ARE YOU SLEEPING WITH A KILLER - YOU MAY BE! 

Published in:  Health & Healing Wisdom - Millennium Issue - Journal of the Price-Pottenger Nutrition Foundation, Summer 2000, 24(2), 6-7.

I hope this title caught your attention.  I am writing this article on the night I was told my brother, only five years my senior, had a massive stroke (April 16, 1995).  One of the main contributing factors of his stroke may have been what I want to discuss in this article. 

For over 20 years I have been studying and researching the reasons for the collapse of the oral cavity and the airway.  I have combined that information with the materials I have received from the physicians who specialize in sleep, and now work in co-operation with them, in the treatment of snoring and sleep apnea.  

What is so serious about snoring and sleep apnea?

If you snore loudly and often, you may be accustomed to elbow thrusts in the middle of the night and a lot of bad jokes.  But snoring is no laughing matter.  It is a signal that something is wrong with breathing during sleep.  It means that the airway is not fully open.  The “log sawing” noises come from efforts to force air through narrowed passageways. 

Perhaps 4 in every 10 adults snore and for most, snoring has no serious medical consequences.  However for some, habitual snoring is the first indication of a potentially life threatening disorder called “Obstructive Sleep Apnea (OSA)”.  

Sleep apnea is a multi-factorial sleep disorder that is gaining greater recognition among physicians and the lay public.  It has recently had much coverage in the news media.   

What is Sleep Apnea?

Obstructive sleep apnea is the stoppage of airflow for at least 10 seconds because of an upper airway obstruction in the presence of a respiratory effort.  The respiratory effort continues despite the obstruction until the individual is aroused from sleep.  Many times the end of an apnea event ends in a “snort”.  The individual, although aroused, may not be aware of awakening - and that is why he/she has some of the symptoms I will discuss later.  The severity of the apnea is usually categorized by the frequency of the episodes.   Under 5 blockages or “episodes” per hour is considered normal.  More than 20 apnea episodes per hour of sleep can increase the risk of a heart attack 23 times!   In my brother’s case, it increased his blood pressure, which caused the stroke.  Duration, or length of the blockage is also a significant factor.  Blockages can last from 10 to 120 seconds and in very severe cases, longer than that.  As you are reading this, some of you are thinking that your spouse or someone else you know may be suffering from just what I am discussing.  That is why I am writing this article. 

During sleep, muscles in the throat and neck relax much more than they do during waking hours.  In most people this normal process causes no problems; sleep is a time of rest.  However, for some people muscles relax excessively, compromising breathing and making sleep a time of danger.  A collapse of the airway walls blocks breathing.  When breathing stops, a listener hears the snoring broken by pauses.  With each gasp the sleeper awakens, but so briefly and incompletely, that he/she usually does not remember doing so. 

Because the etiology of obstructive sleep apnea is multi-factorial and the treatment options are varied, proper diagnosis and treatment are best handled by a team approach.  The only way a definitive diagnosis of obstructive sleep apnea can be obtained is by having a sleep study.   

Some of the symptoms of Obstructive Sleep Apnea include:

- Heavy snoring
- Excessive daytime sleepiness
- High blood pressure
- Morning headaches
- Depression
- Severe anxiety
- Intellectual deterioration
- Temperamental behavior
- Poor job performance
- Dry mouth upon awakening
- Mouth breathing
- Restless sleeps - lot of tossing/ turning
- Difficulty breathing through the nose
- Impotence  

Some of the physical signs of Obstructive Sleep Apnea include:

- Elongated soft palate
- Poor muscle tone in the soft palate and the back of the throat. 
- Enlarged tonsils, adenoids, or uvula.
- Blocked nasal air passages common with cold or allergies.
- Obstructed nasal airways caused by polyps, cysts, or deviated septum.
- Being overweight, and / or having a thick and bulky neck.
- Having a lower jaw that is retruded (dropped back) or small.
- Having a large tongue.

An increase in OSA is directly related to an increase in weight and age.  Men are a little more likely to be affected than women. 

Symptoms of Obstructive Sleep Apnea in children:

- Snoring
- Hyperactivity (a tired child trying to stay awake)
- Developmental delay
- Poor concentration
- Bed-wetting
- Headaches
- Restless sleeps
- Nightmares
- Night terrors
- Obesity
- Chronic runny nose
- Noisy breathers
- Frequent upper airway infections           

What are the treatments for snoring and OSA?

1) Miscellaneous treatments - Try weight loss and muscle toning  - Sleep on your side rather than on your back (put 3 tennis balls in a sock and sew it to the back of your pajamas) - Elevate the head of the bed  - Avoid smoking - Avoid tranquilizers, sleeping pills or antihistamines before going to bed - Avoid alcohol within 3 hours of bedtime - Avoid heavy meals within 5 hours of going to bed.  Going to bed exhausted also increases the chance of snoring. 

2) Continuous Nasal Airway Pressure - CPAP.  The individual wears a mask over the nose while sleeping.  Air under pressure is forced past the obstruction in the airway. 

3) Surgery - Some of the nasal passage, throat, or tongue, may have to be removed.  Sometimes the jaw or tongue may need to be advanced, or the hyoid bone raised. 

4) Oral Appliances - The appliances are designed mainly to advance the jaw or tongue while the individual sleeps.  The appliances are much like those worn after orthodontic appliances (braces) are removed. 

What should you do if you think you have Obstructive Sleep Apnea?

First, discuss your signs and symptoms with your primary care physician.  Sleep apnea is a rather new medical specialty, so not all physicians know as much about it as others.  If you feel you are not getting proper treatment for your condition, see the referral information below. 

If the physician thinks you may have sleep apnea, he/she will probably recommend a sleep study.  This involves being monitored while you are sleeping.  If you have significant sleep apnea, CPAP is usually the first treatment of choice at this time.  If for some reason the CPAP is not effective, other options are available - either surgery or an oral appliance.  Surgery is non-reversible.  Dental appliances are a non-invasive, reversible treatment that I believe will become the initial treatment of choice in the future if CPAP is not effective.  PREVENTION DURING CHILDHOOD DAYS IS THE BEST TREATMENT.   

For information on a hospital sleep center in your area, contact:

American Academy of Sleep Medicine
6301 Bandel Road, Suite 101
Rochester, MN  55901
Phone - (507) 287-6006
Fax - (507) 287-6008
Email: aasm@aasmnet.org

Web site:  http://www.aasmnet.org 

For information on a dentist in your area who has an interest in the fabrication of oral appliances for the treatment of sleep apnea, contact:

Academy of Dental Sleep Medicine
10592 Perry Highway, #220
Wexford, PA  15090-9244
Phone - (724) 935-0836
Fax (724) 935-0383
Email: info@dentalsleepmed.org
Web site: http://www.dentalsleepmed.org  

Author:

Brian Palmer D.D.S.
Broadway Medical Building  
4400 Broadway, Suite 514
Kansas City, Missouri, 64111
Phone - (816) 561-5578
Fax - (816) 561-5601
Email - brianpalmer@kc.rr.com

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