Sleep Apnea Treatment
Treating Sleep Apnea in Leawood
Dr. Laura Bowden is a triple-board certified doctor committed to providing every patient with compassionate, quality care for bite corrections, teeth alignment, and relief from headaches, facial pain, and neck pain. We also offer cutting-edge alternatives to CPAP therapy for Obstructive Sleep Apnea using customized oral appliances and minimally Invasive Laser-Assisted Uvulopalatoplasty.
Sleep Disordered Breathing (SDB) includes obstructive sleep apnea (OSA), central sleep apnea, upper airway resistance syndrome, obesity hypoventilation and snoring. There is a cause-and-effect relationships between SDB, illness and poorer quality of life. Quality of sleep and sleep medicine are two relatively new areas within medicine, with growing awareness of the serious health consequences associated with SDB. This partial or complete cessation of breathing occurs many times throughout the night, resulting in daytime sleepiness or fatigue that interferes with a person’s ability to function and reduces quality of life. Sleep-disordered breathing adversely affects daytime alertness and cognition and has been linked to occupational and driving impairment. Sleep apnea has also been shown to increase healthcare utilization; it contributes to other chronic health conditions, such as heart disease and diabetes, and increases the risk of having a stroke.
The most common breathing disorder of sleep is OSA, which is characterized by recurrent narrowing or collapse of the back of the throat because of the loss of muscle tone that occurs during sleep. The National Sleep Foundation reports that as many as 18 million people suffer from obstructive sleep apnea. Studies show as many as 90% of individuals with sleep apnea are un-diagnosed.
At the present time, obstructive sleep apnea is defined as a medical problem and the diagnosis must be made by a medical doctor or sleep physician who is specially trained in the area of sleep medicine.
Sleep apnea is a type of breathing disorder which is a serious, potentially life-threatening condition characterized by brief interruptions of breathing during sleep. There are basically three types of apnea:
The upper airway is open, but no oxygen is getting into the system. This occurs because the patient is not getting a chemical response from the brain to stimulate the lungs and the diaphragm to assist with breathing.
Obstructive Sleep Apnea
The lungs and the diaphragm are functioning normally, but no oxygen is entering the system because there is an obstruction in the upper airway.
Oral appliances are only indicated for use in patients suffering from obstructive sleep apnea (OSA). The signs and symptoms of OSA include snoring, excessive daytime sleepiness, gasping or choking during the night, non-refreshed sleep, fragmented sleep, clouded memory, irritability, personality changes, decreased sex drive, impotence, and morning headaches.
This is a combination of central and obstructive sleep apnea.
Excessive Daytime Sleepiness (EDS)
People who suffer from obstructive sleep apnea have a fragmented sleep architecture which causes them to spend an excessive amount of time in the lighter stages of sleep at the expense of the Delta Phase (deep stage sleep) and REM stage. This causes them to have excessive daytime sleepiness due to their lack of sleep at night.
Apnea and Hypopnea (AHI #)
Apnea is defined as a period of cessation of breathing during sleep for ten seconds or longer. If the patient has more than five episodes of apnea per hour of sleep, this is considered clinically significant and helps confirm the diagnosis of obstructive sleep apnea. Hypopnea occurs when the decrease in airflow results in a 4% decrease in oxyhemoglobin concentration in the blood.
Factors that affect obstructive sleep apnea are as follows:
- Sedative Hypnotics (sleeping pills)
Children and Sleep Apnea
Children can also snore and suffer from obstructive sleep apnea. Often, they are highly allergic and their airway is blocked due to enlarged adenoids, tonsils, or swollen nasal mucosa. Clinical signs would indicate a turned up nose, allergic shiners under the eyes, mucous draining out of the nose, mouth breathing, and a nasal sound to the voice. Other signs are bed wetting, irritability, difficulty in concentrating at school, and hyperactivity.
Polysomnogram (Sleep Study Test)
The purpose of a polysomnogram is to evaluate the individual sleep architecture including the stages and cycles of sleep as well as to record the electrical activity of the brain, the eyes, muscles, and heart. Most hospitals have sleep diagnostic centers and many sleep specialists now have sleep diagnostic centers associated with their office to properly diagnose OSA. The results of the sleep study will reveal whether you have OSA and how severe it is depending on your AHI#.
Major signs and symptoms of sleep apnea
- Loud and chronic snoring
- Choking, snorting, or gasping during sleep
- Long pauses in breathing
- Daytime sleepiness, no matter how much time you spend in bed
Other common signs and symptoms of sleep apnea include:
- Waking up with a dry mouth or sore throat
- Morning headaches
- Restless or fitful sleep
- Insomnia or nighttime awakenings
- Going to the bathroom frequently during the night
- Waking up feeling out of breath
- Forgetfulness and difficulty concentrating
- Moodiness, irritability, or depression
- Snoring vs Sleep Apnea
Not everyone who snores has sleep apnea, and not everyone who has sleep apnea snores. So how do you tell the difference between garden variety snoring and a more serious case of sleep apnea?
The biggest telltale sign is how you feel during the day. Normal snoring doesn’t interfere with the quality of your sleep as much as sleep apnea does, so you’re less likely to suffer from extreme fatigue and sleepiness during the day.
What’s Your Snore Score?
Your answers to this quiz will help you decide whether you may suffer from sleep apnea:
- Are you a loud and/or regular snorer?
- Have you ever been observed to gasp or stop breathing during sleep?
- Do you feel tired or groggy upon awakening, or do you awaken with a headache?
- Are you often tired or fatigued during the wake time hours?
- Do you fall asleep sitting, reading, watching TV or driving?
- Do you often have problems with memory or concentration?
If you have one or more of these symptoms you are at higher risk for having obstructive sleep apnea.
Source: American Sleep Apnea Association
The most effective treatment is a continuous positive airway pressure (CPAP) device that delivers pressurized air to the upper airway, via a mask, splinting the airway open. However, the effectiveness of this treatment is often substantially reduced or nullified by inconsistent or inadequate use by patients. Some patients cannot tolerate the CPAP and simply stop using it. Surgical options include: pillar implants, laser assisted uvulopalatoplasty, coblation, adenotonsillectomy, uvulopalatopharyngoplasty, tongue base reduction, genioglossus advancement, septoplasty and submucous resection of inferior turbinates. The disadvantage is that these surgeries can be quite painful during the healing period. Following the surgery, patients report voice changes and difficulty in swallowing their food. Patients should be informed of all their options prior to any treatment whether surgical or non-surgical. Some patients either do not want surgery or have had surgery and the procedure has been unsuccessful in solving the problem of OSA. These patients prefer a non-surgical, non-invasive plastic intra-oral appliance that can be worn at night only to help solve their problem.
We also offer non-invasive NightLase® treatments for Obstructive Sleep Apnea. NightLase® can reduce the effects of and decrease the amplitude of snoring by means of a gentle laser treatment of the soft palate. NightLase®: Minimally Invasive Laser-Assisted Uvulopalatoplasty. Shiffman HS, Lukac M. J LA&HA – J Laser Health Acad 2018; 2018(1):39-44
The dental profession can offer alternative treatment options with oral appliances and play an important role in the treatment of snoring and obstructive sleep apnea.
Types of Oral Appliances
Tongue Retaining Appliances
Tongue retaining appliances hold the tongue in a forward position using a suction bulb. When the tongue is in a forward position, it serves to keep the back of the tongue from collapsing during sleep and obstructing the airway in the throat.
Mandibular Repositioning Appliances
Mandibular repositioning appliances reposition and maintain the lower jaw in a protruded position during sleep. The device serves to open the airway by indirectly pulling the tongue forward, stimulating activity of the muscles in the tongue and making it more rigid. The device also holds the lower jaw and other structures in a stable position to prevent the mouth from opening.
Advantages of Oral Appliance Therapy
Oral appliances are comfortable and easy to wear. Most people find that it only takes a couple of weeks to become acclimated to wearing the appliance. Oral appliances are small and convenient making them easy to carry when traveling. Treatment with oral appliances is reversible and non-invasive. An appliance worn during sleep prevents the airway from collapsing by creating extra space. While many models of appliances are available to treat snoring and obstructive sleep apnea, only a specially trained dentist can properly select and fit the type of appliance that is needed.
An orthodontists who treat TMJ – temporomandibular joint disorders – is an excellent choice, because they are very much aware of the jaw position when making the device. This is an important consideration. In fact, TMJ appliances can often be adapted to work for sleep apnea. Appliances are light and easy to wear. In only a few weeks, most patients are comfortable.