Sleep Apnea

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Information about Sleep Disorders:

What Causes Snoring?

Snoring, a condition caused by a narrowing of the airway in the nose and/or throat may be harmless. The actual snoring sound is created when air rushes against soft tissue, such as the tonsils, back of the tongue, throat and soft palate. This causes a vibration that makes a snoring sound.

An airway can become narrow for many reasons. A deviated septum in the nose or excess weight in the throat is often the cause. If the tongue, a muscle, relaxes too much during sleep it can get drawn back into the throat with each breath. All of these conditions may contribute to the snoring noise.

Obstructive Sleep Apnea

This condition in which the tongue is drawn back during breathing, blocking the airway. When oxygen levels in the brain drops, the sleeper awakens and the tongue returns to its normal position. This cycle of short interrupted sleep prevents the person from attaining restful sleep.

Over time this condition can cause complications affecting the heart, blood pressure, alertness and ability to stay awake, among other problems. People who have this condition have a constant feeling of tiredness.

What Can Be Done For Snoring and Sleep Apnea?

Mild snoring can be alleviated by:

• Not sleeping on the back
• Losing weight
• Avoid alcohol and medication that causes drowsiness several hours before sleep

When these methods do not alleviate the problem an evaluation by a physician and a sleep study are necessary. Once a diagnosis of Obstructive Sleep Apnea (OSA) is made, it is necessary to manage the condition.

Options include:

• Nasal CPAP (Continuous Positive Airway Pressure) a device that uses a nose mask to force compressed air into the nasal passages to keep the airway open during sleep.
• Surgery of the throat or Maxillofacial Surgery (this bring the jaw forward and can be extremely effective if done by an oral surgeon with expertise in sleep disorders)
• Dental appliance to hold the jaw in a position that keeps the airway open.

How Does a Dental Appliance Work?

A dental appliance is similar to an orthodontic retainer except that it is not used to move teeth. It works by changing the way the lower jaw meets the upper during sleep. When the appliance is worn, lower jaw moves slightly forward. This creates more space at the back of the tongue and throat for air flow.

To be fitted for a dental appliance, it is important to consult a dentist experienced with the use of appliances. Whenever the jaw is moved, there is risk of creating discomfort or a “TMJ” (jaw joint) problem. The American Academy of Sleep Medicine recommends that the treating dentist “must be capable of treating TMJ Dysfunction.”

Advantages of Dental Appliance Management

• Dental appliances are small, easy to wear and weighs only a couple of ounces. Its size makes it easy to travel with. After a few weeks most people are completely comfortable with the appliance.
• Cost of the appliance is less that the cost of other treatments over time.
• Management with a dental appliance does not require surgery.

A Physician Should Be Consulted

Studies have shown that one out of three severe snorers have a harmful degree of sleep apnea. If you snore heavily and/or suspect that you might have OSA it is very important that you are thoroughly examined by a physician. Examination of the nasal passages by an ENT specialist and a sleep study may be necessary.

What can be done:
I have been helping people with the management of TMJ, face pain, snoring and Obstructive Sleep Apnea conditions for over 25 years. I am a charter member of the Academy of Dental Sleep Medicine and I am credentialed as a Diplomate of the American Board  of Dental Sleep Medicine and a  Diplomate of the American Board of Orofacial Pain.

I have found that oral appliances have to be very comfortable and have a bite position that will not strain the jaw and cause pain problems.

Practice Parameters for the Treatment of Snoring and Obstructive Sleep Apnea with oral Appliances: AN Update for 2005 An American Academy of Sleep Medicine Report(Sleep,vol29,No.2,2005) states that “Oral appliances are indicated for the use in patients with mild to moderate OSA who prefer them to continuous positive pressure (CPAP) therapy or do not respond or fail treatment attempts”.