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SLEEP APNEA

What is Sleep Apnea? Why is sleep apnea a concern?
What are the different types? Who is at risk?
What are the symptoms? Dentist help
What is the difference between sleep apnea and snoring? Treatment options
Updates about sleep apnea
What is Sleep Apnea?

Sleep apnea is a serious, potentially life threatening sleep disorder.  It is as common as adult diabetes and affects more than 12 million Americans.  The Greek work apnea means "want of breath".  Sleep apnea refers to episodes in which a person stops breathing for 10 seconds or more during sleep.  With each episode, the sleeper briefly wakes up in order to resume breathing, resulting in extremely fragmented, poor quality sleep.

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What are the different types of Sleep Apnea?

There are three types, all of which can severely disrupt the regular sleep cycle:

  1. Obstructive apnea (OSA)-The walls of your throat relax as you sleep but in this condition they relax to the point where the airway collapses and prevents air from flowing into your nose and mouth, but efforts to breath continue.  This is the most common type.
  2. Central apnea-Breathing interruptions during sleep are caused by problems with the brain mechanisms that control breathing.
  3. Mixed apnea-Begins with central apnea but usually becomes obstructive in the same cycle.

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What are the symptoms of obstructive sleep apnea?

bulletMorning headaches
bulletExcessive daytime sleepiness
bulletIrritability and impaired mental or emotional functioning
bulletExcessive snoring, choking or gasping during sleep
bulletHeartburns

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What is the difference between snoring and sleep apnea?

Unlike mild snoring individuals with sleep apnea stop breathing completely for 10 or more seconds with frequency of waking episodes between 10-60 in a single night.  If your partner hears loud snoring, punctuated by silences and then a snort or choking sound as you resume breathing, this pattern could signal sleep apnea.  Not all snores will develop sleep apnea and not all sleep apnea patients snore.

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Why is sleep apnea a concern?

  1. Fatigues during the day
  2. Driving skills are similar to that of a drunk driver
  3. Can lead to impaired daytime functions
  4. High blood pressure, heart attack and possible stroke
  5. Stress an already weakened heart during sleep

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Who is at risk for developing sleep apnea?

There is an estimated 18 million American with sleep apnea.

bulletHigher in men
bulletUnder diagnosed in women and African Americans
bulletRuns in families
bulletLoud snoring
bulletPhysical abnormality in the nose, throat, or other parts of upper airway
bulletObesity
bulletHigh blood pressure
bulletSmoking
bulletUse of alcohol or sedative and sleep medications

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How your Dentist Can Help

Your dentist can refer you to a sleep specialist for a proper diagnosis.  If you have been diagnosed with sleep apnea your dentist can work closely with the diagnosing physician to implement and mange the prescribed therapy.

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What are my treatment options?

Treatment is based on medical history, physical examination and results of polysomnography, which measure heart rate and how many times breathing is interrupted.  Treatment for mild OSA may as simple as not sleeping on your back.  Dental appliances that reposition the lower jaw the the tongue have been helpful to some patients with mild sleep apnea.

Severe sleep apnea, a nasal continuous positive airway pressure, resembling something a jet pilot might wear-is a commonly prescribed physical therapy.  It delivers air through a small mask that cover the nose.  The constant pressure keeps the airway open, which prevents snoring and episodes of apnea.  Medications are generally ineffective.  Oxygen is a controversial treatment and it doesn't eliminate sleep apnea or daytime sleepiness and in not used to treat patients with obstructive sleep apnea.

AGD Impact pg 24, January 2004

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Updates on Sleep Apnea

 Alert! Always  get the reflux under control before considering the sleep apnea. Apnea is nasty but Barrett's esophagus is life threatening and is a much worse thing to have....Remember weekly or more reflux is an indication that things are getting worse...if left untreated  Barrett's can lead to needing surgery....they do a resection and end to end anastomosis.  Don't screw with reflux you WILL die. 

New Breathing Machines Could Help Bring People Sleep


Researchers hope to solve restless sleep, which can aggravate other medical conditions. The Cleveland Clinic is testing breathing machines worn over a patient's nose overnight. The machine, called a Continuous Positive Airway Pressure (CPAP), opens the airway to stop symptoms of sleep apnea, a condition in which people repeatedly stop breathing as they sleep -- sometimes for as long as a minute at a time.

The idea behind this study was to see if treating sleep apnea in people with poorly-controlled epilepsy would have a significant impact on seizure control. To test the CPAP's effectiveness, half of the patients will use one
that works and the other half will use one that does not work. I suspect a couple of my patients have been treated with the real thing because I saw positive effects in them pretty quickly. Three other medical centers around the country are also participating in this sleep study.
 4/2005 MSNBC.com
 

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There are lots of physical reasons that can be serious that can cause insomnia.  Diagnosis is important . She may not be relating, or even thinking of other symptoms that may be connected to this. Hormonal problems -a premature menopause and ovarian cysts cause symptoms of insomnia. Over training and lack of body fat can cause a change in hormone levels. Even if it's "only stress" than simply medicating it is short sighted.A good idea is to find a gynecologist and open minded physician to help in with insomnia.

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Treating sleep apnea can ease heartburn

Nighttime heartburn is common among people with a sleep disorder called obstructive sleep apnea, and a device used to treat this disorder may ease patients' heartburn. People with sleep apnea stop breathing for short periods during sleep. Most commonly due to upper airway obstruction, the condition can cause:

bullet loud snoring
bullet repeated near-wakening 
bullet increased blood pressure. 

About 10 percent of people who suffer from heartburn, have symptoms at night. People with nighttime symptoms tend to have a much worse quality of life than those whose symptoms occur only in the daytime. SOURCE: Archives of Internal Medicine 2003;163:41-45.

Speech impediments may prove an important diagnostic clue for assessing and treating sleep apnea. The researchers said 38 percent of the sleep apnea patients reported a history of stuttering or speech impairment. Overall, 7 percent of the general population stutters. In the future, doctors may monitor certain brain structures and examine children for speech or movement problems that may predict a higher sleep apnea risk. ADA News 20Nov2002

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Sex Is Factor In Sleep Apnea

 The public's perception is often that men are more likely to snore and, therefore, to suffer from sleep apnoea, but this is not the case.  This study suggests that the physical examination for this disorder should incorporate gender differences. The study found that women seeking medical help for sleep apnoea were older, had a higher BMI, and had a lower apnoea index, when compared with men. Men more often had an obstruction in the nose, a larger uvula and a shorter distance between the uvula and the pharyngeal wall. This differed from women, who revealed a more marked retro- position of the tongue and tended to have more gag reflexes. In women, BMI and the size of the uvula was associated with AHI; in men, the index score was associated with the BMI, the height of the tongue, the size of the uvula and the distance between the uvula and the pharyngeal wall. The researchers concluded that scores indicating a propensity for sleep apnoea for men and women are associated with BMI and the size of the uvula. But for men alone, the easily identifiable predictive features for this disorder are a high position of the tongue, a decreased distance between the uvula and the pharyngeal wall; in women, a retro-position of the mandible and large tonsils seem to be the primary risk factors for obstructive sleep apnoea.  The research was published at the American Academy of Otolaryngology Head and Neck Surgery Foundation 9/02

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Dental Appliance Beats Surgery for Sleep Apnea

     A dental appliance worn at night appears to be more successful in treating obstructive sleep apnea (OSA) than surgery.  People with OSA stop breathing dozens of times each night, causing them to gasp for breath. The condition is conservatively estimated to affect up to 4% of middle-aged Americans, and is particularly common among obese people.

Sleep apnea has been linked to daytime sleepiness, as well as an increased risk of high blood pressure and cardiovascular disease.

The Swedish study found the success rate in patients with OSA who wore the dental appliance was 81%, compared to 53% in OSA patients who had surgery. However, after 4 years, many patients were no longer
wearing the device when they slept.

Surgery called uvulopalatopharyngoplasty (UPPP), in which tissue from the back of the throat is removed, may also be performed to treat OSA. This is the main surgical treatment for people with mild to moderate OSA, the study.

The current study compared UPPP to a dental appliance worn at night that pushes the lower jaw slightly forward, increasing airflow in and out of the throat. One group underwent UPPP surgery and the other patients were fitted with the dental appliance. All of the men went through a battery of sleep tests that evaluated their OSA before treatment and again 1 and 4 years after treatment.

"The success rate in the dental appliance group was 81%, which was significantly higher than in the UPPP group, 53%.

However, only 62% of the patients in the dental appliance group were still wearing the device when they slept after 4 years. But the researchers found that the:
bulletdental appliance had few adverse effects on the jaw and throat
bulletnumber of adjustments and repairs of the appliances over time was moderate.

SOURCE: Chest 2002;121:674-677, 739-746.

http://www.aasmnet.org/
 

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