Snoring/Sleep Apnea - David B. Miller D.D.S.

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916-786-4TMJ Advanced Dental Concepts 916-786-4865

Sleep and Breathing Disorders

sleep.gif (7771 bytes) Sleep disorders are among the most common difficulties reported! As many as seventy million Americans suffer, thousands of hours are lost and the cost in U.S. production exceeds sixty billion dollars annually.

There are more than eighty known sleep disorders. They occur due to adverse physical conditions, stress, and other factors.

It is important to realize that our sleep pattern will change as we go though life, that all sleep is not the same, and the amount of restful sleep we get decreases with age. Sleep researchers have identified several different stages and two distinct types of sleep.

N-REM SLEEP makes up approximately eighty percent of a normal night's sleep, provides the physical renewal we require and is essential for life! During this type of sleep, we progress from wakefulness to drowsiness to moderate and finally to deep restorative sleep.

REM SLEEP is neither light nor deep sleep! It is characterized by dreaming, faster breathing, higher heart rates and rapid eye movement.

This type of sleep, which makes up approximately twenty percent of a normal night's sleep, is responsible for the emotional renewal we require, and is not essential for life.

Tips For Better Sleep

1. Go to bed only when sleepy.
2. Sleep at least seven hours and rise at the same time daily.
3. Keep your bedroom dark, quite and cool.
4. Listen to the radio, television does not work for most.
5. Eat a light and earlier dinner.
6. Make a to-do list 30 minutes prior to bedtime.
7. Avoid caffeine after early afternoon.
8. Avoid eating and exercise prior to bedtime.
9. Do not smoke and avoid alcohol prior to bedtime.
10. Avoid stressful encounters prior to bedtime.
11. Add a short nap between noon and three p.m.
12. Herbal teas, and a warm bath can be helpful.

Note: Aerobic exercise increases deep sleep, but not after seven PM.

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Normal Breathing

When you breathe, air passes through your throat on its way to the lungs. The air travels past the soft, flexible structures in the throat such as the soft palate, uvula, tonsils, and tongue. During the day, the muscles surrounding these structures tighten to prevent blockage of the air way. During the night, these muscles relax somewhat and, in the absence of an obstruction, the airway stays open enough to allow air to flow freely into and out of the lungs.

Snoring

If your throat structures are enlarged, or the muscles relax too much during sleep, the air way may be partially blocked. As air from the nose or mouth flows by this partial blockage, the structures in the throat vibrate and rattle, causing the familiar sound of snoring. Noise from snoring increases with age, weight gain, and when more of the airway is blocked. The noise level can be loud enough that those who snore may wake themselves or others several times during the night.

What causes Snoring?

Snoring occurs when floppy tissue in the airway relaxes during sleep and vibrates. Most snoring is caused by an enlarged soft palate at the back of the mouth, though the tongue, tonsils, adenoids and congested nasal passages can also contribute to the sound. The level of snoring can be aggravated be excess weight, alcohol intake, and smoking.

Is snoring dangerous to my health?

Snoring may be a sign of obstructive sleep apnea, a serious disorder in which the snorer stops breathing several times an hour during sleep. Your physician will perform a full examination to determine whether you are a "simple snorer" or if you have a more significant breathing disorder. Either condition may be easily treated.

Sleep Apnea

Snoring and sleep apnea are related Night time noise may be just an annoyance, however, it may indicate a serious problem If you suffer from sleep apnea, the muscles of the soft palate, tongue and uvula relax, sag and obstruct the airway! As the airway wall collapses, breathing stops periodically and sleep is temporarily interrupted A listener may hear a deep gasp as breathing begins again and the sleeper may awaken, but so briefly that he/she may not remember doing so. Those who suffer from apnea may stop breathing for ten seconds or longer, hundreds of times each night The heart sometimes beats irregularly and may pause for several seconds Each time breathing stops, oxygen in the blood stream decreases and the heart must work harder causing blood pressure to rise The lack of restful sleep and fresh air will strain your lungs, heart, and other organs, leading to problems such as morning headaches, poor decision making, weight gain, high blood pressure, heart attack and/or stroke!

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Snoring & Sleep Apnea

1.Ninety percent (90%) of those who snore exhibit apnic tendencies.
2.Twenty-four percent (24%) of the males and eighteen percent (18%) of the females under age sixty snore.
3.Sixty percent (60%) of the males and forty percent of the females over the age of sixty snore.
4.Noise from snoring may reach ninety (90) decibels! (Eighty-five decibels is considered hazardous).
5.Fifty percent (50%) of people with sleep apnea experience hypertension.
6.Sleep apnea can over time cause memory loss and poor decision making.

Sleep & Night Time Behavior

Epsworth Scale

The following questions are designed to identify a sleep problem. Chose the most appropriate number for each situation. To send this to the doctor, fill in the blanks and click on "Send to Doctor". You can also go to the printable version and give a copy to your doctor. A score of 6 or more indicates the possibility of a sleep disorder and should be discussed with your physician or dentist.

Name:
Phone:	E-Mail:
In contrast to feeling tired, are you likely to doze or fall asleep in the following situations? 0= Never 1= Slight Chance 2= Moderate Chance 3=Regularly
		Sitting & Reading?
		Watching Television?
		Sitting inactive in a public place (i.e. theater)?
		Passenger in a car for an hour without a break?
		Lying down to rest in the afternoon?
		Sitting and talking to someone?
		Sitting quietly after lunch without alcohol?
		In a car while stopped for a few minutes in traffic?
		Total Score

Sleep Behavior Scale

Chose the most appropriate number for each situation. To send this to the doctor, fill in the blanks and click on "Send to Doctor". You can also go to the printable version and give a copy to your doctor. A score of 8 or more indicates your sleep behavior is likely to cause a problem for you or others!!

Name:
Phone:	E-Mail:
During a typical night's sleep, have you noticed or been told that you: 0= Never 1= Once a week 2= Two- three nights/week. 3= Four or more times/week.

	Snore in a manner that affects your bed partner
	Snore in a manner that affects others when sleeping.
	Stop breathing or "hold your breath."
	Toss and turn frequently.
	Cough and/or struggle for breath.
	Sweat excessively.
After a typical night's sleep, have you noticed the following:
	Headache.
	Feel tired and feel a lack of energy.
	Lose concentration and/or more forgetful.
	Sleepiness during the day.
	Feel depressed or "down."
	Dry and/or sore throat.
	Total

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Contact the Doctor

Treatment

Treatment may be as simple as:

1. losing excessive weight which reduces the soft tissue obstruction to the airway,

2. getting regular exercise and

3. within three hours of bedtime, avoiding alcohol, heavy meals and medication that make you drowsy.

When the symptoms and the OSA is more severe other treatment options may include:

* Nasal CPAP Therapy (Continuous Positive Airway Pressure) - an air compression device and a nose mask are used to force the airway open to aid breathing during sleep. This device appears and sounds similar to a small vacuum sweeper which blows air rather than sucking it. This treatment is considered the "Gold Standard" of treatment. It is the most successful when the patient wears the mask, but compliance is notoriously low due to the cumbersome nature of its application.

* Surgery may be used to correct the physical abnormalities which cause the OSA, but sometimes the negative consequences and irreversibility of the procedure may be devastating to the patient.

* Dental Appliance Therapy is an alternative treatment for patients with mild or moderate OSA and for snoring patients without active OSA. The dental appliance is an acrylic or plastic device and looks similar to a double orthodontic retainer or athletic mouthpiece. The goal of the appliance is to prevent the tongue and other soft throat-tissues from collapsing and obstructing the airway during sleep. Dentists with special, extensive education and training in dental appliance therapy can design and then fit these special appliances to meet each OSA/Snoring patient's individual need and condition. Compliance with these intraoral devices is high and, in the event of failure, the treatment is "reversible", since the appliance may be removed.

Patients with Snoring or Sleep Disorders, including OSA, need the following medical/dental procedures to obtain the most appropriate treatment for their specific problem:

1. A complete Dental examination to determine if the patient qualifies for an intraoral appliance.

2. An upper respiratory airway examination by an ENT (ear, nose & throat specialist), to rule out organic disorders, such as tumor or polyps causing the airway obstruction.

3. A Sleep Study usually in a Sleep Clinic, to determine if the Obstructive Sleep Apnea is Mild, Moderate or Severe. This helps to ascertain the most appropriate treatment for the patient.

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The dotted circle shows the tongue against the back of the throat allowing the air to vibrate and cause snoring a if severe enough, result in Obstructive Sleep Apnea.

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Dotted area shows airway open with dental appliance in place bringing the jaw forward thus solving the problem of OSA.

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The "Silencer" is a specially designed dental appliance which has been shown to be effective in reducing or eliminating snoring as well as mild to moderate Obstructive Sleep Apnea.

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