Obstructive sleep apnea is a potentially serious sleep disorder in which breathing repeatedly stops and starts during sleep from which about 1 in 5 Americans suffer. Many people do not deal with this condition because they have gotten used to it, the others in their house have given up on it, and it seems like a personal problem. This could not be farther from the truth. Some studies are looking into seeing if people can go on disablilty because of their chronic OSA. This was the topic of our recent continuing education course by Dr. Harrison for our hygienists in Dr. Langston’s Suncoast Hygiene Study Club and was featured in the March 2014 Access dental hygiene journal published by the ADHA.
It’s National Nutrition Month right now, and nutrition, exercise, and sleep are the 3 things that will help with a longer quality life. So many people skip over the sleep part of the 3-part equation. We need to bring back the importance of a great night of sleep.
Complications of OSA
Other complications besides the sleep-deprived partner includes the following from the Mayo Clinic:
Obstructive sleep apnea is considered a serious medical condition. Complications may include:
- Cardiovascular problems. Sudden drops in blood oxygen levels that occur during obstructive sleep apnea increase blood pressure and strain the cardiovascular system. Many people with obstructive sleep apnea develop high blood pressure (hypertension), which can increase the risk of heart disease. The more severe the obstructive sleep apnea, the greater the risk of coronary artery disease, heart attack, heart failure and stroke. In a study, men with obstructive sleep apnea appeared to be at risk of heart failure, but women with obstructive sleep apnea didn’t appear to have a higher risk of heart failure. People with obstructive sleep apnea are much more likely to develop abnormal heart rhythms (arrhythmias). If there’s underlying heart disease, these repeated multiple episodes of low blood oxygen (hypoxia or hypoxemia) could lead to sudden death from a cardiac event.
- Daytime fatigue. The repeated awakenings associated with obstructive sleep apnea make normal, restorative sleep impossible. People with obstructive sleep apnea often experience severe daytime drowsiness, fatigue and irritability. They may have difficulty concentrating and find themselves falling asleep at work, while watching TV or even when driving. There are many reported car accidents because people have fallen asleep behind the wheel. Children and young people with obstructive sleep apnea may do poorly in school and commonly have attention or behavior problems. Treatment of obstructive sleep apnea can improve these symptoms, restoring alertness and improving quality of life.
- Complications with medications and surgery. Obstructive sleep apnea also is a concern with certain medications and general anesthesia. These medications, such as sedatives, narcotic analgesics and general anesthesia, relax your upper airway and may worsen your obstructive sleep apnea. If you have obstructive sleep apnea, you may experience worse breathing problems after major surgery, especially after being sedated and lying on your back. People with obstructive sleep apnea may be more prone to complications after surgery. Before you have surgery, tell your doctor if you have obstructive sleep apnea or symptoms related to obstructive sleep apnea. If you have obstructive sleep apnea symptoms, your doctor may test you for obstructive sleep apnea prior to surgery.
- Eye problems. Some research has found a connection between obstructive sleep apnea and certain eye conditions, such as glaucoma. Eye complications can usually be treated.
- Dry Mouth and a higher risk for cavities. Often patients are mouth breathers which dries out the mouth.
- Sleep-deprived partners. Loud snoring can keep those around you from getting good rest and eventually disrupt your relationships. It’s not uncommon for a partner to choose to sleep in another room. Many bed partners of people who snore are sleep deprived as well.
People with obstructive sleep apnea may also complain of memory problems, morning headaches, mood swings or feelings of depression, and a need to urinate frequently at night (nocturia).
OSA Risk Factors
Anyone can develop obstructive sleep apnea. However, certain factors put you at increased risk, including the following from the Mayo Clinic:
- Being overweight. Around half of people with obstructive sleep apnea are overweight. Fat deposits around the upper airway may obstruct breathing. Also, people with obstructive sleep apnea tend to have a larger waist. However, not everyone with obstructive sleep apnea is overweight and vice versa. Thin people can develop the disorder, too.
- Having a large neck. The size of your neck may indicate whether you have an increased risk. A thick neck may narrow the airway and may be an indication of excess weight. A neck circumference greater than 17 inches for men and 16 inches for women is associated with an increased risk of obstructive sleep apnea.
- Having high blood pressure (hypertension). Obstructive sleep apnea is relatively common in people with hypertension.
- Having a narrowed airway. You may inherit a naturally narrow throat. Or your tonsils or adenoids may become enlarged, which can block your airway.
- Having chronic nasal congestion. Obstructive sleep apnea occurs twice as often in those who have consistent nasal congestion at night, regardless of the cause. This may be due to narrowed airways.
- Having diabetes. Obstructive sleep apnea may be more common in people with diabetes.
- Being male. In general, men are twice as likely to have obstructive sleep apnea.
- Being black. Among people under age 35, obstructive sleep apnea is more common in blacks.
- Being a certain age. Obstructive sleep apnea usually occurs in adults who are ages 18 to 60, but it can occur at any age.
- Having a family history of sleep apnea. If you have family members with obstructive sleep apnea, you may be at increased risk.
- Smoking. People who smoke are more likely to have obstructive sleep apnea.
- Using alcohol. Alcohol may worsen obstructive sleep apnea.
- predominant mouth breathing
For milder cases of obstructive sleep apnea, your doctor may recommend lifestyle changes:
- Lose weight if you’re overweight.
- Exercise regularly.
- Diet – often 100 lbs need to be lost to be affective
- Home bedroom hygiene improvement – no electronics, pets, or lights on
- Drink alcohol moderately, if at all, and don’t drink several hours before bedtime.
- Quit smoking.
- Use a nasal decongestant/antihistamine.
- Breathe rite strips
- Use nasal steroids
- Address acid reflux/GERD
- Don’t sleep on your back.
If these measures don’t improve your sleep or if your apnea is moderate to severe, then your doctor may recommend other treatments. Certain devices can help open up a blocked airway. In other cases, surgery may be necessary.
- Positive airway pressure. If you have obstructive sleep apnea, you may benefit from positive airway pressure. In this treatment, a machine delivers air pressure through a piece that fits into the nose or is placed over the nose and mouth while you sleep.Positive airway pressure reduces the number of respiratory events that occur as you sleep, reduces daytime sleepiness and improves your quality of life.The most common type is called continuous positive airway pressure, or CPAP (SEE-pap). With this treatment, the pressure of the air breathed is continuous, constant and somewhat greater than that of the surrounding air, which is just enough to keep your upper airway passages open. This air pressure prevents obstructive sleep apnea and snoring.Although CPAP is the most consistently successful and most commonly used method of treating obstructive sleep apnea, some people find the mask cumbersome, uncomfortable or loud. However, newer machines are smaller and less noisy than older machines.Also, with some practice, most people learn to adjust the mask to obtain a comfortable and secure fit. You may need to try different types to find a suitable mask. Several options are available, such as nasal masks, nasal pillows or face masks.If you’re having particular difficulties tolerating pressure, some machines have special adaptive pressure functions to improve comfort. You also may benefit from using a humidifier along with your CPAP system.CPAP may be given at a continuous (fixed) pressure or varied (autotitrating) pressure. In fixed CPAP, the pressure stays constant. In autotitrating CPAP, the levels of pressure are adjusted if the device senses increased airway resistance.Bilevel positive airway pressure (BPAP), another type of positive airway pressure, delivers a preset amount of pressure when you breathe in and a different amount of pressure when you breathe out.CPAP is more commonly used because it’s been well studied for obstructive sleep apnea and has been shown to effectively treat obstructive sleep apnea. However, for people who have difficulty tolerating fixed CPAP, BPAP or autotitrating CPAP may be worth a try.Don’t stop using your positive airway pressure machine if you have problems. Check with your doctor to see what adjustments you can make to improve its comfort. In addition, contact your doctor if you still snore despite treatment, if you begin snoring again or if your weight changes.
- Mouthpiece (oral device). Though positive airway pressure is often an effective treatment, oral appliances are an alternative for some people with mild or moderate obstructive sleep apnea. These devices may reduce your sleepiness and improve your quality of life.These devices are designed to keep your throat open. Some devices keep your airway open by bringing your jaw forward, which can sometimes relieve snoring and obstructive sleep apnea. Other devices hold your tongue in a different position.If you and your doctor decide to explore this option, you’ll need to see a dentist experienced in dental sleep medicine appliances for the fitting and follow-up therapy. We here at Creating Smiles Dental can help with this process. We screen for OSA and that is the first step.A number of devices are available. Close follow-up is needed to ensure successful treatment. There are complications with these and a dentist needs to be involved.
- Medications. If you continue to experience daytime sleepiness after treatment for your obstructive sleep apnea, your doctor may prescribe medications to reduce sleepiness.
Surgery or other procedures
The goal of surgery for obstructive sleep apnea is to prevent blockage of the upper airway during sleep. Surgery is usually considered only if other therapies haven’t been effective or haven’t been appropriate options for you. Surgical options may include:
- Surgical removal of tissue. Uvulopalatopharyngoplasty (UPPP) is a procedure in which your doctor removes tissue from the back of your mouth and top of your throat. Your tonsils and adenoids are commonly removed as well.UPPP usually is performed in a hospital and requires a general anesthetic.Doctors sometimes remove tissue from the back of the throat with a laser (laser-assisted uvulopalatoplasty) or with radiofrequency energy (radiofrequency ablation) to treat snoring. These procedures don’t treat obstructive sleep apnea, but they may reduce snoring.
- Jaw surgery. In this procedure, called maxillomandibular advancement, the upper and lower parts of your jaw are moved forward from the rest of your facial bones. This enlarges the space behind the tongue and soft palate, making obstruction less likely.This procedure often requires an oral surgeon and possibly an orthodontist. Complications could include numbness of the mouth, bleeding, infection, removal of hardware or temporomandibular joint problems.
- Palatal expansion. Growing children may benefit from this. A child should NEVER snore.
- Surgical opening in the neck. You may need this form of surgery if other treatments have failed and you have severe, life-threatening obstructive sleep apnea. A tracheotomy is 100% successful.In this procedure, called a tracheostomy, your surgeon makes an opening in your neck and inserts a metal or plastic tube through which you breathe. Air passes in and out of your lungs, bypassing the blocked air passage in your throat.
- Implants. The Pillar procedure is a minimally invasive treatment that involves placement of three tiny polyester rods in the soft palate. These inserts stiffen and support the tissue of the soft palate and reduce upper airway collapse and snoring. This treatment is recommended only for people with mild obstructive sleep apnea.
- hypoglossal stimulation -wires to the tongue with a chest implant
- Nasal valves – Provent
- tongue bulb
- micro sensor chips and telemetry receptors and transmitters
Other types of surgery may help reduce snoring and sleep apnea by clearing or enlarging air passages, including:
- Nasal surgery to remove polyps or straighten a crooked partition between your nostrils (deviated nasal septum)
- Surgery to remove enlarged tonsils or adenoids
We screen for obstructive sleep apnea. We can help with your options. But remember, NO child should snore, and nobody should live with OSA.