What is Sleep Apnea?
Sleep Apnea is a common sleep disorder that is often overlooked. Millions of Americans suffer from it, but many people don’t even know they have it. Although relatively harmless in most cases, it can lead to serious health risks if left untreated. At New Smiles, we team with medical professionals to diagnose, treat, helping you sleep like a baby once again.
Sleep Apnea Diagnosis
Sleep apnea is characterized by sudden, interrupted breathing during sleep. This happens repeatedly as the person sleeps, sometimes occurring hundreds of times in a night. Common symptoms include:
- Waking up with a very sore or dry throat
- Loud snoring
- Occasionally waking up with a choking or gasping sensation
- Sleepiness or lack of energy during the day
- Sleepiness while driving
- Morning headaches
- Restless sleep
- Forgetfulness, mood changes, and decreased interest in sex
- Recurrent awakenings
Sleep Apnea Causes
Some people think that snoring is sleep apnea, but it’s not. Snoring occurs when there is resistance to airflow during sleep. Sleep apnea involves a more pronounced blockage.
There are various causes for sleep apnea:
- Enlarged tonsils or adenoids
- Cardiovascular problems
- Throat and tongue muscles that are abnormally relaxed
- Nasal congestion
- Family history
- Lack of brain signals to the breathing muscles
Types of Sleep Apnea
With obstructive sleep apnea, the muscles in the back of the throat relax. These muscles support all of the surrounding tissues such as the tonsils and the sidewalls of the throat. When these muscles relax, the airway narrows or closes. The brain senses this and briefly jolts you awake to open the airway. These interruptions of your sleep can be so brief that you have no recollection of them. You may snort, choke, or make a gasping sound, and you may do it up to 30 times…per hour, all night!
In central sleep apnea, your brain doesn’t tell your breathing muscles to do their job. Your body awakens with shortness of breath, or it may not allow you to get to sleep in the first place.
What constitutes severe sleep apnea?
When you have your sleep study, the number of apneas or hypopneas you experience during sleep is recorded. These are the occurrences of partial and complete blockage of the airway. The number is based on the events per hour and this is called the Apnea-Hypopnea Index (AHI). Based on the AHI, the severity of obstructive sleep apnea is classified as follows:
- None/Minimal: Under 5 AHI per hour
- Mild: 5 or more, but less than 15 AHI per hour
- Moderate: 15 or more, but less than 30 AHI per hour
- Severe: Over 30 AHI per hour
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What Happens if Sleep Apnea is Left Untreated?
Sure, you can manage drowsiness during the day, although it affects your productivity and increase the chances you’ll fall asleep while driving. But moderate to severe sleep apnea is much more than being a little sleep deprived — it can be life-threatening. 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.
Will I have to use a CPAP machine for life?
You can think of your CPAP machine metaphorically like a pair of glasses. When you wear the glasses your refractive errors with your vision are gone and your vision is perfect. But when you go without your glasses, your refractive errors are still there. The glasses only correct your problem when you wear them.
The CPAP machine is the same way. It stops your sleep apnea while you are wearing the mask and benefitting from the variance in air pressure it creates. But the system does not “cure” your sleep apnea. As soon as you stop using it, your sleep apnea will cause the same symptoms again.
Does this mean you will need the CPAP system for life? Technology in treating sleep apnea is advancing, so a new treatment could come along. Even the CPAP systems are becoming smaller and less intrusive. But at this point, CPAP is the best option for many sufferers of obstructive sleep apnea. There are things you can do (such as losing weight if you are overweight) that can help with your condition, but at this point, CPAP will be necessary for the foreseeable future.
It helps to not think of using CPAP as a life sentence or a lifelong burden. As with wearing glasses or contact lenses, think of it as a tool that improves your life.
Sleep Apnea Treatment
There can be simple treatments for mild forms of sleep apnea. At New Smiles, we may help train patients to simply sleep on their sides. We may advocate the removal of the tonsils. Treatment can be as simple as losing weight, cutting back on alcohol consumption at night, or quitting smoking. But moderate to severe cases demand more involved intervention.
Continuous positive airway pressure (CPAP) is a breathing system that uses air pressure to keep the upper airway passages open. The patient wears a mask over his or her nose during sleep. The mask creates air pressure that is somewhat greater than the air pressure in the bedroom, and this difference in pressure keeps the airway open. The problem with CPAP, however, is that some people find it difficult to sleep with the tubes and mask. This can lead to a low compliance rate.
An alternative to CPAP is oral appliance therapy (OAT). The OAT appliance is similar to a sports mouthguard or an orthodontic retainer. The appliance supports the jaw in a forward position to help maintain an open upper airway. At New Smiles, we have extensive experience with the various oral appliances (there are over 100 FDA-approved options) and will work with you to create or find the right one.
What are my OAT options?
There are over 100 oral appliances that have been cleared by the FDA for the treatment of mild to moderate sleep apnea. These appliances prevent your airway from collapsing by either holding your tongue or supporting the jaw in a forward position.
At New Smiles, we don’t recommend over-the-counter devices, as they can alter the position of your teeth and cause other problems with your bite. Plus, they’re just not as comfortable, which is pretty important considering you’ll be wearing it every night.
We will help you find the right oral appliance that gives you the best combination of fit and function to help you move past your sleep apnea.
Is it difficult to sleep with a CPAP machine?
It can be difficult for patients to sleep when using their CPAP machine, especially when using it initially. But there are some things you can try to make CPAP work better for you. These are some adjustments you can make to the system.
- Mask size or style — There are different CPAP masks and sizes of those masks. Be sure the style and fit are right for you.
- Adjusting to the system — Don’t go all-in on the CPAP system immediately. Try wearing the mask for short periods of time, such as while watching TV. Then try the mask with the hose with the system turned on, again while awake.
- Dry, stuffy nose — Leaky masks can dry out your nose. Also, there is a CPAP device that features a heated humidifier, which attaches to the machine.
- Difficulty falling asleep — Wearing your mask alone during the day can help you get used to it. Also, machines can have a ramp feature that slowly and gradually increases the air pressure as you fall asleep, making it more comfortable when you’re first in bed.
- Removing the device at night — It’s not unusual to sometimes wake up and find you’ve removed the mask in your sleep. If you move a lot in your sleep, you may find a full-face mask that will stay on your face better.
- Patience — Getting used to the CPAP device can be frustrating, but patience is key. Don’t give up on it, as the benefits of treating your obstructive sleep apnea are worth the adjustments you need to live with the system.
Is my OAT appliance hard to sleep with?
There are over 100 different models of oral appliances for treating mild to moderate sleep apnea. Your New Smiles Dental dentist will work with you to find the model that works best for you. Some oral appliances work by holding your tongue forward, while other reposition the lower jaw. It’s important to have an oral appliance that is custom-fitted for you. We take digital impressions for use in making your OAT device. Once we receive your custom-made appliance, we can make some adjustments to ensure a comfortable fit.
These really are not difficult to sleep with. They are less intrusive than a sports mouthguard. They will take a little getting used to, but if you wear it around the house when awake that will ensure the appliance feels natural when you wear it when you go to bed.
How will I know if OAT is working for me?
Although you’ll likely have some signs that your oral appliance is helping your sleep apnea, things such as feeling more rested and more alert during the day, we will recommend that you undergo a second sleep study with your oral appliance in place. We will have this done at the same location as your original sleep study. When can then compare the two studies to assess the effectiveness of your oral appliance?
How can I treat sleep apnea at home?
For obstructive sleep apnea, certain factors increase your risk. Some of these are physical (neck circumference) and you cannot control. Others, such as smoking or excessive alcohol use, can be controlled.
- 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.
Other than using CPAP or OAT, which are both home therapies, you can lose weight (if you’re overweight), cut down on drinking, don’t take sedatives, and stop smoking
How often should I change my CPAP supplies?
Just as you replace your toothbrush or razor, it’s important to replace parts of your CPAP system on a schedule to keep them sanitary:
- Replace your mask every 3 months
- Replace your mask cushions every 2 weeks for nasal cushions, once a month for full-face cushions
- Replace your headgear and chin strap every 6 months
- Replace your filters every 2 weeks
- Replace your tubing every 3 months
- Replace your humidifier water chamber every 6 months
- Replace your CPAP machine every 3-7 years (low-end timeframe would be to allow you to make use of new technology that may have been incorporated into CPAP systems)