Questions

Sleep apnea and Snoring

What Causes Snoring?

Snoring occurs when the soft tissue structures of the upper airway collapse onto themselves and vibrate against each other as we attempt to move air through them. This produces the sound we know as snoring. Large tonsils, a long soft palate, a large tongue, the uvula, and excess fat deposits in the throat all contribute to airway narrowing and snoring. Usually, the more narrow the airway space, the louder or more habitual the snoring.

ENT specialists (or otolaryngologists, as they are known to those who can spell) are not the only ones to treat snoring. Your dentist can help too, and may suggest a special type of mouthpiece.
(But read this whole article before rushing to your dentist for a device that may cost you hundreds of dollars!)

Mouthpiece devices — also known as dental appliances, or mandibular advancement splints — have been effective for many snorers, including those suffering from mild or moderate obstructive sleep apnea. They are usually small plastic devices worn in the mouth during sleep to prevent the soft throat tissues from collapsing and obstructing the airway. They do this by bringing your lower jaw forward and/or by lifting your soft palate. Some devices also stop the tongue from falling back over your windpipe.

Your dentist will usually be the one to fit these special appliances to meet your individual condition. Typically they will take a mold of your mouth and then either send off for a custom mouthpiece or fashion it themselves.

Sleep apnea

Sleep apnea is a serious sleep disorder that occurs when a person’s breathing is interrupted during sleep.
People with untreated sleep apnea stop breathing repeatedly during their sleep, sometimes hundreds of times.

There are two types of sleep apnea:

  • Obstructive sleep apnea
    The more common of the two forms of apnea, it is caused by a blockage of the airway, usually when the soft tissue in the back of the throat collapses during sleep.
  • Central sleep apnea
    Unlike OSA, the airway is not blocked but the brain fails to signal the muscles to breathe due to instability in the respiratory control center.

Who are at Risk for Sleep Apnea?

Sleep apnea can affect anyone at any age, even children. However, risk factors for sleep apnea include:

  • Male gender
  • Being overweight
  • Being over the age of forty
  • Having a large neck size (17 inches or greater in men and 16 inches or greater in women)
  • Having larger tonsils
  • Having a family history of sleep apnea

What Are the Effects of Sleep Apnea?

If left untreated, sleep apnea can result in a growing number of health problems including:

  • Hypertension
  • Stroke
  • Heart failure, irregular heart beats, and heart attacks

In addition, untreated sleep apnea may be responsible for poor performance in everyday activities, such as at work and school, motor vehicle crashes, as well as academic underachievement in children and adolescents.

Symptoms of Sleep Apnea

Common sleep apnea symptoms include:

  • Waking up with a very sore and/or dry throat
  • Occasionally waking up with a choking or gasping sensation
  • Sleepiness during the day
  • Morning headaches
  • Forgetfulness, mood changes and a decreased interest in sex
  • Recurrent awakenings or insomnia
  • Heavily snoaring
  • Heart diseases and high blood pressure
  • Fast and easy weight gain
  • Polyurea
  • Psychological disorders and depression
  • Concentration problems

Sleep Apnea Tests & Diagnosis

If you have symptoms of sleep apnea, your doctor may ask you to have a sleep apnea test in a sleep disorder center.
This often includes a polysomnogram.

A sleep study or polysomnogram (PSG) is a multiple-component test that electronically transmits and records specific physical activities while you sleep.
The recordings are analyzed by a qualified sleep specialist to determine whether or not you have sleep apnea or another type of sleep disorder.

If sleep apnea is determined, you may be asked to return to the lab for further evaluation in order to determine the best treatment option.

What to Expect

On the night of your sleep study, you will be assigned to a private bedroom in a sleep center or hospital. Near the bedroom will be a central monitoring area, where the technicians monitor sleeping patients.

You will be hooked up to equipment that may look uncomfortable. However, most people fall asleep with little difficulty.Surface electrodes will be put on your face and scalp and will send recorded electrical signals to the measuring equipment. These signals, which are generated by your brain and muscle activity, are then recorded digitally. Belts will be placed around your chest and abdomen to measure your breathing. A bandage-like oximeter probe will be put on your finger to measure the amount of oxygen in your blood.

Sleep Apnea Treatments

Sleep apnea treatments range from conservative measures — such as losing weight if you are overweight or changing sleep positions — to surgery.

Behavioral Modifications

In mild cases of sleep apnea, conservative therapy may be all that is needed. Conservative approaches include:

  • Lose weight
  • Avoid alcohol and sleeping pills
  • Change sleep positions to promote regular breathing
  • Stop smoking. Smoking can increase the swelling in the upper airway which may worsen both snoring and apnea.
  • Avoid sleeping on your back

Continuous Positive Airway Pressure (CPAP)

Continuous positive airway pressure (CPAP) is a treatment in which a mask is worn over the nose and/or mouth while you sleep. The mask is hooked up to a machine that delivers a continuous flow of air into the nostrils. The positive pressure from air flowing into the nostrils helps keep the airways open so that breathing is not impaired.

Dental Devices

Dental appliances can be made that help keep the airway open during sleep. Such devices can be specifically designed by dentists with special expertise in treating sleep apnea.

Surgery

If you have a deviated nasal septum, markedly enlarged tonsils, or a small lower jaw with an overbite causing the throat to be abnormally narrow, surgery may be needed to correct sleep apnea.

The most commonly performed surgical procedures for sleep apnea include:

  • A minimally invasive procedure to reduce the soft tissue in the upper airway.
  • Correction of nasal obstructions such as a deviated septum.
  • Uvulopalatopharyngoplasty (UPPP):
    A procedure that removes soft tissue on the back of the throat and palate, increasing the width of the airway at the throat opening.
  • Mandibular maxillar advancement surgery:
    Invasive surgery to correct certain facial abnormalities or throat obstructions that contribute to sleep apnea.

Other Options: Pillar Palatal Implant

New research suggests that a simple procedure — known as the Pillar Palatal Implant — can reduce snoring and improve sleep for people suffering from snoring and
sleep apnea.

The implants work by reducing the movement or vibration of the soft palate with implants designed to stiffen it. Using a special needle, three pieces of polyester mesh are inserted into the soft palate near where it meets the hard palate. Although considered a surgical procedure, implantation takes only about 10 minutes and is done under local anesthesia in a doctor’s office.

The implants have been approved by the FDA for snoring and sleep apnea, but their use has been slowed by its price tag, which is upwards of $2,000. The makers of the implants expect that health insurers will begin reimbursing the procedure in one to two years, after more studies on the implants are completed.

What is snoring?

You snore when the flow of air from your mouth or nose to your lungs makes the tissues of your throat vibrate when you sleep. This can make a loud, raspy noise. Loud snoring can make it hard for you and your partner to get a good night’s sleep.

You may not know that you snore. Your bed partner may notice the snoring and that you sleep with your mouth open. If snoring keeps you or your bed partner from getting a good night’s sleep, one or both of you may feel tired during the day.

Snoring may point to other medical problems, such as obstructive sleep apnea. Sleep apnea can be a serious problem, because you stop breathing at times during sleep. So if you snore often, talk to your doctor about it.

Snoring is more common in men than in women.

What causes snoring?

When you sleep, the muscles in the back of the roof of your mouth (soft palate), tongue, and throat relax. If they relax too much, they narrow or block your airway. As you breathe, your soft palate and uvula vibrate and knock against the back of your throat. This causes the sounds you hear during snoring.

The tonsils and adenoids may also vibrate. The narrower the airway is, the more the tissue vibrates, and the louder the snoring is.

How is it treated?

You may be able to treat snoring by making changes in your activities and in the way you sleep. For example:

  • Lose weight if you are overweight.
  • Quit smoking.
  • Sleep on your side and not your back.
  • Limit your use of alcohol and medicines such as sedatives before you go to bed.
  • If a stuffy nose makes your snoring worse, use nose strips, decongestants, or nasal steroid sprays to help you breathe.
  • When you sleep, use a device in your mouth that helps you breathe easier. This device pushes your tongue and jaw forward to improve airflow.

If these treatments do not work, you may be able to use a machine that helps you breathe while you sleep. This treatment is called continuous positive airway pressure, or CPAP (say “SEE-pap”). In rare cases, your doctor may suggest surgery to open your airway.

Snoring is not always considered a medical problem, so find out if your insurance covers the cost of treatment.

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