Thursday, January 12, 2012

Sleep Apnea- Snoring may be a sign of something more severe


It has been estimated that 90 million people in North America have breathing problems leading to snoring and sleep apnea.  Snoring is not just a social nuisance; it is a serious health risk.  Cardiovascular disease is the number two cause of death in N. America and patients who suffer from snoring and sleep apnea have a higher incidence of heart attacks and strokes due to high blood pressure as a result of lack of oxygen.

Snoring occurs when the tongue partially blocks the airway when the patient sleeps on their back and sleep apnea occurs when the tongue completely blocks the airway.  Both situations are harmful since the patient is deprived of oxygen.

Some patients actually stop breathing for 30 seconds or more, many times each night.  These patients wake up several times at night gasping for breath.  When they are deprived of oxygen, they have problems getting to sleep, wake up frequently at night, have morning headaches, loss of memory, ear aches, grind their teeth at night and find it difficult to concentrate.

Could you be at risk?

Do you snore?
Are you overweight?
Are you tired during the day?
Are you approaching or going through menopause?
Do you have hypertension?
Do you suffer from gastroesophageal reflux?
Do you have morning headaches?
Have you been told that you stop breathing or hold your breath while you sleep?
Are you still tired and irritable in the morning even though you slept through the night?
Have you noticed your heart pounding or beating irregularly during the night?
Have you suddenly awakened gasping for breath during the night?
Do you seem to be losing your sex drive?
Do you toss and turn frequently?
Do you sometimes doze off during the day?

Daytime fatigue is the number one sign and results in an increase in industrial accidents and traffic accidents.  Many patients are prescribed CPAP units that consist of an air compressor that forces air up the nose in order to open the airway.  While these are effective and necessary for patients with severe sleep apnea, the problem is that 80% of patients are non-compliant after one year.  Patients much prefer to wear oral appliances that reposition the lower jaw and move the tongue forward, thus opening up the airway.  Patient compliance with oral appliances is over 90%.

So, what causes sleep apnea?  One of the main causes of snoring and sleep apnea is excess weight.  Men with necks more than 17” and women with necks in excess of 16” have a greater tendency for these problems.  Many patients, who are presently being treated for hypertension and gastroesophageal reflux would benefit from an oral appliance that would open their airway, give them more oxygen and put less stress on their cardiovascular system.

As soon as you are sleeping, the autonomic nervous system takes over-your body goes on autopilot.  The role of the muscles during the daytime is to keep the airway open.  As we age and perhaps gain a few pounds, the muscles that hold the airway open relax and lose their tonicity and the airway collapses.  As men grow older and gain weight, excess fat seems to go to their neck, which leads to airway obstruction.  Prior to menopause, women’s excess fat usually goes to their hips but after menopause, the excess fat goes to their necks.

As the airway collapses due to the muscles losing their tonicity with age as well as increased fat deposits, the air is forced through a very narrow opening that causes the tissues to vibrate.  This vibration results in the patient snoring.  As one drifts into deeper sleep, the muscles surrounding the airway relax even more, which causes partial obstruction-SNORING or complete obstruction-OBSTRUCTIVE SLEEP APNEA.  The body is then fighting for air so it can get the oxygen it needs. 

Signals go from the heart and lungs to the brain.  The brain responds to this emergency situation-lack of oxygen, by releasing adrenalin, which causes among other things, an increase in your heart rate.  In cases where the heart is severely strained, this can lead to a heart attack.  Patients with obstructive sleep apnea have their chests heave as the muscles try and force the patient to wake up in order to re-establish normal muscle tone in the muscles surrounding the airway.

Your body is usually successful and for a moment the airway opens, the patient gasps and breathes, air goes to the lungs and then the patient falls back to sleep.  Depending on the severity of your sleep disordered breathing problem, this could happen hundreds of times each night, which has an adverse effect on your cardiovascular system, causes sexual dysfunction, depression and strokes.  Patients are not aware of the fact they are waking up, but you can see that they are not getting a restful sleep when they frequently demonstrate that fact when they are extremely tired during the daytime.

What to do?

  • Loss weight
  • No alcohol
  • Stop smoking
  • Eliminate sedatives
  • Sleep on side
  • Lifetime commitment to change

  • Uncomfortable
  • Unattractive/noisy
  • Irritation & rashes
  • Dry throat
  • Cumbersome for travel
  • Less than 50% worn on a nightly basis

  • Painful
  • Non-reversible
  • Unpredictable results
  • Recovery time
  • Side effects may be permanent
  • Success ranges from 30-50%

  • Comfortable
  • Travels easily
  • Non-invasive
  • Reversible
  • 90% compliance

People who snore and have obstructive sleep apnea often have no idea of the extent of their snoring.  Many are not aware that their breathing stops and starts many times while they sleep.  Spouses, family members, friends, roommate and co-workers are in the unique position to help identify a loved one or a friend who shows symptoms of obstructive sleep apnea.  We designate these people as “SNORER’S FIRST LINE RESPONDERS”?


Snore loudly?                                                              YES     NO            Overweight?                                               YES            NO
Stop breathing during sleep?                                        YES     NO            Decreased sex drive?                                  YES            NO
Awaken gasping or short of breath?                            YES     NO            Have little or no dreams?                YES     NO
Have high blood pressure?                                          YES     NO            Gastroesophageal reflux?               YES     NO
Experience excessive daytime sleepiness?                   YES     NO            Man’s neck size 17” or larger         YES     NO
Have congestive heart failure?                                     YES     NO            Woman’s neck size 16” or larger?  YES     NO
Lack concentration or have memory lapses?               YES     NO            Fall asleep in less than 5 minutes?  YES     NO           

Epworth Sleepiness Scale

How likely are you to doze off or fall asleep in the following situations, in contrast to feeling “just tired”?  This refers to your usual way of life at present and in the recent past.  Even if you have not done some of these things recently, try to work out how they would have affected you

Use the following scale to choose the most appropriate number for each situation:

0 = would never doze                         2 = moderate chance of dozing
1 = slight chance of dozing                 3 = high chance of dozing

SITUATION                                                                          CHANCE OF DOZING

Sitting and reading                                                                             ______
Watching television                                                                            ______
Sitting, inactive in public place-theatre, meeting                                ______
As a passenger in a car for an hour without a break                           ______
Lying down to rest in the afternoon when circumstances permit       ______
Sitting and talking to someone                                                           ______
Sitting quietly after lunch without alcohol                                         ______
In a car, while stopped for a few minutes in traffic                           ______

TOTAL SCORE                                                                                 ______

Scores  6-7 considered normal
             8-12 mild sleepiness
             13-17 moderate sleepiness
             18+ severe sleepiness

Caroline Wallace DDS
Complete Dental Care
103 South Colorado Street
 Salem, Virginia, 24153

No comments:

Post a Comment