What Is Sleep Apnea?
These terms describe parts of the continuum of airway collapsibility expressed as sleep-disordered breathing. This spectrum ranges from slight vibration of tissues at its mildest to death from asphyxiation at its severe extreme. Between lies pathologic snoring and periods of complete airway closure and breathing cessation called “apnea”.
Some of the most serious chronic diseases of man have been associated with snoring and sleep apnea, including: stroke, hypertension (high blood pressure), myocardial infarction (heart attack), arteriosclerosis (hardening of the arteries), cardiac arrhythmias (irregular pulse), diabetes, gastro-esophageal reflux disorder (GERD), polycythemia vera (thickening of the blood) and others.
Sleep disordered breathing also disrupts the normal patterns of brain activity and relaxation, precluding restorative sleep. Overwhelming daytime sleepiness contributes to the risk of accident and injury from decreased attention span, judgment and reflex. The risk of automobile accident in the untreated sleep apnea patient is about 8 times that of the normal sleeper. Work productivity and safety suffer.
During the increasing muscular relaxation of deepening sleep, the airway can become increasingly flaccid. The relaxing tongue falls back, sealing against the back of the throat during the sucking, negative pressure of the attempt to take a breath. Snoring is the vibration of the uvula, soft palate and throat walls against the tongue during the inspiratory phase of breathing, with reduced airflow due to increased resistance. As collapsibility increases, complete closure can occur.
In either narrowing (hypopnea) or closing (apnea) events, oxygen levels of the blood can drop precipitously triggering a response of the brain to prevent asphyxia. This “sympathetic discharge” of adrenaline, corticosteroids and other agents raise blood pressure, pulse rate, muscle activity and brain activity to protect the unconscious sleeper from death.
The sleep apnea patient may have these events occur up to 600 times or more per night resulting in fragmented, non-refreshing sleep as well as chronic activation of the sympathetic nervous system. This activation is thought to be the reason for such devastating long-term negative effects on cardio-pulmonary health. Untreated for nine years, sleep apnea patients may lose 20-50% of lifespan.
The main types of sleep apnea are:
- Obstructive sleep apnea, the more common form that occurs when throat muscles relax.
- Central sleep apnea, which occurs when your brain doesn’t send proper signals to the muscles that control breathing.
- Complex sleep apnea syndrome, also known as treatment-emergent central sleep apnea, occurs when someone has both obstructive sleep apnea and central sleep apnea.
If you think you might have any form of sleep apnea, contact Los Gatos Dentist Dr. Anthony Peterson today. Treatment can ease your symptoms and may help prevent heart problems and other complications.
Oral Appliance Therapy
Oral appliance therapy is an effective treatment option for snoring and obstructive sleep apnea (OSA). A custom-fit oral sleep appliance can improve your sleep, restore your alertness and revitalize your health.
1. How common is this disorder?
Recent research estimates that about 1/3 of the population has some form of sleep disordered breathing which is a spectrum of severity from mild snoring to complete closures of the airway (obstructive sleep apnea) to death from asphyxiation.
17% of the population has obstructive sleep apnea, and in the age groups over 60 years, the occurrence rate doubles. Sleep apnea is made worse with increasing body weight. As the obesity rates are rising in the United States, so is the incidence and severity of Obstructive Sleep Apnea (OSA)
2. How would I know if I have OSA?
Several peer-reviewed research articles have examined the relationship between patient medical history and sleep testing for the presence of OSA.
If you answer “yes” to two questions:
A. “Do you snore regularly?” and
B. “Do you sometimes gasp for air?”
there is an 88% chance of accurately diagnosing OSA at a severity level of 10 collapses per hour. This is significant and requires treatment.
Adjusted Neck Circumference Survey for OSA
New England Journal of Medicine 347:498-504, 2002
The adjusted neck circumference survey uses 4 predictors of OSA to screen patients for the likelihood and possible severity of the disorder.
|1. Neck circumference in cm (2.5 X inches)
2. History of high blood pressure (treated or not) ADD 4
3. Snoring ADD 3
4. Gasping or choking in sleep (observed or awakened) ADD 3
Probability of Obstructive Sleep Apnea
Less than 44 = LOW
44 – 48 = MODERATE
Greater than 49 = HIGH
3. How do I get treatment for OSA?
Any practitioner treating OSA should do so by practice parameters established by the American Academy of Sleep Medicine (AASM). To be in compliance, patients must be diagnosed by polysomnography (PSG) which is an overnight sleep test at a sleep laboratory. 16 channels of physiology are studied including brain function and cardio-pulmonary status.
A. Get an evaluation appointment with Dr. Peterson. Referrals for diagnostic sleep testing can be obtained at that visit if you have not been tested. If you have been tested and are looking for treatment, Dr. Peterson will be able to make sure that you are fully informed of all treatment options available.
B. If you select oral appliance therapy, Dr. Peterson will provide standardized care with proper informed consent, proper follow up therapy and objective measurement of results in accordance with AASM standards of care.
4. Will my insurance cover this therapy?
It is very likely that your medical insurance carrier will cover oral appliance therapy for you. Dr. Peterson can offer a complete insurance assessment at the initial visit. This assessment, prior to accepting any therapy virtually eliminates patient uncertainty over any financial obligations. Please contact Dr. Peterson for complete details.
About Oral Appliance Therapy
Worn only during sleep, an oral appliance fits like a sports mouth guard or an orthodontic retainer. It supports the jaw in a forward position to help maintain an open upper airway. Research shows that oral appliance therapy is an effective treatment option for snoring and obstructive sleep apnea.