APRIL 23, 2020
Tired of Being Tired?
Sleep, Breathe, and Live Better!
One of the first descriptions of an Obstructive Sleep Apnea (OSA) sufferer is attributed to the novelist Charles Dickens, who described ‘‘Joe’’ in The Posthumous Papers of the Pickwick Club, published in 1836. Joe was an excessively sleepy, obese boy who snored loudly and had possible right-sided heart failure that led to his being called ‘‘young dropsy’’.
OSA syndromes afflict various age groups. 17-20% of adults have OSA, 15 million Americans and 90% goes undiagnosed. OSA is reported to be more prevalent in middle-aged men (24%) compared with women (9%) in the United States between the ages of 30 and 60 years, but the real prevalence may be higher because OSA syndromes are underdiagnosed. These patients can also suffer from hypertension, cardiovascular disease, and Obesity-metabolic syndrome.
Daytime sleepiness is the most common complaint among patients with OSA. It can occur following meals, while sitting as a passenger in a car, watching television, attending a meeting or a lecture, eating, talking, or even while driving. Patients may notice difficulty with attention, concentration, memory, judgment, erectile dysfunction and impaired performance of tasks requiring dexterity.
Nocturnal symptoms in OSA are more specific than daytime symptoms. Loud snoring with short gasps alternating with episodes of silence lasting from 20 to 30 seconds occurs frequently. Spouses report apnea episodes terminated by gasps, choking sounds, snorts, vocalizations, or brief awakenings. Restlessness manifested as tossing and turning, probably caused by increased respiratory effort related to upper airway obstruction, has been described in about half of the patients. Other symptoms can be a sensation of choking interrupting sleep, esophageal reflux; dryness of the mouth, and drooling.
Physical examination findings in OSA include obesity (BMI >28 kg/m2),neck circumference greater than 40 cm regardless of gender, deviated septum; high and narrow hard palate; elongated low-lying uvula; redundant and low-lying soft palate; crowding of the airway with enlarged tonsils and adenoids; prominent tonsils; narrow arches; and dental malocclusion.
The severity of sleep apnea influences treatment for symptomatic OSA syndromes. CPAP therapy can be used for all categories of OSA and represents the first line of treatment for moderate to severe OSA. Compliance is the key to any OSA treatment. CPAP patients often complain of noise, partner intolerance, inconvenience, as well as: mask problems (leaking mask, mask rubbing, skin rash or abrasion, conjunctivitis); side effects (nasal congestion, sinus discomfort, claustrophobia, difficulty exhaling, and incomplete resolution of symptoms (frequent awakening, persistent fatigue or sleepiness).
For mild forms of OSA, nonsurgical options include:
- Weight loss;
- Avoidance of sleep deprivation, alcohol, nicotine, and sedatives;
- Body positional therapy (pillows to avoid sleeping in the supine position)
- Oral Dental Appliances
Oral appliances, also called dental appliances or devices are useful for mild OSA and for patients with moderate or severe OSA who are unable or unwilling to tolerate CPAP and who have failed surgery or are not surgical candidates. Oral appliances work by increasing airway space, providing a stable anterior position of the mandible, and advancing the tongue or soft palate. The American Academy of Sleep Medicine recommends dental devices for patients with mild-to-moderate obstructive sleep apnea who are not appropriate candidates for CPAP or who have not been helped by it. (CPAP should be used for patients with severe sleep apnea whenever possible.)
Dental devices seem to offer the following benefits:
- Significant reduction in apneas for those with mild-to-moderate apnea, mainly if patients sleep either on their backs or stomachs. They do not work as well if patients lie on their side. The devices may also improve airflow for some patients with severe apnea.
- Improvement in sleep in many patients.
- Improvement and reduction in the frequency of snoring and loudness of snoring in most (but not all) patients.
- Higher compliance rates than with CPAP.
- A trained dental professional such as a dentist can prescribe and fit these Mandibular advancement devices. These devices are the most widely used effective dental device for sleep apnea. It is similar in appearance to a sports mouth guard. Patients fitted with one of these devices should have a check-up early on to see if it is working; short-term success usually predicts long-term benefits. It may need to be adjusted or replaced periodically. Dental devices have shown better long-term control of sleep apnea when compared to uvulopalatopharyngoplasty (UPPP), the standard surgical treatment.
Now, to clear up a few misnomers:
- You do not have to be obese to have sleep apnea
- 50% of snorers have OSA, but 50% of OSA sufferers do NOT snore
- 90% of loud snorers have OSA
- The appliance will decrease/stop snoring even if OSA is not involved
- 15-20% of motor vehicle accidents worldwide are caused by excessive daytime sleepiness resulting from OSA
- The most severe consequence of OSA is to the heart (arterial hypertension, coronary heart disease, myocardial infarction, stroke)
- OSA causes death
- There is a 70% overlap with OSA and temporomandibular disorder
If you or someone you know fits the description we have given, then please take the time to have an evaluation! It could improve your quality of life or more importantly – save your life!
Dr. Wallace practices on Lady’s Island at Palmetto Smiles of Beaufort and can be contacted at 843-524-7645 or through her website @ www.palmettosmilesofbeaufort.com.