve been diagnosed with sleep apnea and were prescribed a CPAP by your physician, you know exactly what we mean when we say WHEN it is used; compliance is the biggest challenge with this therapy. Most people find that wearing a mask and having air pushed down their throat is a challenge. The problems patients complain about from CPAP therapy are very real and often difficult, if not impossible, to overcome.
A partial list of the most common patient complaints from CPAP:
- Mask leaks
- An inability to get the mask to fit properly
- Discomfort or interrupted sleep caused by the presence of the device
- Noise from the device disturbing sleep or bed partner’s sleep
- CPAP restricted movements during sleep
- CPAP does not seem to be effective
- Pressure on the upper lip causes tooth related problems
- Latex allergy
- Claustrophobic associations
- An unconscious need to remove the CPAP apparatus at night
Do you currently use CPAP and have problems? Here are some tips that may help you sleep more effectively while using CPAP:
- Try a different CPAP mask
- Masks come in many shapes and sizes. Some go over just your nose; some your nose and mouth; others simply have a small tube that fits into your nose. Sometimes switching masks can help you.
- Call the company where you purchased your CPAP
- Work with the DME (Durable Medical Equipment) company where you got your CPAP. They are experts at helping people adapt to the therapy.
- Consider adding heat / humidification
- The constant air moving through your airway and across your mucous membranes tends to dry you out; so adding humidification to your CPAP can help. Heat can also be added and can make a significant difference, especially in Northern climates and the winter time.
- Ask about BiPAP
- If your pressure seems to be just too much, you may want to ask your physician if a BiPAP is a possible solution. BiPAP machines have a sensor in them that adjust the pressure based on whether you are trying to inhale or exhale. The sensor lowers the pressure when you are trying to exhale and makes it easier to get air out.
Surgery may also be a treatment option for Obstructive Sleep Apnea (OSA). The upper airway goes from your nose and mouth to the middle of your throat. The upper airway is dynamic and complex. Here is a partial list of surgeries that may be utilized to treat sleep apnea:
- nasal septal surgery
- turbinate reduction surgery
- Somnoplasty turbinate reduction
- Uvulopalatopharyngoplasty (UPPP)
- partial uvulectomy/ Pillar Procedure
- CO2 laser palatoplasty (LAUP)
- uvulopalatal flap
- Woodson Procedure (transpalatal palatopharyngoplasty)
- turbinate reduction
- tongue base reduction – soft palate for snoring
- Tonsillectomy (total/ partial)
- lingual tonsillectomy
- tongue base reduction
- glossectomy (anterior vs. posterior)
- linguoplasty (CO2)
- tongue-base suspension sutures (Repose procedure)
- hyoid suspension and advancement to mandible
- hyoid myotomy and suspension to thyroid cartilage
- Expansion hyoidplasty
- geniotubercle/genioglossus skeletal advancement (with multiple variants)
- jaw advancement (telegnathic) surgery (LeFort I, Bilateral Sagittal split Advancement Osteotomies)- ? Distraction Osteogenesis
- maxillary transverse expansion
Most surgeries are performed by Ear Nose and Throat physicians, though Oral and Maxillofacial surgeons are also generally able to perform surgeries to treat Obstructive Sleep Apnea. Surgery is appealing to many patients because if it works, you are usually cured. However, sSurgery carries many severe and potentially life-threatening risks that should be discussed in detail with your physician so that you can evaluate the risk and reward for this treatment option. Dental devices can often be used as an initial treatment, and surgery used later if desired.
Positional Therapy is often overlooked by the medical profession as a treatment option of Obstructive Sleep Apnea (OSA). Often times OSA is worse in the supine position (lying on you back). The severity of apnea is sometimes diminished when sleeping in positions other than on one’s back. There are various apparatuses available to help train an individual to sleep in a non-supine position (like on your stomach, or on your side). These include various mechanisms that strap to the back, or even a tennis ball sewn into the back of a shirt that is worn at night. These methods can help reduce the severity of Obstructive Sleep Apnea (OSA), but you should be cautioned not to attempt to treat OSA with positional therapy without proper medical supervision. Positional therapy alone is rarely a cure for OSA, but it can often be of helpful when used with other therapies.
Weight loss usually can help decrease snoring Obstructive Sleep Apnea (OSA) in most cases. However, precaution should be taken in relying on weight loss alone to treat OSA, because it is rarely a cure. You should work in conjunction with your trained sleep specialist and Dental Sleep Solutions® dentist to determine the effect of weight loss on your Obstructive Sleep Apnea (OSA).