Sleep Apnea

Sleep apnea is the total blockage of airflow for ten seconds or more during sleep. The severity of the condition depends on the number of times it occurs per hour. In mild apnea, it occurs less than twenty times per hour, while in severe apnea over sixty per hour. These events can last for much longer than ten seconds.

Sleep apnea has two types of effects:

1) Physiological effects: increased blood pressure, alterations in heart rhythm, GERD (gastro-esophageal reflux disorder) caused by pumping of acid up from the stomach with muscular contractions as the person tries to breathe, stroke and a variety of effects caused by decreased oxygen levels in the blood.

2) Sleep deprivation effects: excessive daytime sleepiness, changes in personality, headaches, sexual problems and decreased memory or concentration.

Most patients see their physician out of concern for their bed partner who has witnessed them struggling for breath or because of excessive daytime sleepiness. Fifty percent of these patients have had an automobile accident, an occupational accident and many have lost their jobs due to poor performance as a result of sleep apnea.

More adults suffer from sleep apnea than from asthma. Children can also suffer from this disorder. The symptoms that children show can be opposite to those of adults. Rather than daytime sleepiness, they can be hyper-active and have learning disabilities.

If symptoms are present, your physician will refer you to a sleep specialist for overnight studies, called polysomnography. While you sleep, recordings are made of your breathing, heart rate, blood oxygen levels, brain waves and muscle activity. A diagnosis can be made from these recordings.

There are several treatments people can access through their physician. There is a strong correlation between sleep apnea and obesity. Men with a neck size of over 17 inches and women with a neck size of over 15 ½ inches are more likely to have sleep apnea. Reducing and maintaining an ideal weight, therefore, may help; however, the first patient I encountered with sleep apnea was a very slim and fit middle aged man.

Sleep position (on the side) may help, and reducing intake of alcohol for several hours before bed can also make a difference. CPAP (Continuous Positive Airway Pressure) is a mask which fits over your nose and held by a strap. Under pressure, air is forced into your lungs when you inhale. CPAP can be a very effective treatment. A high percentage of patients stop using CPAP devices because of discomfort. This is unfortunate, as Sleep Apnea can result in life threatening health effects.

Dentistry has a great deal to offer patients with this condition. For years, dentists have been making dental appliances to treat tooth grinding or clenching (bruxism) and for movement of teeth in orthodontics. By using a specially designed appliance, it is possible to open the jaws and move the lower jaw forward just as you do when you begin CPR. This can effectively open the airway. Dental appliances can be used to treat mild to moderate sleep apnea, but they can even help in some severe cases. For individuals who just cannot tolerate CPAP machines, dental appliances can be a life saving alternative. Most people find them quite comfortable to wear.

If you suspect that you, your bed partner or someone you know may have sleep apnea, have them discuss it with their health care professional. They will be able to be referred for appropriate testing.

Published by Dr. Larry Hill

Dr. Larry Hill traveled to Nepal as a volunteer dentist in September 2008.