SLEEP APNEA 

What is Sleep Apnoea?

Many people who snore have a disorder known as obstructive sleep apnoea (OSA) when breathing stops periodically during sleep. This is due to the soft tissues in the throat, including the tongue, falling backward and obstructing the airway. Normal breathing slows or stops completely causing blood oxygen levels to drop. The brain senses this and needing oxygen acts to arouse the person from deep relaxed sleep. With arousal, muscle tone returns, allowing the airway to open again, usually with a loud gasp, and breathing begins again. 

Unfortunately, when a person with OSA falls back into a deep sleep the muscles relax again and the cycle repeats itself again and again over the course of the night. In OSA the apnoeas can last 10 or more seconds and this cycle of apnoea-obstruction and breathing can be repeated hundreds of times per night in severe cases. The classic picture of Obstructive Sleep Apnoea includes episodes of heavy snoring that begin soon after falling asleep. The snoring proceeds at a regular pace for a period of time, often becoming louder but is then interrupted by a long silent period during which no breathing is taking place (apnoea). The person struggles to breathe and the apnoea is then interrupted by a loud snort or gasp after which the snoring returns to its regular pace. This behaviour recurs frequently throughout the night. Symptoms are often worse when lying on the back in the deepest and dreaming phases of sleep.

Most people suffering from obstructive sleep apnoea (OSA) are unaware of their disrupted sleep, and low blood oxygen levels but awaken unrefreshed, feeling tired and in need of more sleep. During apnoea, people make constant effort to breathe against their blocked airway, which has been associated with cardiovascular problems.

Older, obese men seem to be at higher risk, though as many as 40% of people with obstructive sleep apnoea are not obese. OSA also affects females although female hormones and a difference in throat anatomy may protect women until the menopause. Nasal obstruction, a large tongue, a narrow airway and certain shapes of the palate and jaw also increases the risk of sleep apnoea. A large neck or collar size is strongly associated with Obstructive Sleep Apnoea. Ingestion of alcohol or sedatives before sleep may predispose to or aggravate episodes of apnoea.

During the apnoeas, the oxygen level in the blood falls. Persistent low levels of oxygen (hypoxia) may cause many of the daytime symptoms. If the condition is severe, pulmonary hypertension may develop leading to right-sided heart failure or corpulmonale.

The condition known as upper airway resistance syndrome (UARS) lies midway between benign snoring and true obstructive sleep apnoea. People with UARS suffer many of the symptoms of obstructive sleep apnoea but normal sleep testing will be negative.

The good news is that Sleep Apnoea and Upper Airway Resistance Syndrome can be treated easily and effectively. Don’t wait to fall asleep at the wheel before seeking treatment. 

SLEEP APNOEA SYMPTOMS

Sufferers of Obstructive Sleep Apnoea may experience the following symptoms:
- Loud snoring
- Witnessed Cessation of Breathing
- Non-refreshing sleep
- Excessive daytime sleepiness
- Choking or gasping during sleep
- Sore dry throat on waking
- Morning headaches
- Poor concentration memory and concentration problems
- Decreased sex drive or impotence
- Personality changes (i.e. irritability)
- A decrease in work performance
- Anxiety or depression
- Recent weight gain

It is also important to realize that often, the person who has obstructive sleep apnoea does not remember the episodes of apnoea during the night. Most patients identify the symptom of excessive daytime sleepiness due to poor, fragmented sleep during the night. Often, family members, especially partners, witness the snoring interspersed with periods where it appears that breathing has stopped. It is often partners or family members who witness the snoring and then the episodes of Apnoea. If your partner shows any of the above signs, you should encourage them to have a full assessment for possible OSA

SLEEP APNOEA TREATMENT

Dental Appliance Therapy is scientifically proven as an effective and comfortable treatment for snoring and mild to moderate Sleep Apnoea. In more severe cases of Sleep Apnoea, dental appliances are an alternative therapy when other treatments such as CPAP are not tolerated or are otherwise contraindicated.

Dental Appliance Therapy is also ideal for people who cannot use their CPAP machine while traveling, camping, or in any situation with no access to electricity. The main way that appliances work is by preventing the tissues at the back of the throat and the base of the tongue from collapsing back into the airway.

There are many different appliances available to dentists. They are often referred to as Mandibular Advancement Splints or Dental Sleep Appliances. These appliances take the lower jaw forward bringing the tongue with it, thereby clearing the airway at the back of the throat. The ideal most comfortable type of appliances are those made from impressions and models of the patient’s own teeth.

There are two basic types- non-adjustable and adjustable: Non-adjustable - Many available appliances are non-adjustable, making the ideal forward position of the jaw a guess by the dentist.

Adjustable - An adjustable appliance is far superior because it allows the dentist, or importantly the patient, to slowly bring the lower jaw forward to the ideal most comfortable position to clear the airway.

Current scientific research demonstrates that the adjustable design as the most effective. Dental Sleep Devices control both snoring and sleep apnoea at the same time.

CONTINUOUS POSITIVE AIRWAY PRESSURE [CPAP]

The most effective and primary medical treatment for severe Sleep Apnoea is continuous positive airway pressure (CPAP).

A CPAP machine is a small air blower connected by a flexible hose to a cushioned plastic mask that covers your nose. The blower delivers air pressure of adjustable intensity through the hose and mask into your nose and throat to keep the air passage open during sleep. While many patients find it difficult to adapt to CPAP therapy, new “state of the art” machines have features which have enhanced patient comfort and compliance. 

A highly effective treatment, unfortunately, many patients find this treatment difficult to tolerate, so do not continue with it over time.

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