Sleep Apnea

What is Sleep Disordered Breathing (SDB)?

If you suffer from Sleep Disordered Breathing – snoring or sleep apnea – it can be a nuisance and also a hazard to your health.

Sleep disordered breathing is the general term used to describe a range of problems that occur as you try to breathe while you sleep. Sleep disordered breathing includes simple snoring to severe sleep apnea.

Snoring is the sign of a breathing problem. When you snore, you are breathing through a narrowed airway, which is like trying to breathe through a bent hose. In some cases, snoring is a “red flag” for a more serious medical problem called obstructive sleep apnea (OSA). It can have an impact on your quality of life and even affect your relationships.

Why Do I Snore?

Snoring is the sound of tissue that vibrates as you breathe through a narrowed airway. Imagine that you are trying to breathe through a kinked air hose. Snoring occurs at night, when you are asleep and your body fails to keep the airway open all the way. Snoring is caused by a blocked or partially blocked air passage. Most snoring occurs in the back of the throat but it may also be related to a blockage that restricts airflow in the nose.

Under normal conditions, the muscles in the upper part of your throat keep your airway open so air can easily flow into your lungs. These muscles relax when you fall asleep. When this happens, the soft tissue in your throat can cave in and your tongue can fall into the back of your throat. Sometimes a change in your jaw position will change the shape of your airway. When you try to breathe in through a smaller or more narrowed airway, the tissue in your throat will vibrate and cause the snoring sound.

If I snore, should I be concerned?
Simple snoring does not necessarily affect the health of the person who is snoring. But, snoring is considered the “warning sign” of two more serious breathing problems – Airway Resistance and Obstructive Sleep Apnea (OSA).

If you snore, it is important that you get tested for airway resistance and obstructive sleep apnea. If these conditions are not treated, they can lead to more serious health problems like high blood pressure and heart disease.

Snoring can affect your quality of life and may have an impact on those who sleep within earshot of you. For instance, people who snore sometimes feel embarrassed about their snoring and stop participating in activities (like travel) that may expose their problem to friends.

Snoring can affect your relationships with others and especially with your bed partner. If your snoring disturbs the sleep of another, you may prevent that person from getting the sleep that he or she needs. Sleep deprivation can lead to many problems like irritability, excessive daytime sleepiness and a higher likelihood of having an accident at work or on the road.

People with Upper Airway Resistance Syndrome (UARS) snore but they don’t have all the symptoms that must be present to be diagnosed with obstructive sleep apnea.

Upper Airway Resistance Syndrome falls between snoring and sleep apnea on the range of sleep disordered breathing. People with Airway Resistance experience a partial blockage of the airway, which results in resistance to airflow and difficulty breathing. Although snoring may or may not be present, patients with Airway Resistance do not stop breathing like patients with obstructive sleep apnea. However, airway resistance is a serious problem.

If you have Airway Resistance, it’s as if you have to breathe through a very small straw. To get enough air into your lungs you have to suck with much greater pressure which causes more work for the muscles of your heart and puts extra stress on your cardiovascular system. This can cause numerous symptoms including sleepiness or fatigue, clenching of the teeth, headaches, reflux, weight gain, and fibromyalgia.

Unfortunately, most people with Airway Resistance don’t know they have it and as a result don’t get any treatment. In fact, most people only get treated for sleep disordered breathing if they meet the diagnosis criteria for sleep apnea.

Treatment for Airway Resistance can do a lot to improve your health because it will be easier for you to breathe at night. If you start treating your sleep disordered breathing early when it is classified as Airway Resistance, you may prevent it from turning into the more severe problem of obstructive sleep apnea.

Obstructive sleep apnea (OSA) occurs when your airway completely collapses and blocks airflow to your lungs. People with sleep apnea can stop breathing hundreds of times during the night, which limits how much oxygen circulates through the body. Obstructive sleep apnea is a chronic disease that can lead to serious health problems, such as extreme daytime sleepiness and high blood pressure.

Obstructive sleep apnea occurs when the muscles surrounding your airway completely give way. Basically, your throat closes and blocks airflow into your lungs. This blockage – whether partial or complete – cuts off your oxygen supply. You may or may not be aware that you stop breathing when you fall asleep. A bed partner will often hear you gasp or choke when the blockage opens and you are able to breathe again. People with mild sleep apnea may stop breathing only a few times an hour. People with severe sleep apnea can stop breathing as many as eighty times an hour or more

Warning: Obstructive Sleep Apnea is Serious

Obstructive sleep apnea is a chronic disease that can lead to serious health problems, like extreme daytime sleepiness and high blood pressure. If you have sleep apnea and stop breathing multiple times a night, you don’t get the oxygen your body needs to function well. Your brain has to wake you up enough to start breathing again.

The repeating cycle – falling asleep, blocked airway, brain activation to start breathing again – is the reason you never get a restful night of sleep. Plus, the lack of oxygen puts extra stress on your entire body and especially on your heart. Studies have shown that you are more likely to have a heart attack or stroke if you have untreated sleep apnea. In some cases, obstructive sleep apnea can be fatal. The pro-football player Reggie White died of sleep apnea in 2004.

Signs and Symptoms of Sleep Apnea
The most common signs of sleep apnea are:

• Loud snoring
• Choking or gasping during sleep
• Fighting sleepiness during the day (even at work or while driving)

Your family members may notice the symptoms before you do. Otherwise, you will probably not be aware that you have problems breathing while you are asleep.

Others signs of sleep apnea may include:

• Morning headaches
• Memory or learning problems
• Feeling irritable
• Not being able to concentrate on your work
• Mood swings or personality changes; perhaps feeling depressed
• Dry throat when you wake up
• Frequent urination at night

A major side effect or symptom of obstructive sleep apnea is chronic sleepiness. People with obstructive sleep apnea often:

• Feel sleepy even if they get enough sleep
• Take naps during the day
• Find it easy to nod off or fall asleep (e.g. in front of the TV, at a traffic light)

People with obstructive sleep apnea (OSA) have disrupted sleep and low blood oxygen levels. When obstructive sleep apnea occurs, the tongue is sucked against the back of the throat. This blocks the upper airway and airflow stops. When the oxygen level in the brain becomes low enough, the sleeper partially awakens, the obstruction in the throat clears, and the flow of air starts again, usually with a loud gasp.

Repeated cycles of decreased oxygenation lead to very serious cardiovascular problems. Additionally, these individuals suffer from excessive daytime sleepiness, depression, and loss of concentration.

Some patients have obstructions that are less severe called Upper Airway Resistance Syndrome (UARS). In either case, the individuals suffer many of the same symptoms.

The first step in treatment resides in recognition of the symptoms and seeking appropriate consultation. Oral and maxillofacial surgeons offer consultation and treatment options.

In addition to a detailed history, the doctors will assess the anatomic relationships in the maxillofacial region. With cephalometric (skull x-ray) analysis, the doctors can ascertain the level of obstruction. Sometimes a naso-pharyngeal exam is done with a flexible fiber-optic camera. To confirm the amount of cardiovascular compromise and decreased oxygenation levels, a sleep study may be recommended to monitor an individual overnight.

There are several treatment options available. An initial treatment may consist of using a nasal CPAP machine that delivers pressurized oxygen through a nasal mask to limit obstruction at night. Another non-surgical option which is very effective in select mild and moderate cases is a special oral appliance fashioned by our doctors. One of the surgical options is an uvulo-palato-pharyngo-plasty (UPPP), which is performed in the back of the soft palate and throat. A similar procedure is sometimes done with the assistance of a laser and is called a laser assisted uvulo-palato-plasty (LAUPP). In other cases, a radio-frequency probe is utilized to tighten the soft palate. These procedures usually performed under light IV sedation in the office.

In more complex cases, the bones of the upper and lower jaw may be repositioned to increase the size of the airway (orthognathic surgery). This procedure is done in the hospital under general anesthesia and requires a one to two day overnight stay in the hospital.

OSA is a very serious condition that needs careful attention and treatment. Most major medical plans offer coverage for diagnosis and treatment.