What is Obstructive Sleep Apnea?
As many of you know, I have been involved with treatment of sleep apnea or Obstructive Sleep Apnea (OSA) since 1989. Obstructive Sleep Apnea is a condition that the patient experiences difficulty in breathing while they are asleep. The obstruction happens because as the muscles of the tongue and jaw relax, the gravity and / or the elasticity of the tongue, pull the tongue towards the back of the mouth where it partially obstructs the airway. This obstruction of the airway could be severe enough to cause various degrees of drop in the blood oxygen level. Depending on how low the blood oxygen saturation goes, the person may experience lack of energy, fatigue and/or sleepiness during the day. In severe cases, the lack of oxygen in blood can be so severe as to cause cardiac arrest and death. Needless to say that severe sleep apnea must be investigated by a sleep study and treated by an MD (real doctor!).
What is Snoring?
Of course you have heard people snore, who hasn’t? Snoring is one of the symptoms of OSA. People who snore may or may not experience drop in their blood oxygen level. Obviously, the greater the drop in blood oxygen level, the more severe is the apnea but the degree or loudness of snoring is NOT related to the drop in blood oxygen level. You could be bringing the roof down when you fall asleep but you may not have any apnea. Or you may make very subtle noises but suffer from a dangerous level of sleep apnea.
The level of sleep apnea is determined by pulse oxymetry in a sleep study. The degree of snoring is determined by the complaining partner! Interestingly, the snoring, the partial obstruction of the airway due to relaxed muscles occurs during sleep and totally oblivious to the snorer. As soon as they wake up (you elbow them to wake up) they stop snoring because they regain the muscle tone!
Why and How Do We Snore?
Remember that your air way is only as wide as the width of your “pinky” finger! That’s it. It really does not take much to encroach on this space. Loss of muscle tone during sleep combined with gravity and abundance of soft tissues in the throat (I mean obesity) will bring the tissues so close that the passage of air is interrupted by the tissues slapping each other. This interruption and forced passage of air through the narrowed airway make loud noise of snoring and/or actually reduce the air exchange at the lung level causing drop in blood oxygen level.
What can be done?
Severe OSA cases must be evaluated and diagnosed by sleep studies under care of real doctors (physicians) . The treatment of choice is by a CPAP (Continuous Positive Air Pressure) machine that is highly effective but somewhat cumbersome to use, not to mention very not sexy! Other measures like weight loss can be effective if sustained over time (good luck with this one!).
In the past surgical procedures were used to clear the airway (removing the tonsils, adenoids , uvula and parts of soft palate with dramatic results. However, high relapse rate due to growth and elasticity of the tissues in this area have made these procedures
useless and in my opinion unnecessary.
How can I help?
Mild cases of sleep apnea with or without snoring can be relieved by preventing the tongue from falling back in the throat when we fall asleep. Since the tongue is attached to the lower jaw and is in between the teeth during sleep, variety of dental appliances have been designed over the years to remedy this annoying and potentially dangerous condition.
I have made hundreds of these appliances over the past 25 years with 90 percent success. Whether a dental appliance can help you or not is to be determined by number of factors that are beyond the scope of this writing. Fortunately, there is no harm in getting measured and fitted with a dental appliance for sleep apnea (snoring) because it is a removable device like a retainer that can be discontinued if not effective.
The great news is that the medical insurances and Medicare have recognized the health benefits of treating sleep apnea and in many cases, they pay for the treatment. If you snore and/or suspect that you suffer from obstructive sleep apnea, call the office for a free consultation to see if a dental appliance can help you overcome this condition.
Parsa T. Zadeh, DDS, FICOI, MAGD
Beverly Hills Center for
Reconstructive & Cosmetic Dentistry
Founder and President, Dental Evolutions Inc.