Sleep Apnea

Not all snorers suffer from sleep apnea. It may however, be a sign that someone who snores is predisposed to obstructive sleep apnea.

OSA, or Obstructive Sleep Apnea is a progressive disease, beginning with an inability of the upper airway to remain fully open while sleeping. When the upper airway reduces in size or patency during sleep, snoring becomes louder over time as an individual ages, until finally the airway becomes obstructed and breathing stops briefly, then begins again with a gasp for air, much like when someone is holding their breath under water and then takes a huge breath when surfacing. This can happen many times per hour of sleep throughout the night, leading to fragmented sleep and gets worse over time until changes in the body begin.

It is estimated that the incidence of moderate to severe OSA is 9.1% in men and 4.0% in women. If mild OSA is factored in, these figures may be upwards to 20%.

Untreated OSA can lead to high blood pressure, diabetes, and daytime sleepiness with inability to remember and concentrate.

Difficulty to control weight gain is also associated with changes that occur to blood chemistry in the body.

The “gold standard” for treatment of OSA is with Continuous Positive Airway Pressure (CPAP). This forces pressurized air into the airway during sleep. It is done with a bedside machine and a mask or nasal apparatus placed on the individuals head.

Although very effective, only some 40% of patients who are prescribed such a device actually wear it regularly.

For those who cannot or will not tolerate a CPAP, an Oral Appliance (OA) is an alternative treatment. An Oral Appliance is inserted into the mouth before going to bed. It acts by re-positioning the lower jaw forward, holding the upper airway open during sleep and allowing you to breathe normally on your own. Oral Appliances are very effective in treating mild to moderate OSA. They are also extremely effective in reducing snoring. Although helpful, they are not as effective as CPAP when treating severe OSA.

With proper adjustment and regular follow up in treatment, Oral Appliances are worn regularly by 72% of individuals who have one.

Dental management of the treatment of OSA with Oral Appliances should be done by a qualified dentist who has had serious training in sleep medicine and sleep related breathing disorders. It is imperative that there be proper protocol for diagnosis, and follow up.

FOLLOW UP office visits cannot be overstated in their value for the treatment of OSA with an Oral Appliance.

Weight loss is also an effective treatment for snoring and sleep apnea. It may be easier to lose weight when using a CPAP or Oral Appliance.

Sleeping on your side will help as well.

There have not been any effective drugs or medications for treatment of OSA. Use of alcohol ( having a “night cap”) or taking a sleeping pill will make OSA worse.

Surgical treatment has benefit in certain individuals.

Early management of this condition can prevent and in some cases reverse bodily changes such as high blood pressure, diabetes, and drowsiness. Unfortunately, some of these changes are permanent when OSA has not been treated for many years.

I would be happy to discuss your situation. The initial consult regarding possibility of using an Oral Appliance is free. My concern is for your well being. Please feel free to contact the office.

Dr Steve Lipinski Diplomat candidate of the American Academy of Dental Sleep Medicine