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Sleep Apnea And Snoring

At Ensodentistry, we recognize the devastating effect sleep apnea can have on your systemic health including increasing the risk of cardiac disease by 500% and significantly increasing the risk of chronic ailments such as diabetes and high blood pressure. We screen our patients for sleep apnea and we are happy to discuss this with you to improve your quality of life.

An individual with sleep apnea is rarely aware of the condition. Sleep apnea is recognized as a problem by others witnessing the individual during episodes or is suspected by an individual or a healthcare provider because of its effects on the body. Symptoms may be present for years without identification, during which time the sufferer may become conditioned to the daytime sleepiness and fatigue associated with significant levels of sleep disturbance.

Sleep apnea is a sleep disorder characterized by abnormal pauses in breathing or instances of abnormally low breathing, during sleep. Each pause in breathing, called an apnea, can last from a few seconds to minutes, and may occur 5 to 30 times or more an hour. The standard definition of any apneic event includes a minimum 10-second interval between breaths, with either a neurological arousal (a 3-second or greater shift in EEG frequency, measured at C3, C4, O1, or O2) or a blood oxygen desaturation of 3–4% or greater, or both arousal and desaturation. Clinically significant levels of sleep apnea are defined as six or more episodes per hour of any type of apnea. Sleep apnea is diagnosed after a physician ordered sleep study also known as a polysomno gram.

There are 3 kinds of sleep Apnea but Obstructive sleep apnea (OSA) is the most common category of sleep-disordered breathing. The muscle tone of the body ordinarily relaxes during sleep, and at the level of the throat the human airway is composed of collapsible walls of soft tissue which can obstruct breathing during sleep. Mild occasional sleep apnea, such as many people experience during an upper respiratory infection, may not be important, but chronic severe obstructive sleep apnea requires treatment to prevent low blood oxygen (hypoxemia), sleep deprivation, and other complications. The most serious complication is a severe form of congestive heart failure.

Individuals with low muscle tone and soft tissue around the airway due to obesity and structural features that give rise to a narrowed airway are at high risk for obstructive sleep apnea. The elderly are more likely to have OSA than young people. Men are more likely to suffer sleep apnea than women.

The risk of OSA rises with increasing body weight, active smoking and age. In addition, patients with diabetes or "borderline" diabetes have up to three times the risk of having OSA. Common symptoms include loud snoring, restless sleep, and sleepiness during the daytime.

For mild cases of sleep apnea avoiding alcohol and sleeping pills, which can relax throat muscles, losing weight and sleeping on the side are all lifestyle changes that can help.

For moderate to severe sleep apnea, the most common treatment is the use of a continuous positive airway pressure (CPAP) device. The patient typically wears a plastic facial mask, which is connected by a flexible tube to a small bedside CPAP machine. The CPAP machine generates the required air pressure to keep the patient's airways open during sleep.

Recently, American academy of sleep medicine gave us dentists, who are specially trained in making sleep appliances a giant “thumbs-up” when they declared that Oral appliance therapy may be considered a first choice in mild to moderate cases of sleep Apnea. The oral appliance is a custom-made mouthpiece that shifts the lower jaw forward, opening up the airway. OAT is a relatively new treatment option for sleep apnea in the United States, but it is much more common in Canada and Europe. Its use has led to increasing recognition of the importance of upper airway anatomy in the pathophysiology of OSA. It is always a great treatment option for patients who cannot use the CPAP device.

CPAP and OAT are generally effective only for obstructive and mixed sleep apnea which have a mechanical rather than a neurological cause.

For patients who do not tolerate nonsurgical measures, surgical treatment to anatomically alter the airway is an option. Several levels of obstruction may be addressed, including the nasal passage, throat (pharynx), base of tongue, and facial skeleton. Surgical treatment for obstructive sleep apnea needs to be individualized in order to address all anatomical areas of obstruction. Often, correction of the nasal passages needs to be performed in addition to correction of the oropharynx passage. Septoplasty and turbinate surgery may improve the nasal airway. Tonsillectomy and uvulopalatopharyngoplasty (UPPP or UP3) is available to address pharyngeal obstruction. Base-of-tongue advancement by means of advancing the genial tubercle of the mandible may help with the lower pharynx. Where appropriate jaw surgery to reposition the mandible forward, may be the answer.

At Ensodentistry, we recognize the devastating effect sleep apnea can have on your systemic health including increasing the risk of cardiac disease by 500% and significantly increasing the risk of chronic ailments such as diabetes and high blood pressure. We screen our patients for sleep apnea and we are happy to discuss this with you to improve your quality of life.