How are snoring and sleep apnea connected?
Snoring is the sound of partially obstructed breathing during sleep. While snoring can be harmless, it can also be a sign of a more serious condition known as Obstructive Sleep Apnea (OSA). When Obstructive Sleep Apnea occurs, the tongue and soft palate collapse onto the back of the throat and completely block the airway, which restricts the flow of oxygen.
What are the signs and symptoms?
- Bed partner reports snoring and periods of no breathing followed by choking or gasping
- Decreased sex drive
- Excessive daytime sleepiness
- Frequent awakenings
- Memory impairment and cloudy intellect
- Morning headaches
- Sour taste upon wakingDecreased sex drive
- Unrefreshing sleep
What are the health issues?
OSA is the 2nd leading cause of stoke (2x higher risk than non-apenic patients) and the 4th leading cause of heart attack (2-3x higher risk than non-apenic patients). It can lead to hypertension (50% of OSA patients have elevated blood pressure). It has been associated with an increase in traffic accidents due to decreased care and attention. Patients who suffer with OSA also have a decreased quality of life. It has also been estimated that 36% of patients with moderate to severe sleep apnea will die from related causes within 9 years.
What are the contributing factors?
- Age – At age 60, 60% of men and 40% of women snore. 30-40% of these have some degree of OSA.
- Excessive weight
- Large tonsils and tongue
- Use of sleeping pills
- Use of tobacco and alcohol
What are the treatment options for Sleep Apnea?
- Conservative Therapy
- Avoid caffeine, alcohol or stimulants 4 hours before bed
- Avoid sedatives
- Avoid strenuous exercise 2-3 hours before bed
- Decongest nasal cavity
- Develop a consistent pre-sleep routine
- Limit daytime naps
- Limit noise and light in bedroom
- Lose weight
- No large meals before bed
- Sleep on your side (the prevalence of positional sleep apnea is approximately 50%)
- Surgical Treatment
UPPP (uvulopalatopharyngoplasty): an aggressive surgical reconstruction of the uvula, soft palate and pharynx.
LAUP (laser assisted uvuloplasty): recontouring of the uvula and soft palate using a laserSomnoplasty; use of computer directed heat to reduce tongue size and stiffen soft palate.
These procedures are primarily useful to treat snoring and as adjunctive therapies to treat apnea. They generally show some regression and other options must be looked at.
There are also several treatments aimed at improving airflow through the nasal cavity. These include correction of a deviated septum, removal of hypertrophied turbinates and removal of polyps.
This is the use of continuous positive air pressure (CPAP) to act as a splint to force the airway open. Air from a portable air compressor is delivered via a nose or mouth mask. It is very effective if used all night, every night. Unfortunately the compliance is only about 60% due to issues with the device. Problems with maintaining the proper humidity of the air can lead to a runny or stuffy nose as well as a dry mouth, nose or throat. Leakage of air from the mask can also cause sore or dry eyes, skin irritation and problems with noise. Some patients also have problems tolerating the air pressure.
- Oral Appliances
These fall into two categories, the first are tongue retaining devices and the second are mandibular advancement devices. The tongue device works by using a suction bulb to grasp the tongue and hold it in a forward position. They are used in edentulous cases as well as cases with an insufficient number of teeth as well as in patients with severely compromised periodontal status. By far the more common type of oral appliance is the mandibular advancement device (MAD). This device generally is made up of two custom-fit mouth guards covering the mandibular and maxillary teeth and joined together in such a way as to position the mandible anteriorly. This works in two ways, it advances the tongue and musculature and it supports the mandible in an anterior position. This prevents collapse of the airway. The success rate is about 75% in mild OSA, 60% in moderate OSA and 40% in severe OSA. At present it is recommended as a first treatment option for patients who present with simple snoring as well as mild and moderate OSA. It is also recommended for severe OSA patients who are non-CPAP compliant.
What are the benefits of treatment?
- Better relationships
- Decreased blood pressure
- Decreased chance of a car accident
- Decreased chance of a stroke or heart attack
- Improved Quality of life
- Increased energy
- More and better sex
- More successful at work
- Wake up refreshed