Snoring and Sleep Apnea
If you snore loudly, you know of the social implications of your problem. It's bad enough
when your spouse can't sleep in the same room with you, but when your travel
companions stop inviting you places because they can't get a decent night's sleep, it may
be time for you to do something about it.
Snoring is no laughing matter. It is a signal that something is wrong with your breathing
during sleep. It means that the airway is not fully open and the noise you make comes
from efforts to force air through the narrowed passageways.
For many people who snore the problem has no significant medical consequences.
However, for others snoring is the first sign of a potentially life threatening disorder called
Obstructive Sleep Apnea.
What causes snoring?
During sleep, the muscles and soft tissues in the throat and mouth relax making the
breathing airway smaller. This decrease in space increases the velocity of air flowing
through the airway during a breathing cycle. As the velocity increases in the constricted
space, the soft tissues vibrate producing the classic snoring sound.
What is Obstructive Sleep Apnea?
An apnea episode is defined as the absence of breath for 10 seconds or more. Someone
is considered to suffer from Obstructive Sleep Apnea if they stop breathing like this for 5 or
more times an hour while sleeping. In severe cases of Obstructive Sleep Apnea a patient
can suffer from 30 or more apnea events per hour.
When these interruptions of breathing occur, oxygen in the blood drops causing your blood
pressure to rise and your heart to work harder. It also disrupts normal sleep cycles
causing you to suffer from excessive daytime sleepiness (EDS). That is why some people
are chronically tired or sleepy even after "sleeping" for 7 to 8 hours. Over time, these
episodes of apnea can be associated with high blood pressure and other cardiovascular
diseases, risk for heart attack, risk for stroke, pulmonary hypertension, migraine
headaches, hyperactivity in children, memory problems, depression and anxiety, job
impairment, and motor vehicle crashes. Bottom line is that Obstructive Sleep Apnea is an
extremely serious sleep disorder that can decrease quality of life and significantly
decrease life expectancy.
How do I know if I suffer from Obstructive Sleep Apnea?
The only way to know if you have OSA is to be seen by a sleep specialist and be tested.
These tests can be performed at a sleep center or at your home and will provide the
necessary information to make a diagnosis.
The following screening questions are a good start to determine if you need to be
evaluated by a sleep specialist:
- Do you snore?
- Do you have high blood pressure?
- Has anyone reported that you choke or gasp for air while sleeping?
- What is your neck size? (>17 for men or >15 for women is a concern)
- Do you wake refreshed?
- Are you excessively tired during the day?
Dr. Yanell is not a sleep specialist and therefore cannot make a medical diagnosis of OSA.
He does however work in close collaboration with multiple sleep disorder centers in the
area and can help you get in contact with the proper medical professionals.
Treatment options for Obstructive Sleep Apnea
CPAP - A CPAP is a medical device that delivers continuous positive air pressure through
a face mask or nasal tube attached to a pump. It is the gold standard of treatment due to
the fact that if tolerated it is the most effective treatment of OSA. Unfortunately,
approximately 50% of people who need CPAP are unable or unwilling to tolerate it and are
therefore required to seek alternative therapy.
Surgical Procedures - Over the years several surgical procedures have been used to
address snoring and sleep apnea. These surgeries can be to the soft palate, uvula, and
tongue to eliminate the tissue that collapses during sleep. Many of these procedures have
not had a high level of success and have therefore decreased in popularity. More complex
surgery can reposition the bones of the mouth and face in order to permanently increase
the size of the upper airway. This surgery called MMA (maxillomandibular advancement)
has proven to be extremely successful in treating OSA for those who qualify for it. As with
all surgeries, there is always a risk of complications.
Oral Appliance Therapy (OAT) - OAT is often a viable alternative to CPAP therapy. A
specially designed oral appliance repositions the jaw and tongue in a forward position
which keeps the airway from collapsing. Dentists who are trained in dental sleep
medicine are qualified to fabricate oral appliances.
More information about Oral Appliance Therapy (OAT)
There are many dental appliances that either hold the tongue or lower jaw in a forward
position. With your tongue or lower jaw in a forward position, the airway stays open and
prevents soft tissue vibrations which cause snoring.
Dental appliances have also been proven effective in treating cases of mild to moderate
Obstructive Sleep Apnea. In February 2006 the American Academy of Sleep Medicine
stated that oral appliances are the first treatment option for patients who are diagnosed
with mild or moderate Obstructive Sleep Apnea. It also stated that: "Oral appliances are
indicated for use in patients with mild to moderate OSA who prefer them to CPAP therapy,
or who do not respond to, are not appropriate candidates for, or who fail treatment
attempts with CPAP."
Since dental appliances are made to fit your teeth with a high level of precision, all
necessary dental work should be performed prior to fabricating the appliance.
What is your next step?
If you snore and are interested in Oral Appliance Therapy you need to call and make an
appointment to be screened. Dr. Yanell will not make an appliance for someone who
snores until they have been screened and tested for Obstructive Sleep Apnea.
If you have been diagnosed with Obstructive Sleep Apnea and you either don't want or
cannot tolerate CPAP, Dr. Yanell will work with your physician in order for you to receive
any medical benefits that are applicable.
_______________________________________________________________________
Children and Sleep Apnea
Does your child snore? 20% do and it is not normal. Of those that do snore 2-3% suffer
from sleep apnea. If your child has any of the following symptoms they should be seen by
an ENT or sleep specialist.
Continuous loud snoring
Episodes of not breathing at night
Failure to thrive (weight loss or poor weight gain)
Chronic mouth breathing
Enlarged tonsils and adenoids (with frequent sore throat infections)
Bed wetting and restless sleep
Excessive daytime sleepiness
Frequent headaches
Behavior problems, including problems paying attention, aggressive behavior, ADHD, and
hyperactivity.
_______________________________________________________________________
Take the Epworth Sleepiness Test to see if you have Excessive Daytime
Sleepiness (EDS)
Use the following scale to choose the most appropriate number for each situation:
0 = Would never doze
1 = Slight chance of dozing
2 = Moderate chance of dozing
3 = High chance of dozing
Situation
* Sitting and reading
* Watching TV
* Sitting, inactive in a public place (e.g. theatre, meeting)
* As a passenger in a car for an hour without a break
* Lying down to rest in the afternoon when circumstances permit
* Sitting and talking to someone
* Sitting quietly after lunch without alcohol
* In a car, while stopped for a few minutes in traffic
TOTAL SCORE.....................
(A score of 9 or more may warrant further testing)
Facts about snoring and sleep apnea:
* An estimated 30 million - or one in eight - Americans snore.
* Individuals who snore have a high likelihood of having (or developing) obstructive sleep
apnea.
* Approximately 18 million Americans suffer from sleep apnea.
* Some 28 percent of men over the age of 65 suffer from sleep apnea.
* Up to 50 percent of sleep apnea patients have high blood pressure.
* Risk for heart attack and stroke also may increase among those who have sleep apnea.
* Nearly 60 percent of Americans suffer from daytime sleepiness, a side effect of sleep
apnea.
* Snoring and mild-moderate apnea is improved and often eliminated in many patients
who use oral appliances.
* Each year, sleep disorders add an estimated $15.9 billion to the national heath care bill.
Sources: American Academy of Sleep Medicine, American Sleep Apnea Association and
the National Sleep Foundation
If you snore loudly, you know of the social implications of your problem. It's bad enough
when your spouse can't sleep in the same room with you, but when your travel
companions stop inviting you places because they can't get a decent night's sleep, it may
be time for you to do something about it.
Snoring is no laughing matter. It is a signal that something is wrong with your breathing
during sleep. It means that the airway is not fully open and the noise you make comes
from efforts to force air through the narrowed passageways.
For many people who snore the problem has no significant medical consequences.
However, for others snoring is the first sign of a potentially life threatening disorder called
Obstructive Sleep Apnea.
What causes snoring?
During sleep, the muscles and soft tissues in the throat and mouth relax making the
breathing airway smaller. This decrease in space increases the velocity of air flowing
through the airway during a breathing cycle. As the velocity increases in the constricted
space, the soft tissues vibrate producing the classic snoring sound.
What is Obstructive Sleep Apnea?
An apnea episode is defined as the absence of breath for 10 seconds or more. Someone
is considered to suffer from Obstructive Sleep Apnea if they stop breathing like this for 5 or
more times an hour while sleeping. In severe cases of Obstructive Sleep Apnea a patient
can suffer from 30 or more apnea events per hour.
When these interruptions of breathing occur, oxygen in the blood drops causing your blood
pressure to rise and your heart to work harder. It also disrupts normal sleep cycles
causing you to suffer from excessive daytime sleepiness (EDS). That is why some people
are chronically tired or sleepy even after "sleeping" for 7 to 8 hours. Over time, these
episodes of apnea can be associated with high blood pressure and other cardiovascular
diseases, risk for heart attack, risk for stroke, pulmonary hypertension, migraine
headaches, hyperactivity in children, memory problems, depression and anxiety, job
impairment, and motor vehicle crashes. Bottom line is that Obstructive Sleep Apnea is an
extremely serious sleep disorder that can decrease quality of life and significantly
decrease life expectancy.
How do I know if I suffer from Obstructive Sleep Apnea?
The only way to know if you have OSA is to be seen by a sleep specialist and be tested.
These tests can be performed at a sleep center or at your home and will provide the
necessary information to make a diagnosis.
The following screening questions are a good start to determine if you need to be
evaluated by a sleep specialist:
- Do you snore?
- Do you have high blood pressure?
- Has anyone reported that you choke or gasp for air while sleeping?
- What is your neck size? (>17 for men or >15 for women is a concern)
- Do you wake refreshed?
- Are you excessively tired during the day?
Dr. Yanell is not a sleep specialist and therefore cannot make a medical diagnosis of OSA.
He does however work in close collaboration with multiple sleep disorder centers in the
area and can help you get in contact with the proper medical professionals.
Treatment options for Obstructive Sleep Apnea
CPAP - A CPAP is a medical device that delivers continuous positive air pressure through
a face mask or nasal tube attached to a pump. It is the gold standard of treatment due to
the fact that if tolerated it is the most effective treatment of OSA. Unfortunately,
approximately 50% of people who need CPAP are unable or unwilling to tolerate it and are
therefore required to seek alternative therapy.
Surgical Procedures - Over the years several surgical procedures have been used to
address snoring and sleep apnea. These surgeries can be to the soft palate, uvula, and
tongue to eliminate the tissue that collapses during sleep. Many of these procedures have
not had a high level of success and have therefore decreased in popularity. More complex
surgery can reposition the bones of the mouth and face in order to permanently increase
the size of the upper airway. This surgery called MMA (maxillomandibular advancement)
has proven to be extremely successful in treating OSA for those who qualify for it. As with
all surgeries, there is always a risk of complications.
Oral Appliance Therapy (OAT) - OAT is often a viable alternative to CPAP therapy. A
specially designed oral appliance repositions the jaw and tongue in a forward position
which keeps the airway from collapsing. Dentists who are trained in dental sleep
medicine are qualified to fabricate oral appliances.
More information about Oral Appliance Therapy (OAT)
There are many dental appliances that either hold the tongue or lower jaw in a forward
position. With your tongue or lower jaw in a forward position, the airway stays open and
prevents soft tissue vibrations which cause snoring.
Dental appliances have also been proven effective in treating cases of mild to moderate
Obstructive Sleep Apnea. In February 2006 the American Academy of Sleep Medicine
stated that oral appliances are the first treatment option for patients who are diagnosed
with mild or moderate Obstructive Sleep Apnea. It also stated that: "Oral appliances are
indicated for use in patients with mild to moderate OSA who prefer them to CPAP therapy,
or who do not respond to, are not appropriate candidates for, or who fail treatment
attempts with CPAP."
Since dental appliances are made to fit your teeth with a high level of precision, all
necessary dental work should be performed prior to fabricating the appliance.
What is your next step?
If you snore and are interested in Oral Appliance Therapy you need to call and make an
appointment to be screened. Dr. Yanell will not make an appliance for someone who
snores until they have been screened and tested for Obstructive Sleep Apnea.
If you have been diagnosed with Obstructive Sleep Apnea and you either don't want or
cannot tolerate CPAP, Dr. Yanell will work with your physician in order for you to receive
any medical benefits that are applicable.
_______________________________________________________________________
Children and Sleep Apnea
Does your child snore? 20% do and it is not normal. Of those that do snore 2-3% suffer
from sleep apnea. If your child has any of the following symptoms they should be seen by
an ENT or sleep specialist.
Continuous loud snoring
Episodes of not breathing at night
Failure to thrive (weight loss or poor weight gain)
Chronic mouth breathing
Enlarged tonsils and adenoids (with frequent sore throat infections)
Bed wetting and restless sleep
Excessive daytime sleepiness
Frequent headaches
Behavior problems, including problems paying attention, aggressive behavior, ADHD, and
hyperactivity.
_______________________________________________________________________
Take the Epworth Sleepiness Test to see if you have Excessive Daytime
Sleepiness (EDS)
Use the following scale to choose the most appropriate number for each situation:
0 = Would never doze
1 = Slight chance of dozing
2 = Moderate chance of dozing
3 = High chance of dozing
Situation
* Sitting and reading
* Watching TV
* Sitting, inactive in a public place (e.g. theatre, meeting)
* As a passenger in a car for an hour without a break
* Lying down to rest in the afternoon when circumstances permit
* Sitting and talking to someone
* Sitting quietly after lunch without alcohol
* In a car, while stopped for a few minutes in traffic
TOTAL SCORE.....................
(A score of 9 or more may warrant further testing)
Facts about snoring and sleep apnea:
* An estimated 30 million - or one in eight - Americans snore.
* Individuals who snore have a high likelihood of having (or developing) obstructive sleep
apnea.
* Approximately 18 million Americans suffer from sleep apnea.
* Some 28 percent of men over the age of 65 suffer from sleep apnea.
* Up to 50 percent of sleep apnea patients have high blood pressure.
* Risk for heart attack and stroke also may increase among those who have sleep apnea.
* Nearly 60 percent of Americans suffer from daytime sleepiness, a side effect of sleep
apnea.
* Snoring and mild-moderate apnea is improved and often eliminated in many patients
who use oral appliances.
* Each year, sleep disorders add an estimated $15.9 billion to the national heath care bill.
Sources: American Academy of Sleep Medicine, American Sleep Apnea Association and
the National Sleep Foundation
Snoring and obstructive sleep
apnea (OSA) have been linked
to increased risks of high
blood pressure, stroke,
coronary artery disease,
diabetes, automobile
accidents and injury in the
workplace. Snoring and OSA
also effects quality of life
issues such as annoying the
sleep partner, excessive
daytime sleepiness and
reduction in thought
processes of mental functions.
apnea (OSA) have been linked
to increased risks of high
blood pressure, stroke,
coronary artery disease,
diabetes, automobile
accidents and injury in the
workplace. Snoring and OSA
also effects quality of life
issues such as annoying the
sleep partner, excessive
daytime sleepiness and
reduction in thought
processes of mental functions.
| 203-838-2003 |
| Donald D. Yanell, DDS |
Snoring and Obstructive Sleep Apnea
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| Video of Patient experiencing an Apnea Event |