Sleep Apnea

There are 3 different types of sleep apnea.  One is called Central Apnea(CA), where the brain will shut down the respiratory center causing the stoppage of breathing.  A second kind of apnea is called Obstructive Sleep Apnea(OSA) which occurs when the air way is closed off causing the cessation of breathing.  The third apnea is called Mixed referring to a combination of both CA and OSA. CA’s tend to less prevalent when compared to OSA.

OSA is when your airway becomes blocked or partially blocked while you’re asleep. It’s the result of the muscles of the throat relaxing to a point where they collapse and close off the air supply. Fortunately, your brain will wake you up to resume breathing.  Many times, you’ll be fully aroused and other times you will move from a deeper sleep to a lighter sleep without being awaken. This interruption of your sleep can make you susceptible to other health challenges.

CA is different from OSA. While OSA is a mechanical disorder where a part of your body collapses on itself to close up the airway, the body is still trying to be breath. There is still  movement in the intercostal muscles in the chest trying to take a breath. CA is characterized by a neurological condition in which the brain simply doesn’t send the proper signal to the chest muscles to breath.

OSA is measured using a scoring index called AHI. This stands for Apnea-Hypopnea-Index and is determined hourly . Apnea refers to the number of events of not breathing during the night. To qualify for an event, the cessation of breathing needs to be at least 10 seconds or longer. Hypopnea is the reduction of airflow but not to the point that one stops breathing. The definition of a hypopnea is 10 seconds or more of shallow breathing in which your airflow drops by at least 30% and the blood oxygen levels drop at least 3 to 4%. The AHI is divided into 3 levels, mild, moderate and severe. Mild is 5 to 15 events an hour while Moderate is 16 to 30 and Severe is anything greater than 30. If a person has a AHI score of 27 this means he or she will have either a apnea or hypopnea events totally 27 in a given hour. Imagine either waking up or going from a deep sleep to a lighter sleep 27 times and hour! If you have Sleep Apnea this is the challenge that you face every night.

Treatment of Sleep Apnea

There are two fundamental treatments of OSA.  Unfortunately OSA is considered a progressive disease process that can only be managed during the adult life of the patient. However, if a pediatric patient presents with OSA there are protocols to help these patients rid themselves of these problems for years to come.

The two commonly used adult treatments are:

1) Continuous Positive Airway Pressure(CPAP)  
2) Oral Appliance (OA)

What is a CPAP?

A CPAP is a device that is worn over the face that continuously pumps air into the nose to create a “hammock” or “pillow of air” in the back of the throat.  When a patient experiences an apnea event the continuous blowing of the air prevents the back part of the throat and tongue from collapsing, hence reducing the apnea events.  

What is a OA?

The OA is a dental device that is placed on the upper and lower teeth and is connected by some form of a strap or elastic.  The OA prevents the patients lower jaw from falling back during sleep which prevents the collapse of the airway.  

Our approach in making these devices is very much a different technique when compared to how other OA's are constructed. The primarily difference is the positioning of the upper and lower jaws.  Most dentists, constructing these appliances, will place the lower jaw anywhere from 60% to 100% protrusive from its normal position.  To put yourself in this position simply protrude your lower jaw out as much as you can.  when this distance is achieved then this would be a 100%. This position is held throughout the night.  Most patients wake up with the need to reposition their jaws back to the “normal” position by using an “aligner” that the dentist will construct.

Our Centre does not feel a need to place a patient in this protrusive position. The idea is to prevent the collapse or prevent the lower jaw from falling back during a persons sleep. Because the lower jaw is not protruded, the “aligner” is not needed. When using the OA it is our intent that the lower jaw to be kept in a physiologic, neutral position, maintaining an open airway which can help in having a quiet nights sleep.

Both devices have their merits and downfalls.  In order to understand what is best for you please don’t hesitate to reach out to our office.

What are the signs of Sleep Apnea?

The following symptoms can indicate the presence of sleep apnea. If you notice one or more of these, don’t hesitate to call our office.

•    Insomnia or difficulty sleeping
•    Loud snoring at night
•     Poor concentration and/or poor memory
•    Waking up at night short of breath
•    Snorting or choking sounds during the night (indicating a restart of breathing)
•    Headaches upon waking in the morning
•    Falling asleep unintentionally during the day
•    Extreme drowsiness throughout the day
•    Male impotence / erectile dysfunction

What are the risk factors of Sleep Apnea?

Obstructive sleep apnea is more common in males than females, and more common in older adults (40+) than younger adults and children. However, anyone — regardless of gender or age — can suffer from sleep apnea. Other risk factors include obesity, smoking, drinking, use of sedatives or tranquilizers, and family history. Apnea can be associated with people with heart disorders, neuromuscular disorders, strokes, or brain tumors.

Is Sleep Apnea dangerous?

Sleep apnea is considered a serious medical problem and if left untreated it can lead to high blood pressure, increasing the risk of heart failure and stroke, as well as blood sugar fluctuations. The ongoing state of sleepiness caused by sleep apnea can lead to problems at work or school, as well as danger when driving or operating heavy machinery.  Sleep apnea can also cause complications with medication or surgery; sedation by anesthesia can be risky, as can lying flat in bed after an operation. If you know or suspect you suffer from sleep apnea, contact us immediately for a comprehensive airway exam and testing.

You may reach us at (480)248-7788

Contact Us

TMJ & Sleep Therapy Centre-East Valley
9002 E Desert Cove Ave. # 101 Scottsdale, AZ 85260
Hours
Monday: by appointment only
Tuesday: 7:00am-3:30pm
Wednesday: 8:00am-5:00pm
Thursday: Online consults available
Friday: Closed
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