Obstructive Sleep Apnea and Your Health - Sleep Therapy in Battle Creek, Kalamazoo and Grand Rapids.
In the past, snoring was viewed as an innocuous event that was only a problem for the poor bed partner that was unable to sleep over the loud noise. Today we understand that this is far from the truth. Snoring of any kind is not normal and may be a warning sign of a potentially deadly condition called obstructive sleep apnea (OSA).
Before I discuss OSA let me define snoring. Snoring occurs when the soft palate falls back against itself at the back of the throat and vibrates as air moves through it. The sound of that vibration is snoring. As we age, unfortunately, we begin to loose muscle tonus. This loss of tonus presents in the soft tissue of the palate and we see an increase in the incidence of snoring with age.
OSA. is snoring with intermittent periods of ten seconds or greater when there is no breathing (apneic event) due to a total obstruction of the airway. Apneic episodes lead to decreased oxygenation of the blood. When the blood desaturates by 4% or more it is termed a hypopnea. The severity of OSA is categorized by the average number of apneas and hyponeas per hour. This is the AHI or apnea hypopnea index. A mild case of OSA has an AHI between 5-10. To put this in perspective, this would be like having someone hold a pillow over your face for at least 10 seconds every 6 minutes of your workday. When we stop to consider that an apneic event is at least 10 seconds, but may last for more than one minute, we can see how much an OSA patient suffers at night.
This suffering sets in motion a myriad of physiological effects. First of all, the lack of oxygen sets off an alarm in the brain that it is being suffocated. This triggers the fight or flight response and adrenal activity increases leading to increased heart rate and elevated blood pressure. It also causes the liver to dump a couple of grams of sugar into the bloodstream for energy. This excess sugar is ultimately is stored as fat in the stomach of males and hips and thighs of females. All of this activity occurs at night when the body should be in a relaxed and restorative state.
Common conditions that are directly related to OSA are adult onset diabetes, hypertension, decreased sex drive or impotence, excessive daytime sleepiness, irritability and inability to loose weight. The risk factors for OSA include obesity, increased age, genetic disorders, family history, alcohol or sedative use, and anatomically small airway.
Fortunately, we have options in the treatment of OSA. These options include CPAP (continuous positive air pressure), oral appliance therapy, and surgery (which this author does not subscribe to unless all non-surgical methods fail).
The modality that I will discuss is the mandibular advancement appliance. The American Academy of Sleep Medicine recognized the oral appliance as an alternate treatment to CPAP in mild to moderate apnea. This device is similar in shape and size to an orthodontic retainer and holds the lower jaw in a position that maximizes the airway. To determine this position we use equipment called the pharyngometer and rhinometer. This allows us to map the oral and nasal airway and quantify on a percentage basis how much we can improve breathing with the change in jaw position. Once this position is determined the appliance is made to comfortably maintain an open airway. This position is verified by an overnight sleep monitor which the patient uses in their own home and bed. The appliance is then adjusted or titrated until normal breathing is established.
In closing, OSA is a condition that should not be ignored. Quality and quantity of life can be greatly improved with successful treatment. It is important that the patient seek treatment from a qualified healthcare provider. That person should be a part of the sleep community and work very closely with a sleep physician. OSA or any other sleep disorder should never be treated withoutﾠ polysommonography (a sleep study) and post-treatment follow-up to verify efficacy.
Dr. Morris is a general practice dentist in Battle Creek, graduate of the University of Michigan Dental School, and has completed an advanced residency in temporomandibular and sleep disorders at the TMJ and Sleep Center,ﾠﾠ L.L.C., in San Diego, CA.