Snoring and Sleep Apnea

Snoring affects 1 in 10 people

Obstructive Sleep Apnea affects 1 in 100 people
What causes Snoring?
Snoring occurs when the there is air turbulence in the sinuses and/or throat.  When you fall asleep all the muscles of the airway relax, and this is often enough to cause the airway to narrow and partially obstruct the flow of air.  Air travels faster through a slender tube, this rapidly moving air causes the soft tissue in the throat to vibrate, which produces the loud sound of snoring and compromises the ability to breath.   As the air passes through potential obstructions, these structures vibrate producing the snoring sound.  Some of these obstructions include sinus obstructions, large tonsils, a long soft palate and uvula and excess fat deposits, any of which may contribute to airway narrowing.
Symptoms and Effects of Sleep Apnea:
  •  Snoring    
  •  Morning headaches
  •  Disturbed and/or restless sleep
  •  Low blood oxygen levels (machine monitored)
  •  Periodic cessation of breathing
  •  Attention problems
  •  Irritability
  •  Excessive daytime sleepiness/drowsiness
  •  Cardiovascular problems - high blood pressure, heart attack, stroke, death
 
What causes Sleep Apnea?
Narrowing airway passages can cause Obstructive Sleep Apnea.  When awake your muscles are active, but relax during sleep.  The airway can collapse in an anterior-posterior (front to back) direction or in a lateral (side to side) direction.   The air pressure on the outside of the airway is greater than the air pressure inside the flaccid tube and when breathing in it collapses.  (Remember paper straws, they worked great at the start but as they got wet and flaccid they collapsed as you sucked through them because the pressure from the outside was to great for the flimsy walls to hold out.)  One of the most common contributing causes of airway obstruction during sleep is the tongue.  The tongue can fall against the back of the throat causing airflow to stop.  When air exchange stops, the oxygen level in the blood drops.  The body has sensing organs that tell the brain to wake up and breathe!  This is called an arousal or awakening, and is often not remembered.  When the breathing starts, the obstruction temporarily clears and the flow of air starts again (usually with a loud gasp).  If the air completely stops for 10 seconds or more this is called an apnea.  If only half (50%) of the air stops, but is still associated with a lowering of the blood oxygen level this is called an hypopnia.    It is not uncommon for some patients experience up to 300 apnea episodes each night and some severe cases may even have up to 700 per night.  It doesn’t take much to figure out that if you are waking up so many times at night, whether you remember it or not, that you are not going to get a good nights sleep!!
Treatment for Sleep Apnea/Snoring:
There are four potential treatments for these type of sleep problems.  
1.  Conservative modification: weight reduction, sleep position, etc.
2.  Surgery
3.  Continuous Positive Airway Pressure (CPAP)
4.  Oral Appliance Therapy (OA)
Historically sleep physicians (specialists in sleep medicine) have typically combined the first three alternatives before thinking of OAs, but with the continued success, they are turning to this as a treatment choice.  Let’s look at each of the above separately.
Conservative modification - These are inexpensive and often dramatically effective methods of treating snoring and sleep apnea.  Many patients can benefit by weight loss to help treat their sleep apnea and snoring.  Sometimes apnea/hypopnia events are related to the position of the individual while they are sleeping.  If one can train to sleep on the side and not the back this often helps.  Also a correct diagnosis and treatment for simple allergies and congestion can make a dramatic change.
Surgery - Many surgeries can reduce or eliminate snoring and sleep apnea problems.  So if it can correct the problem you would have a cure.  There are many different surgeries depending on the specific situation.  Unfortunately the cure rate is not 100%.  But many times even the surgery can lessen the need for other therapies.  These options are best discussed with the experts, the Otolaryngologist (ENT) and Oral Surgeon.
CPAP - Since the airway is flaccid during sleep (remember the paper straw above), artificially inflating it can overcome the outside pressure.  So a continuous stream of air as a positive pressure artificially inflates the airway to keep it open the breathe.  The “gold standard” in medicine is CPAP therapy, which is virtually 100% effective, IF it can be tolerated.  However, CPAP has many drawbacks.  It is a cumbersome machine that is frequently noisy, and can even keep bed partners awake even if the patient can sleep with them.  Compliance with using them is challenging and many patients do not use them as they should.
The Sleep Apnea/Snoring Appliance:
Oral appliances have several advantages over other forms of therapy. They are comfortable to wear, and easy to care for.  Treatment is essentially reversible and non-invasive.
Dr. Hummert has been associated with the Sleep Disorders Center at the University of North Carolina Hospital in Chapel Hill, NC for the past 5 years.  He has been treating patients with oral appliances that have proven successful in the treatment of snoring and sleep apnea.  Non-invasive and comfortable to wear, these appliances has been proven effective in treating sleep apnea.  Patients have expressed their satisfaction in using these appliances.  Follow-up clinical studies with a polysomnography (sleep study) have shown that the appliance is effective in reducing or eliminating symptoms of Obstructive Sleep Apnea in the majority of cases.
Dr. Hummert can provide several types of oral appliances, depending on the particular needs and desires of the patient.  The devices all work in a similar manner, by moving the jaw forward and open and holding it in this position.  The Sleep Apnea/Snoring Appliance is made up of 2 small custom-made plastic devices that looks similar to orthodontic retainers or athletic mouthguards.  They are made to fit over the teeth in the mouth in a specific position while sleeping.  The device works by physically splinting the airway open by moving the lower jaw and tongue forward thereby opening the airway to allow air to flow.
Most medical insurance policies will cover the cost of this appliance when the patient is diagnosed with Obstructive Sleep Apnea by a certified sleep disorder center.  Dr. Hummert works closely with physicians and sleep centers who determine a diagnosis and develop the best treatment protocol for each patient.  
IMPORTANT!
ALL SLEEP APNEA DISORDERS MUST BE PROPERLY DIAGNOSED BY AN OVERNIGHT SLEEP STUDY, CALLED A POLYSOMNOGRAPHY.  A DENTIST IS NEITHER LEGALLY QUALIFIED NOR ALLOWED TO DIAGNOSE AND TREAT SLEEP APNEA.

THEREFORE, ALL SLEEP ORAL APPLIANCES FOR SLEEP APNEA MUST BE PRESCRIBED BY A PHYSICIAN BEFORE THEY CAN BE MADE AND DELIVERED TO THE PATIENT.

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