Sleep Apnea—Snoring

Print This Page

Sleep Disordered Breathing (SDB)

SDB is a group of disorders that disrupts a person’s breathing during sleep, usually resulting in daytime sleepiness and a host of systemic health compli­cations. Snoring, Upper Airway Resistance Syndrome (UARS), and Obstructive Sleep Apnea (OSA) are all forms of SDB. While snoring is a very common phenomenon - roughly 90 mil­lion Americans snore - it is not normal and can be the first clue to diagnosing SDB. SDB is independent of age, sex and BMI.

Snoring is the sound of partially obstructed breathing during sleep. While snoring can be harmless, it can also be the sign of a more serious medical condition known as Obstructive Sleep Apnea (OSA).

Obstructive Sleep Apnea (OSA) is the most severe for of Sleep Disordered Breathing. Apnea means to stop breathing. OSA describes an effort to breath, but there is a physical obstruction of the airway causing apnea. OSA is a complete cessation of breathing lasting at least 10 seconds - and is diagnosed as mild, moderate or severe. When Obstructive Sleep Apnea occurs, the tongue and soft palate collapse onto the back of the throat and completely block the airway, which restricts the flow of oxygen.

Upper Airway Resistance Syndrome (UARS), is a condition that is midway between primary snoring and true obstructive sleep apnea. People with UARS suffer many of the symptoms of OSA but require special sleep testing techniques. 

Signs and Symptoms of OSA consist of:

• Snoring 

• Excessive daytime Sleepiness 

• Loud, disruptive snoring

• Irregular breathing during sleep (e.g. Gasping, Choking, Long pauses)

• Restless Sleep 

• Difficulty concentrating 

• Irritability

• Morning Headaches

• Dry Mouth and throat

• TMJ Symptoms

Obstructive Sleep Apnea (OSA) has been linked to:

• Hypertension

• Stroke 

• Heart attack

• Atherosclerosis

• Cardiovascular Disease

• Right and left congestive heart failure 

• Gastro-esophageal Reflux Disease (GERD)

• Cognitive Impairment

• Sexual dysfunction

• Type II Diabetes

• Obesity 

• Depression

• Injury/death due to automobile accident from excessive daytime sleepiness

In Children:

• Failure to Thrive

• Attention problems 

• Behavioral Issues

• Academic under performance

• ADD/ADHD and bed-wetting in children

Treatment Options:

Good sleep hygiene, weight loss, and exercise are some helpful OSA treatments a patient can practice on their own. However, medical and dental treatments include Oral Appliance Therapy, Continuous Positive Airway Pressure, and surgery.

Oral Appliance Therapy

Involves the selection, design, fitting and management of a custom designed oral appliance that is worn during sleep. This appliance then attempts to maintain an opened, unobstructed airway in the throat by Repositioning the lower jaw, tongue, soft palate and uvula, stabilizing the lower jaw and tongue and increasing the muscle tone of the tongue.

There are many different oral appliances available. Dr. Nehawandian is familiar with the various designs of appliances. She can determine which one is best suited for your specific needs. Effectively treating sleep apnea with an oral appliance can have the following benefits:

• Improved energy and decreased daytime sleepiness 

• Reduction in blood pressure

• Improved cognitive ability

• Elimination of machine and tubes associated with CPAP

• Easy to use and travel with 

Oral appliance therapy is indicated for:

• Patients with primary snoring or mild OSA who do not respond to, or are not appropriate candidates for treatment with behavioral measures such as weight loss or sleep-position change.

• Patients with moderate to severe OSA should have an initial trial of nasal CPAP, due to greater effectiveness with the use of oral appliances.

• Patients with moderate to severe OSA who are intolerant of or refuse treatment with nasal CPAP. Oral appliances are also indicated for patients who refuse treatment, or are not candidates for tonsillectomy and adenoidectomy, cranofacial operations, or tracheostomy. Back

Continuous Positive Airway Pressure (CPAP) is pressurized air generated from a bedside machine. The air is delivered through a tube, connected to a mask, covering the nose. The force of the pressurized air splints the airway open. The CPAP opens the airway like air into a balloon; when air is blown into the balloon, it opens and gets wider. This is exactly how CPAP clears the airway.

Surgical procedures are another treatment modality for OSA. An ENT specialist may evaluate you for other types of surgery, mainly the removal of the excess tissues in the throat. It may be necessary to remove tonsils and adenoids (especially in children), the uvula, or even parts of the soft palate and the throat. Back