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Snoring & Sleep Apnea

Based on recommendations from the American Academy of Dental Sleep Medicine and the American Academy of Sleep Medicine, a physician is responsible for the diagnosis of sleep disorders and for recommending a treatment. A sleep medicine physician at a sleep centre uses an overnight sleep study to detect and diagnose sleep apnea. Once a patient is diagnosed with sleep apnea or a sleep related breathing disorder, a dental sleep specialist may provide treatment. A dentist assists patients in the selection and fitting of an oral appliance and provides long-term follow-up care.

Snoring

Snoring is noisy breathing during sleep.  If you snore you are definitely not alone.

Snoring is a condition that affects 40 % of Men and 25% of women at least some of the time and as many as 16% of all adults on a regular basis.  It tends to get worse with age and weight gain.  When you are asleep the muscles that form the walls of the airway between the back of the nose and the voice box relax.  In many individuals this collapse of the airway results in turbulence of the air flow and the muscles flap like a flag in a wind.  The result is the snoring noise that can keep bed partners awake, disturbing their sleep and often the sleep of the snorer.  For the snorer the condition can result in fragmented sleep which contributes to daytime sleepiness and heart disease.  Sometimes the airway can collapse entirely on an intermittent basis.  This condition is called Obstructive Sleep Apnea.  About one half of people who snore loudly have obstructive sleep apnea.  If your bed partner reports hearing pauses in your breathing during sleep you may have obstructive sleep apnea.

While snoring affects men more than women it also tends to get worse with age.  It tends to be worse in heavier people partly due to a narrowing of the airway with a bigger neck.  Any medications that relax muscles will make snoring worse, such as many over the counter cold medications, sleeping aids and alcohol.  Smokers also have a greater tendency to snore due to chronic inflammation of the airway tissues.  The same can be true for people suffering with allergies. Many people snore more while sleeping on their back, or when overtired when going to bed.  Anatomical issues may also contribute to snoring.  Enlarged tonsils or adenoids, deviated septum or nasal polyps, narrow palate or long soft palate may contribute to the likelihood of snoring.

Snoring can result in wakening with a headache, a feeling of not having enough sleep in the morning, feeling sleepy during the day, and a lack of concentration during the day.  Bed partners reporting pauses in breathing during sleep indicates a more serious condition known as Obstructive Sleep Apnea.

Treatment of snoring may require one or a combination of therapies.  Many people can control their snoring simply by not sleeping on their back.  This can be aided with a number of devices such as the Rematee.  Weight loss can help some individuals.  Often snorers are chronically tired making it difficult to include exercise as part of their regular routine. Avoidance of muscle relaxing medications can be helpful.  Many people only snore when they have consumed alcohol too soon before bedtime.  Reducing or eliminating smoking has many benefits and stopping snoring may be one of them.  Soft palate surgery may be a treatment option for some individuals as constant positive airway pressure or CPAP.

Obstructive Sleep Apnea

Obstructive sleep apnea, or OSA, is a result repeated intermittent partial or complete collapse of the airway while sleeping. Approximately 2-3% of the population has OSA, and the rate increases with age and weight gain.  The most common symptom of OSA is snoring.  The only way to diagnose OSA is with a sleep study.

When you are asleep the muscles that form the walls of the airway between the back of the nose and the voice box relax.  This can cause a narrowing of the airway so that it is like breathing through a straw, or completely block the airway despite continued effort to breath.  This can happen hundreds of time a night. The resulting drop in adequate delivery of oxygen to the body including the brain causes you to awaken sufficiently to open the airway.  People are typically unaware or these arousals. Instead of normal sleep architecture which allows prolonged periods of refreshing deep sleep the OSA sufferer has a fragmented sleep causing daytime sleepiness and risk for cardiovascular disease.

A partial collapse of the airway is known as a “hypopnea” and a complete collapse is known as an “apnea”.   The average number of time this happens per hour is referred to as the “apnea-hypopnea index” or AHI.  An AHI of under 15 is considered mild, 15-30 is considered moderate and greater than thirty is severe.  Proper diagnosis of a sleep related breathing disorder requires an overnight sleep study, known as a polysomnogram, in a sleep laboratory.  In this way the severity of the disease can be evaluated as well as determining if other sleep disorders may be present.

The fragmented sleep pattern and repeated fluctuations in blood oxygen levels has a number of health consequences. 

Fragmented sleep results in excessive daytime sleepiness.  This can result in a lack of concentration, mood and memory problems, irritability, depression and sexual dysfunction.  People with OSA are prone to workplace accidents and up to six times more likely to have a car accident.

The repeated drop and recovery of blood oxygen levels has significant cardiovascular consequences.   Obstructive sleep apnea is an independent risk factor for high blood pressure, coronary artery disease, cardiac arrhythmia, heart attack, depression and stroke.  OSA also increases the chances of weight gain and Type 2 diabetes, and sudden death while asleep. 

Like snoring OSA affects men more than women it tends to get worse with age.  It can be worse in heavier people partly due to a narrowing of the airway with a bigger neck.  Any medications that relax muscles will make OSA worse, such as many over the counter cold medications, sleeping aids and alcohol.  Smokers are more prone to OSA due to chronic inflammation of the airway tissues.  The same can be true for people suffering with allergies.  Anatomical issues may also contribute to OSA.  Enlarged tonsils or adenoids, deviated septum or nasal polyps, narrow palate or long soft palate may contribute to the likelihood of snoring and OSA.