Obstructive Sleep Apnea
Obstructive sleep apnea (OSA) is a sleep-related breathing disorder that prevents airflow during sleep. OSA occurs when the tissue in the back of the throat collapses and blocks the airway. This keeps air from getting into the lungs.
When the blood-oxygen level drops low enough, the body wakes up. It happens so quickly that the sleeper may not even remember the arousal. But waking up hundreds of times a night can make a person feel very tired the next day.
OSA patients are much more likely to suffer from strokes and heart problems, such as heart attack, congestive heart failure, and hypertension. They also have a higher incidence of work and driving-related accidents.
Sleep apnea is a very common sleep disorder. More than 18 million Americans suffer from the condition.
How do you know if you have OSA?
OSA is most common in obese, middle-aged men. OSA risk increases with weight gain because excess fat in the back of the throat can narrow the airway. Women and men with OSA often have neck sizes of more than 16 or 17 inches, respectively.
However, OSA can affect anyone.
Do you ever wake from sleep choking or gasping for breath? Has your bed partner noticed that you snore loudly or stop breathing during the night? Do you feel excessively tired during the day?
If yes, then you might have OSA.
The Epworth Sleepiness Scale can help screen for sleep apnea.
A physician needs to diagnose OSA. Diagnosis is based on the results of an overnight sleep study, called a Polysomnogram (PSG). This test will chart brain waves, heart beat and breathing during sleep. It also records arm and leg movements.
A sleep specialist will look for other conditions that may mimic or worsen the symptoms of OSA, such as:
- Another sleep disorder
- A medical condition
- Medication use
- A mental health disorder
- Substance abuse
The specialist will consider your symptoms. Ask someone who has seen you sleep if you snore loudly, stop breathing, or gasp for breath during the night. The specialist will also want to know if your symptoms began after gaining weight or stopping exercising.
You might consider keeping a sleep diary for two weeks to track the following information:
- What time you went to bed each night
- What time you got up in the morning
- How many times you woke up during the night
- Whether you felt rested when you woke up
- If you took naps during the day
- Whether you felt sleepy or rested throughout the day
Behavior therapies such as losing weight, avoiding alcohol and tobacco smoke, and sleeping on your side can decrease the severity of sleep apnea.
Medical and dental treatments include Continuous Positive Airway Pressure (CPAP), oral appliance therapy (OAT) and upper-airway surgery.
Continuous Positive Airway Pressure (CPAP)
CPAP uses pressurized air generated from a bedside machine. The air moves through a tube, connected to a mask that covers your nose, mouth, or nose and mouth. The force of the pressurized air keeps the airway open. CPAP opens the airway like air into a balloon; when air is blown into the balloon, it expands.
Oral Appliance Therapy
Oral appliances are worn in the mouth to treat snoring and OSA. These devices are similar to orthodontic retainers or sports mouth guards. They maintain an opened, unobstructed airway. There are many different FDA-approved oral appliances available.
OAT involves the selection, design, fitting and follow-up care of a custom-made oral appliance for sleep apnea treatment. Dentists trained in dental sleep medicine (DSM) are familiar with the various designs of appliances. They can determine which one best suits your specific needs.
Your dentist will work with your physician and sleep specialist as part of a medical team. Initiation of oral appliance therapy can take several weeks to several months to complete. Your dentist will continue to monitor your treatment and evaluate the response of your teeth and jaws.
Oral appliances work in several ways:
- Repositioning the lower jaw, tongue, soft palate and uvula
- Stabilizing the lower jaw and tongue
- Increasing the muscle tone of the tongue
Oral appliances may be used alone or in combination with other sleep apnea therapies, including weight management, surgery or CPAP.
Dentists who are oral and maxillofacial surgeons may employ a variety of methods to evaluate, diagnose and treat upper-airway obstruction. They may use minimally invasive procedures or more complex surgery, including jaw advancement. It may be necessary to remove tonsils and adenoids (especially in children), the uvula, or parts of the soft palate and throat.