Nearly 30 million adults in the U.S. have obstructive sleep apnea (OSA), which can cause them to stop breathing hundreds of times a night for anywhere from a few seconds to more than a minute. This can result in not just insufficient restful sleep, it has other significant health risks.
Sleep apnea is a chronic condition that occurs when your muscles relax during sleep, allowing soft tissue in the throat to collapse and block the airway. As a result, there are repeated pauses of breathing, which can reduce the oxygen levels in your blood. These breathing pauses lead to brief awakenings (arousals) that disturb your sleep and often cause grinding of the teeth. These repeated episodes reduce the amount of restorative sleep that you get, causing drowsiness during the day. This has been known to contribute to motor vehicle accidents and is a major contributor to several serious diseases. These include:
• High blood pressure
• Heart disease
• Chronic acid reflux
• Erectile dysfunction
• Severe, untreated sleep apnea even increases your risk of death.
Common signs of sleep apnea include snoring and gasping or choking sounds during sleep. Sleep apnea is more common in men, but it occurs in women too, especially during and after menopause. Having excess body weight, a narrow airway or misaligned jaw all increase the risk of having sleep apnea.
How is OSA Diagnosed?
A medical doctor, who is a sleep specialist, can provide you with a complete sleep evaluation. Although your responses to special questionnaires may strongly suggest sleep apnea, the diagnosis, including its severity, is made by doing an overnight sleep test, either at home or in a sleep lab. The sleep doctor will interpret the data from your sleep study to make a diagnosis.
How is OSA Treated?
Your sleep doctor will discuss treatment options with you. These options could include continuous positive airway pressure (CPAP) therapy, oral appliance therapy, or surgery, depending on the data from the sleep study.
CPAP has been a long-standing method of therapy, still considered by some to be the ‘gold standard’, and involves wearing a face or nose mask connected by tubing to a constantly running machine that maintains air flow. It can be very effective but its biggest drawback is patient compliance. It has been shown in studies that even in patients who initially are able to use CPAP during sleep, a high percentage of them eventually discontinue using it. Another reason that it can be a difficult options is that carrying this device when traveling adds to its inconvenience.
Oral appliance therapy (OAT)
This involves the use of a device – worn in the mouth during sleep – that holds your jaw forward to maintain an open, unobstructed airway. This option has been very effective and is now considered an appropriate first-line option for mild to moderate apnea by the American Academy of Sleep Medicine. Most patients find an oral appliance to be fairly easy to wear and compliance is much better than with CPAP. Sometimes OAT is used in conjunction with CPAP in cases of more severe apnea, either simultaneously or as a temporary substitute for CPAP when traveling. When these two are used together, it is sometimes possible to reduce the amount of pressure required on the CPAP maching.
Surgical options include a variety of procedures. All have varying side effects and rates of success. These options are typically appropriate for more severe forms of apnea when more conservative options have been ruled out as insufficient.
Many patients consider an oral sleep apnea appliance to be more comfortable to wear than a CPAP mask. Oral appliances also are quiet, portable and easy to care for. Because taking your CPAP machine on an airplane is cumbersome, an oral appliance is often a good alternative for the frequent flyer, even if you have been successful using CPAP at home.
If you have reason to think that you may have sleep apnea but have not been diagnosed by a sleep doctor, please call our office and we will make a referral to a physician who specializes in Sleep Medicine. If you have previously been diagnosed with sleep apnea and would like to consider an oral appliance in place of CPAP, we will be happy to discuss this with you. It would be necessary for us to obtain a prescription from your sleep doctor (a diagnosis) to be able to provide an oral appliance for sleep apnea. We strongly recommend against trying an over-the-counter appliance that you may find on the internet. These can lead to problems that would only complicate your current condition, whatever it is.