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Sleep Apnea: What is it?

Sleepless in America

For a long time, the mainstays of the "basic human needs" bucket list have been this classic trifecta: food, shelter and clothing. Certainly these resources are essential for survival in modern life; however it is becoming clear that a missing fourth entry to this list is sleep. The growing field of Sleep Science sheds light on the fact that sleep is pivotal to living a happy and productive life. Given that we spend over a third of our life sleeping, it's not that surprising that sleep is fundamental to not only who we are, but how we are as well. Unfortunately, as the scientific community discovers more and more about the nature of sleep, it is also becoming increasingly understood that many people in this day and age suf fer from problematic sleeping. Sleep problems, we are learning, are associated with compromised health and wellbeing, but even with this understanding, we are seeing an epidemic of chronic sleep deprivation. According to the Centers for Disease Control and Prevention (CDC), 1 in 3 US adults don’t get enough sleep.

Obstructive Sleep Apnea

Obstructive sleep apnea – also known as “OSA” or simply , sleep apnea is one of the most common sleep problems. It is a condition that is characterized by shallow breathing or pauses in breath while sleeping. For those 2025 million US adults who suffer from OSA, their breathing can be halted for a few seconds to over one minute for potentially hundreds of times in one night. While you sleep, your muscles typically relax. For those with OSA, the mechanism that relaxes their muscles during sleep results in the collapse of the palate’ s soft tissue, which causes their airway to become blocked. The result of a chronically blocked airway during sleep, which is the case for those with OSA, is reduced oxygen levels while the event occurs.

OSA: Know The Signs

The risk of sleep apnea is typically increased if the following signs and/or conditions are present:

  • Snoring
  • Gasping or choking during sleep
  • Menopause
  • Excess body weight
  • Narrow airways
  • Jaw misalignment

A Close-Up On Snoring

As a comic book standard, the concept of snoring is often used as a funny character quirk. Giant blocklettered “Zs” pouring out of a nightcapped grandpa’s slack jaw or Bruno the bulldog’ s soggy nose you know the drill. But talk to someone whose partner is a chronic snorer or consider the way snoring can have an impact on your overall health and it becomes clear that outside the comic book world, snoring is not a laughing matter .

Though it may not seem that serious, snoring is classified as a legitimate sleep problem – one of the most common sleep problems, in fact. The condition directly affects one’s sleep quality, which, in turn, has serious consequences to one’ s quality of life. It is important to recognize the symptoms of snoring and discuss any concerns you may have with your doctor or dentist.

The term, “snoring” refers to a sound that occurs when the soft tissue of the upper airway resonates with a person’ s breath when they sleep. Though it used to be considered a condition that primarily af fected men, today we understand that snoring can af fect all genders. Aggressive snoring can be a symptom of sleep apnea, however snoring is not the sole indicator of the condition, nor does the presence of snoring necessarily mean you have sleep apnea.

Conditions and behaviors that are known to increase the risk of snoring include:

  • Nasal obstruction
  • Obesity
  • Alcohol consumption
  • Smoking
  • Pregnancy
  • Menopause

Related Conditions: Is Treating OSA Important?

In a word, yes! Treating OSA is incredibly important to your health and wellbeing, both now and in the future. In the short term, untreated OSA can lead to excessive daytime sleepiness, morning headaches and memory loss. Letting your OSA go untreated also puts you at risk of drowsy driving and accidents in the workplace.

More research is coming out about the long term ef fects of untreated OSA. It is becoming increasingly understood that untreated OSA elevates your risk of serious health problems including:

Obesity: in adults, the most common cause of OSA is excess weight and obesity.

Early onset of dementia and Alzheimer’s: studies have shown that people with OSA are at greater risk of developing memory problems and other symptoms of mild cognitive impairment (MCI) earlier than those without OSA.

Drowsy driving: those who drive while fatigued put themselves and others at an elevated risk of road accidents. Drowsy driving is a major issue in the USapproximately 1 in 25 adult drivers report having fallen asleep while driving in the previous 30 days. Drivers with untreated sleep disorders, such as OSA, are at a greater risk of drowsy driving.

High blood pressure: the fluctuation in blood oxygen levels during episodes of sleep apnea can strain the cardiovascular system and increase blood pressure.

Heart disease: OSA is associated with both obesity and high blood pressure, two major risk factors for heart disease.

Stroke: The occurrence of strokes has been found to be far more common in those with moderate to severe OSA, especially in men with OSA whose risk of stroke is three times higher compared to men without OSA.

Diabetes and other metabolic conditions: having sleep apnea increases one’s risk of developing insulin resistance and type 2 diabetes.

Erectile dysfunction (ED): In a 2009 study, it was found that 69% of male participants with OSA also reported ED. It is not yet known why men with OSA have higher rates of ED.

Chronic acid reflux: GERD (gastroesophageal reflux) and sleep disorders are a common pairing. It is thought that the changes in airway pressure that results from OSA contribute to the occurrence of reflux or that acid reflux at night leads to vocal cord spasms that result in sleep apnea.

Treating OSA: An Action Plan For Getting Help

1) Talk to your doctor or dentist:
  • If you are concerned that you or your partner ’s snoring may be more than the occasional nighttime disturbance, or if you are frequently feeling excessively fatigued during the day , consult your physician or your dentist.
  • Explain your concern and express that you would like to be evaluated for sleep apnea.
  • 2) Get diagnosed:
  • Only boardcertified sleep physicians as opposed to your primary care physician or dentist can issue a formal diagnosis of sleep apnea. However, a primary care physician or dentist should be able to consider your symptoms and advise you whether your odds of having sleep apnea are high. If your family doctor or dentist determines that you may indeed suffer from sleep apnea, they can refer you for a formal diagnosed.
  • In order to make the diagnosis, sleep physicians must collect data on your sleep activity. To acquire this data for a potential diagnosis, they can give full evaluations of your symptoms in several ways including:
    • Admittance to a sleep center for an overnight evaluation
    • A self-administered at-home sleep apnea test
  • After you are tested, if you are diagnosed with sleep apnea, your sleep physician will provide you with information including the severity of your condition. They will diagnosis you as having either , “mild,” “moderate,” or , “severe” obstructive sleep apnea (OSA).

3) Get treated:

How Your Dentist Can Help:

  • Research shows that the use of oral appliances for the treatment of mild to moderate sleep apnea and snoring is ef fective and most patients find an oral appliance to be a comfortable and convenient option for the treatment of their apnea. The American Academy of Sleep Medicine recommends use of an oral appliance for cases of “mild” and “moderate” OSA.
  • For patients with “severe” OSA who cannot comply with use of a Continuous Airway Pressure (CPAP) machine, Oral Appliances may be recommended as an alternative.
  • An oral appliance is fitted and monitored by dentists and/or oral surgeons; the appliances help you maintain an open upper airway during sleep
  • Oral appliances are to be worn at night, have a similar fit to a sports mouth guard or orthodontic appliance, are portable and require low maintenance care
  • If you are diagnosed with obstructive sleep apnea, oral appliance therapy is covered by many medical insurance plans.
  • MAD-FIT™s, APP-NEA™ LLC's flagship product, bypasses the trial and error in fitting oral appliances, making it easier for dentists to get the right fit the first time.
  • Note:If you choose a dentist who has received training and is certified by AppNea , LLC, you will be able to choose a MADFIT dentist, which will allow you to avoid the timeconsuming and inconvenient “trialanderror” fitting procedure typical of other oral appliances.

How Your Doctor Can Help:

  • If you are diagnosed with “severe” obstructive sleep apnea you may be advised to use a Continuous Airway Pressure, or CP AP, machine
  • Talk to your doctor about what the best course of treatment is for you. Although CPAPs are the standard practice for the treatment of “severe” OSA, they may not be readily tolerated by all patients
  • If you are unable to tolerate a CP AP, an oral appliance becomes your second line of defense, which is a better option than letting your apnea go untreated.

How You Can Help:

  • There are a number of behavioral and lifestyle changes you can consider when trying to lessen the symptoms of your sleep apnea and snoring.
    These include:
    • Losing weight
    • Avoiding alcohol and smoking
    • Sleeping on your side

No matter what your diagnosis ends up being and what treatment option you choose, we recommend that you make these life changes, regardless!

Relevant Clinical Studies

Effect of exercise training on sleep apnea: A systematic review and meta-analysis.

Associations between Macronutrient Intake and Obstructive Sleep Apnoea as Well as Self-Reported Sleep Symptoms: Results from a Cohort of Community Dwelling Australian Men

Benzodiazepine prescribing patterns and deaths from drug overdose among US veterans receiving opioid analgesics: case-cohort study

Effect of Sleep-Disordered Breathing Severity on Cognitive Performance Measures in a Large Community Cohort of Young School-Aged Children

Obstructive sleep apnea and psychomotor vigilance task performance

http://onlinelibrary.wiley.com/doi/10.1111/dmcn.13091/abstract

Reciprocal dynamics between self-rated sleep and symptoms of depression and anxiety in young adult women: A 14-day diary study .

Risk of Occupational Accidents in Workers with Obstructive Sleep Apnea: Systematic Review and Meta-Analysis

What Is the Prevalence of Symptomatic Obstructive Sleep Apnea Syndrome in Chronic Spinal Pain Patients? An Assessment of the Correlation of OSAS with Chronic Opioid Therapy , Obesity, and Smoking.

Sleep–wake disorders persist 18 months after traumatic brain injury but remain underrecognized

Prediagnostic Sleep Duration and Sleep Quality in Relation to Subsequent Cancer Survival
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