You have heard of the advertisements on the TV and radio for solutions to snoring. Everything from chin straps to adhesive strips you put across your nose at night. But what is sleep apnea and what really works?
Sleep Apnea is defined as a serious sleep disorder where you intermittently stop and start breathing during sleep. As we are oxygen breathing creatures, the slow and progressive destruction of the person by sleep apnea is akin to slowly killing ourselves. It is defined as the total cessation of breathing for 30 seconds or more.
Throughout our development our bodies have refined a mechanism where when faced with an extremely stressful situation, say a non-fatal car accident, the body goes into action to protect itself. Chemicals in the brain immediately go to work. The heart speeds up, breathing becomes rapid and shallow, stored sugars in the body are released immediately to give that extra energy needed for flight or fight. Non-urgent systems like the digestive tract come to a virtual stop. Immediately adrenaline and cortisol flood the system to create a state of increased awareness. All of this takes place in a microsecond.
Once the immediate danger has passed the body then goes back to its “normal” routine. The panic in the brain is over.
When we hold our breath there is no panic because we are controlling the situation. However, if we are choking on a piece of food, the panic in the brain jumps into action.
Sleep apnea is in many ways similar to chocking on a piece of food. The tongue falls to the back of the throat causing the choking off of air to the lungs and the entire cascade of reactions described above takes place. It may not be as immediate and apparent as the auto accident, but the effects are definitely the same.
Patients with a severe apnea may stop breathing from 30 – 50 times an hour. The duration may be from only seconds to over 2 minutes. I think most of us, unless well trained and conditioned, could not willfully hold our breath for 2 minutes. When breathing stops the stress hormone cortisol is released and we wake up, ready to defend whatever the stress is. This also promotes sugar stores to be released, and for diabetics, this can be serious.
Sleep apnea also causes oxidative stress on the body which creates inflammation in the blood vessels. This is particularly dangerous to the patients who may have active or latent cardiovascular problems, not to mention diabetics. Daytime sleepiness occurs because of the lack of good sleep at night as well as a significant risk for additional weight gains. The very system to protect us when we are in a stressful situation can also kill us when we are trying to sleep.
In the past few years, many effective methods of controlling sleep apnea have been designed so the body can make it through the night with no chocking, oxygen starvation or flight or fright events.
Determination of sleep apnea is best done by a proper sleep trained doctor. CPAPs are the gold standard which pushes oxygen into the lungs and comes in all sizes and shapes. Newer devices which use a Bluetooth connection are implanted in the back of the tongue and when the patient is asleep send a small current, which the patient does not feel, to the surrounding muscles and cause the tongue to move forward, opening up the airway. This eliminates the often bulky CPAP machines.
Sometimes patients cannot use the CPAP machines for many reasons and oral appliances which move the lower jaw forward enough to open the airway have the same effect as the CPAP machines. Dentists are best at making an oral appliance, and when working with well trained medical doctors can get the best results for the patient.
But we have not stated what causes sleep apnea. There are two primary causes of sleep apnea. Age and weight. Yes, there are other causes such as neurologic incompetency where there is a disruption of the signal from the brain to the lungs to breath, but these are not in the realm of the routine causes. As we get older the muscles of the throat become lax and when we sleep on our back they fall against the airway. When this happens the jaw falls back and air flow is reduced, or stopped. The fight or flight mechanism begins. In addition, the deposit of fatty tissue around the neck can contribute to the weight on the muscles, causing more pressure on the airway. If you recall in the CPR classes the ABC’s were Airway, Breathing, and Circulation. One of the best ways to open an airway is to move the jaw forward. This pulls the tongue forward and releases the obstructive pressure on the airway.
Some of the signs we as dentists look for when examining our patients include wear of the front teeth with no corresponding wear of the back teeth. This is because the body is trying to help itself at night and will move the lower jaw forward to open the airway. The teeth begin to wear down and flatten out. Another sign we look for is the size of the opening in the back of the mouth when the tongue is stuck out. This can range from a full view of the back of the throat to one where the back of the throat is obscured by the tongue. The more the back of the throat is obscured, the more there is a chance for sleep apnea to occur.
Snoring and sleep apnea can cause serious problems and even death. Fortunately, we are more attuned to these conditions and are able to treat them when they arise.
The enclosed are some questions we use to help determine which patients may be candidates for further investigation of sleep apnea. Feel free to take the test and share it with your dentist or primary care medical doctor.
- Sitting and reading
- Watching TV
- sitting inactive in a public place (e.g., a theater or a meeting)
- As a passenger in a car for an hour without a break
- Lying down in the afternoon to rest if circumstances permit
- Sitting and talking to someone
- Sitting quietly in a lunch without alcohol
- In a car while stopped for a few minutes for traffic
Answer each question with the following scale.
- 0 = I would never doze
- 1 = I have a slight chance of dozing
- 2 = I have a moderate chance of dozing
- 3 = I have a high chance of dozing
If there is a score of 7 or above, next time you see your dentist or medical doctor, talk to them about sleep apnea. It could save your life.