Patients

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Sleep Apnea and Snoring – Overview & Facts for Patients

Proper sleep, a healthy diet, and exercise are the foundation of your overall health. You probably realize that the quality of your sleep has a dramatic impact on your health, well-being and overall quality of life. Snoring and obstructive sleep apnea (OSA) disrupt your sleep and really increase your risk of severe health problems. Sleep apnea and snoring are types of Sleep Related Breathing Disorders (SRBD). You should also know that snoring is a common warning sign for obstructive sleep apnea that should never be ignored.

[1] Resolution 17H-2017 passed by the ADA House of Delegates at ADA 2017, https://www.ada.org/en/publications/ada-news/2017-archive/october/sleep-related-breathing-disorder-treatment-outlined-in-new-policy

Snoring

You or your bed partner recognize snoring as the often loud or harsh sound that can occur as you sleep. As you breathe the flow of air makes the tissues in the back of your throat vibrate. The sound usually occurs as you breathe in air. It can come through the nose, mouth or a combination of the two. It can occur during any stage of your sleep.

Did you know that about half of all people snore at some point in their lives? Snoring is more common in men, though many women snore. It appears to run in families and becomes more common as you get older. About 40 percent of adult men and 24 percent of adult women are habitual snorers. Men become less likely to snore after the age of 70.

Sleeping on your back may make you more likely to snore. It may also occur as your throat muscles relax from use of alcohol or other depressants. Congestion from a cold or allergies can also cause you to snore.

Of course, snoring can be a real nuisance to your partner and anyone else nearby. You may even snore loudly enough to wake yourself up! Though, in many cases people do not realize that they snore. Snoring can also cause you to have a dry mouth or sore or irritated throat when you wake up.

Light snoring may not disrupt your overall sleep quality. However, heavy snoring may be associated with obstructive sleep apnea, a risk factor for heart disease, stroke, diabetes and many other health problems. Not everyone that snores has sleep apnea and not everyone that has sleep apnea snores. However, snoring is a warning sign and you should have your dentist or physician examine you. Your doctor may determine a asleep test is appropriate. Your dentist is an expert in the airway and can create an oral appliance that may alleviate the snoring.

Obstructive Sleep Apnea (OSA)

Obstructive sleep apnea is a common and serious sleep disorder that causes you to stop breathing during sleep. Sleep apnea affects a staggering number of Americans: 1 in 5 adults has mild OSA (obstructive sleep apnea) and 1 in 15 has moderate to severe OSA. Possibly 60 million Americans could be living with undiagnosed OSA and not even know it.

With OSA, the airway repeatedly becomes blocked, limiting the amount of air that reaches your lungs. A temporary pause in breathing is called an apnea. When this happens, you may snore loudly or making choking noises as you try to breathe. Your brain and body become oxygen deprived and you may wake up. This may happen a few times a night, or in more severe cases, several hundred times a night.The muscles of the upper airway relax when you fall asleep. If you sleep on your back, gravity can cause the tongue to fall back. This narrows the airway, which reduces the amount of air that can reach your lungs, and the narrowed airway also may cause snoring.

Sleep apnea can make you wake up in the morning feeling tired or unrefreshed even though you have had a full night of sleep. During the day, you may feel fatigued, have difficulty concentrating or you may even unintentionally fall asleep. This is because your body is waking up numerous times throughout the night, even though you might not be conscious of each awakening.
The lack of oxygen your body receives can have negative long-term consequences for your health.

This includes:

High blood pressure
Heart disease
Stroke
Pre-diabetes and diabetes
Depression

[1] Peppard PE, Young T, Barnet JH, Palta M, Hagen EW, Hla KM., Am J Epidemiol. 2013 May 1;177(9):1006-14. doi: 10.1093/aje/kws342. Epub 2013 Apr 14

Risk Factors

The biggest risk factor for sleep apnea is excess body weight. You are much more likely to have OSA if you are overweight or obese, though it can occur in slim people too. According to the American Academy of Sleep Medicine common risk factors include:

Excess weight – Your risk for sleep apnea is higher if you are overweight with a body mass index (BMI) of 25 or more or obese with a BMI of 30 or higher.
Large neck size – Your risk for sleep apnea is higher if you have a neck size of 17 inches or more for men, or 16 inches or more for women. A large neck has more soft tissue that can block your airway during sleep.
Middle age – Sleep apnea can occur at any age. However, it is more common between young adulthood and middle age.
Male gender – Sleep apnea is more common in men than in women. For women the risk of sleep apnea increases with menopause.
Hypertension – High blood pressure is extremely common in people who have sleep apnea.
Family history – Sleep apnea is a heritable condition. This means that you have a higher risk of sleep apnea if a family member also has it. Inherited traits that increase the risk for sleep apnea include obesity and physical features such as a recessed jaw. Other common family factors – such as physical activity and eating habits – also may play a role.

Treating Snoring and Obstructive Sleep Apnea

Depending on the severity of your snoring and other symptoms, your doctor may want to conduct a sleep study. Sleep studies may sometimes be done at home. To treat your snoring, your doctor likely will first recommend lifestyle changes, such as:

Losing weight
Avoiding alcohol close to bedtime
Treating nasal congestion
Avoiding sleep deprivation
Avoiding sleeping on your back

Dentists are experts in your oral cavity and airway. Across the country, many dentists are prepared to provide oral appliance therapy (link to OA below) to treat snoring. Rest Assured Technologies has a proven screening tool dentists use to determine if you are at risk for OSA. You should talk to your doctor and dentist about your treatment options.

Generally speaking, there are three ways to treat obstructive sleep apnea (OSA), and sometimes they are used to treat snoring also. These treatment options vary in their invasiveness and effect.

Surgery

Surgical treatment options correspond with the most severe cases of sleep apnea and address specific anatomic issues. Surgery is typically a last resort for several reasons:

Prohibitive cost
Any surgery carries risk & can lead to a painful recovery lasting 2-3 weeks
May require time off of work
Not guaranteed to cure sleep apnea (about 25 to 30% success rate)

CPAP

The most common treatment for sleep apnea is continuous positive airway pressure (CPAP) therapy. The CPAP machine keeps your airway open by providing forced air through flexible tubing and a required mask as you sleep. Although CPAP therapy is effective, it is expensive and some people are unable to adhere to it. In fact, it’s estimated that only 17% of CPAP users wear the device more than 4 hours per night.

Expense of cumbersome mask & machine
Ongoing CPAP maintenance (cleaning) & parts
Low compliance rate
May disturb bed partner
Often more intensive treatment than required

In-home sleep testing
Lower cost than CPAP & Surgery
High compliance rate
Ongoing treatment can be provided with regular cleanings

Oral Appliance Therapy

Custom oral appliances prescribed by a physician and created by a trained dentist are an FDA approved treatment for mild to moderate OSA and an alternate treatment for CPAP-intolerant or non-compliant cases. Dentists pioneered the use of oral appliance therapy for the treatment of obstructive sleep apnea and snoring. Many find that oral appliances are preferable compared to CPAP, with use rates objectively measured at 83%. Oral appliances have been shown to be as effective as CPAP on many real-world measures like daytime sleepiness, cognitive performance and high blood pressure. Many people like an oral appliance because it is comfortable, quiet, portable and easy to wear.

Even with these issues, CPAP therapy is considered the “gold standard” for treating OSA by most medical doctors and insurance companies. Unfortunately, this is because many PCPs are not familiar with the success of oral appliance therapy. Your doctor should consider giving you a prescription for a sleep apnea appliance if you are unable to tolerate CPAP therapy or prefer an alternate treatment.

[3] The objective mean use rate was 6.4 +- 1.7 h/night at 1 year follow-up in continuing users, with a regular use rate of 83%. Dieltjens M, et al. Chest. 2013 Nov;144(5):1495-1502. doi: 10.1378/Chest.13-0613.

[4] Comparable effectiveness of OAm and CPAP has been attributed to higher reported nightly use of OAm. Sutherland K, et al., Oral Appliance Treatment for Obstructive Sleep Apnea: An Update. J Clin Sleep Med. 2014 Feb 15; 10(2): 215–227