The human body needs sleep. Research proves this. As we sleep, our brains shed short-term memory to open up room for tomorrow’s needs. It cleans links to memories. It clears malfunctioning neural connections. Our bodies also get busy with repair work.
But as a nation, we seem to take a perverse pride in not getting enough sleep.
It’s one thing to do this to yourself on purpose, but it’s another to suffer from sleep apnea, which robs us of deep sleep. Most people don’t even know they have sleep apnea, although there are lots of signs. It could even be endangering their lives.
Dr. Peters treats sleep apnea with custom oral appliance therapy.
What is sleep apnea?
If you suffer from sleep apnea your breathing is fully interrupted throughout the night. This occurs when your upper airway and the airflow through it are blocked as you’re sleeping. When this happens, your brain senses the lack of oxygen and instantly awakens you. This reopens the airway as you move. This can happen dozens of times every night, although you may not know it. Sleep apnea is thought to affect millions of Americans but most don’t do anything about it.
There are different types of sleep apnea. Dr. Peters diagnoses and treats obstructive sleep apnea, the most common form. Obstructive sleep apnea is the type described above, where muscles in the throat relax, blocking airflow.
What are the symptoms of sleep apnea?
These are the common symptoms of sleep apnea:
- Loud snoring (more prominent with obstructive sleep apnea)
- Abrupt awakenings from sleep
- Episodes of breathing cessation witnessed by another person
- Waking up with a headache in the morning
- Excessive daytime sleepiness
- Waking up with a dry mouth or sore throat
- Difficulty staying asleep
- Attention problems
What causes sleep apnea?
Sometimes Dr. Peters sees patients who confuse snoring with sleep apnea. They are different. Snoring involves resistance to airflow; the resistance causes the noise. Sleep apnea is different; it involves blockage of the airway.
There can be many different causes:
- Enlarged tonsils or adenoids
- Cardiovascular problems
- Throat and tongue muscles that are abnormally relaxed
- Nasal congestion
- Family history
Obstructive sleep apnea has a direct relationship with the muscles in the back of the throat. These muscles support all of the surrounding tissues such as the tonsils and the sidewalls of the throat. When the muscles relax, the airway narrows or closes. Your brain senses this inability to breathe and briefly wakes you from sleep to reopen the airway. These lapses in sleep can be so brief you don’t even remember them. These actions can involve a snorting, choking, or gasping sound and can repeat the pattern up to 30 times per hour all night.
How is sleep apnea diagnosed?
If you’ve noted symptoms of possible sleep apnea, Dr. Peters will give you an assessment that you complete at home called the Eppworth Sleepiness Scale questionnaire. With it, he’ll include a “bed partner survey.” After all, the person sleeping next to you, or trying to sleep, have to deal with your snoring, snorting, and abrupt awakenings. The answers you provide in these surveys will probably discount temporary conditions, such as waking up gasping, which can be due to short-term congestion, for instance.
If your answers point to sleep apnea, the next step for Dr. Peters will be an at-home sleep study. If the results from your at-home sleep study show the probability of sleep apnea, we may refer you to a sleep physician for a polysomnogram, a sleep study performed in a sleep lab.
How do you treat sleep apnea?
At Peters Dental Associates, our treatment depends on the severity of your sleep apnea. We’ll likely start with some lifestyle changes, especially if your sleep apnea is mild and not chronic. Here are some initial treatment options:
- Losing weight — This can reduce the amount of tissue in the throat and lessen the sagging, which blocks the airway.
- Decreasing use of alcohol, sedatives, and sleeping pills — These all relax the throat muscles and can lead to sleep apnea, although it is not usually chronic.
- Stopping smoking — Smokers are three times more likely to develop sleep apnea. Smoking leads to inflammation and fluid retention in the upper airway.
- Treating allergies — Allergies and the congestion they cause can lead to sleep apnea during those seasons.
Oral appliance therapy
After lifestyle changes, our first direct treatment option for cases of mild to moderate obstructive sleep apnea is oral appliance therapy. This involves the patient wearing a mouth guard at night.
You can think of these as similar to a sports mouthguard or orthodontic retainer. Worn only during sleep, the oral appliance supports the jaw in a forward position to help maintain an open upper airway. Dr. Peters has experience with a variety of these appliances — there are over 100 FDA-ap
proved oral appliances — and can help you find the one that works best for you. We take precise measurements and impressions and send them to the appliance manufacturer to create your custom oral appliance. These appliances fit precisely and after an initial period of getting used to it, you’ll barely know it’s there.
Oral appliances offer a comfortable, and far less intrusive, an option to continuous positive airway pressure (CPAP) breathing systems (described below). While oral appliances may not be sufficient for more severe cases of sleep apnea, for many patients a combination of a little weight loss and an oral appliance is all they need.
If these treatment methods don’t resolve your sleep apnea, the next treatment option is CPAP. CPAP is a breathing system where the patient wears a mask and is attached to the CPAP machine with tubing. The system then creates higher pressure within the mask than the pressure in the bedroom. This pressure difference keeps the airway open. But CPAP is difficult for many patients to sleep with. That’s why we strive to make oral appliance therapy work for our patients.
What happens if I don’t treat my sleep apnea?
As mentioned above, the brain and body need deep sleep to perform many of the maintenance functions that keep us healthy and help to ward off sickness and disease. If you opt to live with untreated sleep apnea, however, you’re not just saying you’re fine with daytime drowsiness, irritability, and decreased productivity — you’re also rolling the dice with bigger health issues.
As you stop breathing when asleep, the oxygen level in your body decreases and carbon dioxide builds up. This high concentration of carbon dioxide is detected by chemoreceptors in the bloodstream. These receptors alert the brain, which then wakes you up to get some oxygen. When this happens your heart rate speeds up dramatically, placing a tremendous load on your heart, and increasing your chances of a heart attack, stroke, and cardiovascular disease.
Are treatments for sleep apnea permanent?
That depends. For instance, if you lose weight your sleep apnea may go away with the extra pounds. But if you gain the weight back, odds are your sleep apnea will return as well. Dr. Peters has had good success with oral appliance therapy. This is a long-term solution. It also has the added benefit of stopping any tooth grinding you may do at night in your sleep.
Are there risk factors that make a person more likely to have sleep apnea?
Certain conditions or behaviors put some people at a higher risk for developing obstructive sleep apnea:
- Obesity — People who are obese have four times the risk of sleep apnea. Fat deposits around the upper airway can add to obstruction.
- Neck circumference — People with thicker necks often have narrower airways (men 17 inches and larger, women 15 inches and larger).
- Men — Men are twice as likely to have sleep apnea.
- Age — Sleep apnea is more common in older adults.
- Narrowed airway — Some people simply have a naturally narrow throat or have enlarged tonsils or adenoids.
- Family history — Sleep apnea runs in families.
- Smoking — Smokers are three times more likely to have OSA.
- Alcohol or sedatives — These substances relax the throat muscles.