Obstructive sleep apnea, also known as OSA, is a serious sleep disorder in which the person actually stops breathing for at least 10 seconds each hour during sleep and wakes up gasping for air. It is caused by relaxation of the throat muscles and the soft tissue in the back of the throat collapses and closes, resulting in blocked airways. Severe sufferes experience hundreds of blockages per night. The patient will wake up choking and it is a very serious and prevalent health problem within our society.
Is Obstructive Sleep Apnea Dangerous?
Obstructive sleep apnea increases the risk of heart failure by 140%, the risk of stroke by 60%, and the risk of coronary heart disease by 30%. OSA affects more than 18 million Americans and is it more common than asthma and adult diabetes. Adults make up most of the sufferers, with nearly 20 % of adult males and 9 % of adult females afflicted with some form of the disease at some time in their lives. Sleep apnea puts a tremendous strain on the cardiovascular system due to oxygen desaturation, heart-rate and blood-pressure spikes that are caused by interrupted breathing. For this reason and others, sleep apnea is strongly correlated with high blood pressure, heart disease, heart attacks, and strokes. It is important to treat your OSA so that life threatening cardiovascular events do not occur.
Do I have Obstructive Sleep Apnea?
Approximately 80% of people with Obstructive Sleep Apnea are still undiagnosed which can be a fatal disease. This is primarily due to the circulation of unsaturated blood during the night, which can cause cardiopulmonary changes, congestive heart failure, and strokes. Daytime sleepiness can also lead to more motor vehicle accidents. You may suspect that you or your partner to have sleep apnea if you have any of the following symptoms
Common sleep apnea symptoms in adults include:
Waking up with a very sore or dry throat
Occasionally waking up with a choking or gasping sensation
Sleepiness or lack of energy during the day
Sleepiness while driving
Forgetfulness, mood changes, and a decreased interest in sex
Recurrent awakenings or insomnia
Talk to your doctor if you notice any of these problems to obtain a polysomnography or sleep test. Dr. Cheng and Dr. Sodeifi can also refer you to sleep center to obtain a polysomnography. A polysomnography is a comprehensive recording of the biophysiological changes that occur during sleep. It is usually performed at night,so that you will be sleeping during the procedure. During your sleep a polysomnogram is generated which will typically record a minimum of 12 channels requiring a minimum of 22 wire attachments to the patient. There is a minimum of three channels for the EEG, one or two measure airflow, one or two are for chin muscle tone, one or more for leg movements, two for eye movements (EOG), one or two for heart rate and rhythm, one for oxygen saturation and one each for the belts which measure chest wall movement and upper abdominal wall movement.
To address the complexity of obstructive sleep apnea there are multiple modes of treatment conducted by both medical and dental professionals. These include less invasive modes of treatment such as oral appliances and continuous positive airway pressure (CPAP) as well as more invasive forms of treatment involving skeletal and soft tissue surgery.
Oral Appliance versus CPAP
A custom made oral appliance is an effective life changing treatment option for snoring and obstructive sleep apnea (OSA) which can improve your sleep, restore your alertness and revitalize your health. Worn only during sleep, an oral appliance fits like a sports mouth guard or an orthodontic retainer. It supports the jaw in a forward position to help maintain an open upper airway.
Custom-made oral appliances that advance the mandible are emerging as an ideal treatment option particularly for mild to moderate OSA. Although CPAP is the most definitive medical therapy for OSA, many patients have difficulties wearing CPAP. The CPAP machine supplies a constant and steady air pressure to keep the airways open through a hose and a mask or nose piece.
CPAP has a cumbersome mask connected to a loud machine and has to be worn every night to be effective. However, it is not well tolerated by most patient due to social unacceptability, interference with intimacy, claustrophobia, delayed sleep onset, inconvenient for travel, restriction of sleep position and interference with TV or Reading.
The Oral Appliance
There are currently over 100 types of oral appliances on the market that are FDA approved. Your initial consult with Dr. Amanda Cheng will include an initial assessment of your airway and breathing patterns as well as the severity of your sleep apnea. The purpose of most oral appliances is to prevent your airway from collapsing by either holding the tongue or supporting the jaw in a forward position. Depending on your jaw structure, Dr. Cheng will take 3D scan of your bite to create a customized device that is comfortable and will effectively hold your jaw in the correct position to allow you to continue to breathe while you sleep. The oral appliance is small, removable and portable and is very similar to a retainer or night guard.
It is important for Dr. Cheng to assess how the patient breathe because many people have nasal obstructions due to polyps and seasonal allergies so they need an oral appliance designed to allow oral breathing. One of such device is the Oventus O2Vent which is unique in it’s ability to incorporate an airway to bypass nasal, soft palate and tongue obstructions, allowing the patient to breathe much better when they sleep. The O2Vent is a 3D printed titanium mandibular (jaw) advancement device that is custom fitted to the patient’s mouth. Made from one of the strongest and lightest metals in the world, titanium, the device only weighs 0.5 ounces or 15 grams and is weightless in both your mouth and your luggage.
Another great device is the The SomnoDent Fusion which has wing and screw calibration technology. The calibration allows more adjustments and specific titration for your jaw to be in a comfortable position through out the night. It is also less bulky and well tolerated by patients.
Treating snoring or obstructive sleep apnea with oral appliance therapy can help you feel like a new person. You will find that your tiredness and your quality of life, can improve dramatically when you start using your customized oral appliance. It is likely that you will sleep better, have more energy and feel sharper throughout the day. Having an oral appliance can be the best way to biohack your sleep and improve your health tremendously.
Skeletal Surgery to Treat Sleep Apnea
Due to anatomical variations, a small percentage of the population will not be suitable for treatment with CPAP or the O2Vent. In these cases, Dr. Sodeifi has many years of experience in surgically moving the the upper jaw (maxilla) and lower jaw (mandible) forward to permanently enlarge the airway to most effectively treat obstructive sleep apnea. It is performed on patients with moderate to severe obstructive sleep apnea when other procedures have failed. This procedure is usually performed on adults in a hospital surgery center under general anesthesia.
In children, Dr. Cheng uses rapid palatel expansion as the main treatment procedure to enlarge the maxillary or upper dental arch. By widening the maxilla when the skeleton has not fused, the nasal cavity that exists above palate can be expanded which will allow air to flow more easily for breathing. This will reduce sleep apnea in children and prevent other health problems from developing. It is important to note that obstructive sleep apnea affects up to 10% of children.
Symptoms of obstructive sleep apnea in children may consist of restless sleep, sweating during sleep, snoring, night terror, sleepwalking, bed wetting, daytime fatigue, hyperactive behavior similar to ADHD and poor school performance due to an inability to concentrate
How would your rather sleep?
Continuous positive airway pressure forces air through nose and mouth to open airway
Customized oral appliance shifts the jaw slightly forward to open the airway
Soft Tissue Surgery to Treat Sleep Apnea
In the medical community, CPAP and surgical correction of the soft tissue has been the main methods of treatment. However, evidence has shown that any improvement gained from soft tissue surgery is not lsasting and has only a limited improvement. Excessive soft palate tissue frequently causes airway obstruction leading to obstructive sleep apnea and this is most commonly treated with a uvulopalatopharyngoplasty.
This procedure removes tissue from the palate and/or the back of the throat to increase airway size. However, there are potential significant complications associated with uvulopalatopharyngoplasty, such as foreign body sensation — a feeling that something is in the back of the throat while swallowing — and velopharyngeal insufficiency — liquids or food escape into the nose while drinking or eating. Post-operative pain can be significant, especially when combined with a tonsillectomy.
Bleeding represents another potential but uncommon complication. The last resort procedure is a tracheotomy, which bypasses the pharyngeal airway and is thus 100% effective. Of course it is a rather extreme procedure and not generally recommended. The primary treatment for obstructive sleep apnea in children is adenoidectomy and tonsillectomy. Occasionally, turbinate reduction by radiofrequency may be performed in conjunction to enlarge the nasal airway. In general soft tissue surgeries is that they are not as effective or as long lasting when compared to skeletal surgery or oral appliances.
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