ABOUT SLEEP APNEA
What is sleep apnea?
Sleep apnea is a temporary cessation of breathing during sleep, occurring many times during the night. People suffering from sleep apnea stop breathing for 10 to 20 seconds at a time, then strenuously gasp for air. This may happen as frequently as hundreds of times during the night and sometimes for a minute or longer. Blood oxygen levels typically drop with each apnea.
Prevalence of sleep apnea
It is estimated that at least 12 million Americans suffer from sleep apnea, most of whom are undiagnosed.
Types of apnea
There are two major types of sleep apnea.
- Obstructive sleep apnea (OSA) is more common, occurring when muscles of the tongue, throat, and larynx relax during sleep and temporarily block the airway. The person instinctively tries to breathe with more force, until the airway opens and a breath is taken. These repetitive episodes of upper airway obstructions are usually associated with a reduction in blood oxygen saturation.
Central sleep apnea (CSA) is more rare, occurring when the brain temporarily stops sending signals to the muscles that control breathing.
Central sleep apnea is not the same as obstructive sleep apnea, which is due to a blockage in the airway. Oral appliances are not indicated in the treatment of central sleep apnea.
Some people have a combination of types, called mixed sleep apnea. This is a combination of the above which begins as central and becomes obstructive.
How do you know if you have sleep apnea?
The most obvious indicator is heavy snoring, with gasps and pauses in breathing. Snoring is relatively common; sleep apnea is not. Only a small minority of snorers have sleep apnea. If you think that you might have sleep apnea, check with your doctor.
Other symptoms of sleep apnea may include:
- Excessive sleepiness during the day,
- Waking up tired, sweating, or with morning headaches, and
- Waking up during the night with the sensation of choking.
How is obstructive sleep apnea treated?
A large percentage of people snore to some degree and a portion have some degree of obstructive sleep apnea (OSA). Most have mild OSA and may be treated with mouthpieces or other non-reversible forms of treatment and or lifestyle changes to reduce symptoms. Snore Guard and many other oral appliances are considered by the FDA to be a mandible repositioning device for reducing the symptoms of snoring and mild obstructive sleep apnea.
Note: A small percentage may have severe forms of sleep apnea where sleep studies are prescribed and treatments have included CPAP machines or non-reversible surgery, not mouthpieces. Snore Guard should not be used for severe forms of sleep apnea.
For example: If a male adult patient informs his regular dentist of a case of snoring with mild OSA, the dentist may first prescribe an oral appliance before more drastic measures are taken. A Snore Guard or other device may be fitted to determine if the patient can tolerate an oral appliance. The patient can keep the dentist informed as to the performance during subsequent visits. Should the condition not improve the doctor or dentist may refer the patient to have a sleep study to help determine the degree of sleep apnea and other forms of treatment.
Ask your doctor about your symptoms and choices.
Classification of sleep apnea
Sleep apnea occurs when you regularly stop breathing for 10 seconds or longer during sleep. It can be mild, moderate, or severe, based on the number of times an hour that you stop breathing (apnea) or that airflow to your lungs is reduced (hypopnea). This is called the apnea-hypopnea index (AHI).
A diagnosis by your doctor, often after a sleep study, is the only way to diagnose your classification on sleep apnea.
Mild apnea. Mild apnea is defined as 5 to 15 episodes of apnea or reduced airflow to the lungs every hour with 86% or more oxygen saturation in the blood.
Symptoms may include drowsiness or falling asleep during activities that do not require much attention, such as watching television or reading. These symptoms may cause only minor problems at work or while spending time with friends or family.
Moderate apnea. Moderate apnea is defined as 15 to 30 episodes of apnea or reduced airflow to the lungs every hour with 80% to 85% oxygen saturation.
Symptoms may include drowsiness or falling asleep during activities that require some attention, such as attending a concert or a meeting. These symptoms may cause moderate problems with work or social functioning.
Severe apnea. Severe apnea is defined as more than 30 episodes of apnea or reduced airflow to the lungs every hour with no more than 79% oxygen saturation.
Symptoms may include drowsiness or falling asleep during activities that require active attention, such as eating, talking, driving, or walking. These symptoms may cause severe problems with work or social functioning.
Oral appliances in the treatment of sleep apnea
Current guidelines from the American Sleep Disorders Association recommend that patients being considered for oral appliances have an initial sleep study to assess the presence and severity of sleep apnea. To ensure efficacy, a follow-up study in patients with moderate to severe sleep apnea with the device in place is recommended.
According to the American Academy of Dental Sleep Medicine, oral appliances are a front-line treatment for snoring and mild to moderate obstructive sleep apnea. Oral appliances help prevent the collapse of the tongue and soft tissues in the back of the throat, keeping the airway open during sleep and promoting adequate air intake. Oral appliances may be used alone or in combination with other treatments for sleep-related breathing disorders, such as weight management, surgery or CPAP. With an oral appliance, dentists can minimize or eliminate the symptoms of sleep apnea in mild to moderate cases.
Dentists with training in oral appliance therapy work closely with sleep physicians in the diagnosis, treatment and ongoing care for sleep related breathing disorders. The American Academy of Dental Sleep Medicine and the American Academy of Sleep Medicine recommend that a physician must diagnose sleep disorders including sleep apnea. Sleep physicians at AASM accredited sleep centers use an overnight sleep study to detect and diagnose sleep apnea.
Once a patient is diagnosed with sleep apnea or a sleep related breathing disorder, dentists may provide treatment. Dentists assist patients in the selection and fitting of an oral appliance and provide long-term follow-up care.
Oral appliances (OA) are indicated for use in patients with mild to moderate OSA who:
- prefer OAs to CPAP, or
- who do not respond to CPAP, are not appropriate candidates for CPAP, or
- who fail treatment attempts with CPAP, or
- do not have success with treatment of behavioral measures such as weight loss or sleep position change.
Risks of untreated sleep apnea
Untreated sleep apnea can:
- Increase the risk of high blood pressure, heart attack, stroke, obesity, and diabetes
- Increase the risk of, or worsen, heart failure
- Make arrhythmias more likely
- Increase the chance of having work-related or driving accidents