• What is Obstructive Sleep Apnea?

Are you tired, stressed out, and moody because of poor sleep?  Obstructive Sleep Apnea (OSA) is the most common sleep disorder affecting over 18 million people in the United States.  Sleep Apnea is characterized by loud or heavy snoring interrupted by the stopping of breathing for more than 10 seconds.  These incidences can happen many times per hour and hundreds of times in a night's sleep.  When breathing stops, the snoring stops until individual chokes and gasps for air.  They will awaken briefly, sometimes violently, interrupting their sleep patterns and in the morning will have no memories of these incidences.

Interruption of sleep patterns and reduced blood oxygen levels causes people OSA to have a higher association with high blood pressure, strokes, diabetes, and chronic daytime sleepiness.  It has been found that daytime sleepiness can be attributed to many auto accidents. 

Quality of Sleep

The quality of your sleep affects your daily activities and has a huge impact on the overall quality of your life.  If you are not getting an adequate amount of sleep during the night, then you and your body may suffer from sleep deprivation and be prone to daytime sleepiness. This may:

1. Affect your productivity and performance at work
2. Increase your risk for injury or illness
3. Cause strain in personal relationships
4. Be a  sign of a more serious health problem

Medically Related Problems Associated with Sleep Apnea

The sleep apnea cycle-falling asleep, jaw relaxing, airway collapsing, unconsciously awakening with a gasp, falling back asleep-can repeat itself multiple times in a minute in severe cases.  With a blocked air passage, one does not receive enough oxygen.  Both the awakenings and oxygen deprivation can then trigger other health problems.

Sleep Apnea can cause:

1. Chronic Sleepiness
2. Strokes
3. Heart Attack
4. Heartburn
5. Depression High Blood Pressure
6. Impotence

Diagnosis

How do you know if you have sleep disordered breathing (SDB)?  The only way to be sure is to have a sleep test performed by a qualified sleep physician in a sleep center.  Since Obstructive Sleep Apnea is a serious medical condition, it must be diagnosed by a physician.  Diagnosis is based on the results of an overnight sleep study called a Polysomnogram (PSG).  Other factors are patient evaluation and history. 

The Epworth Sleepiness Scale is used to determine the level of daytime sleepiness.  Are  you wondering if you should be evaluated for OSA?  Take the Epworth assesment to find out.

Epworth Sleepiness Scale

How likely are you to doze off or fall asleep in the following situations? Use the following scale to choose the most appropriate number or each situation.

• 0 = Would never doze
• 1 = Slight chance of dozing
• 2 = Moderate chance of dozing
• 3 = High chance of dozing

Situation	Chance of dozing
Sitting and Reading	__________
Watching TV	__________
Sitting inactive in a public place (i.e., in a theater)	__________
As a car passenger for an hour without a break	__________
Lying down to rest in the afternoon	__________
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 10 or more could mean you are not obtaining adequate sleep and should be evaluated for a sleep disorder.

Treatment Options

Good sleep hygiene, weight loss, and exercise are some helpful treatments a patient can practice on their own.  Medical and Dental treatments include:  Continuous Positive Airway Pressure (CPAP), Oral Appliance Therapy, and surgery.

Continuous Positive Airway Pressure (CPAP)

CPAP is pressurized air from a bedside machine.  The air is delivered through a tube that connects to a mask, covering the nose.  The pressure of the air forces and maintains the airway open while you sleep.  This is a very successful treatment option, however, many people find the masks very uncomfortable and cumbersome to wear.  The noise created by the machines can also cause difficulty sleeping for the patient and partner.  Also, people find that the machines are difficult to travel with.

Oral Appliance Therapy

Oral Appliance Therapy is indicated for patients with primary snoring or mild to moderate Sleep Apnea.  They are small devices that you wear while you sleep.  They are similar in size to an Orthodontic Retainer or Sports Mouthguard.  They are very comfortable, easy to wear, and easy to travel with.  These appliances can be used alone or in conjunction with other treatments.    Oral Appliances work by attempting to prevent the collapse of the tongue and soft tissues in the back of your throat, keeping your airway open to allow adequate air intake.  They work to reposition the lower jaw, tongue, soft palate, and uvula.  Oral Appliance Therapy involves selecting an appropriate design , and then custom fitting it to your teeth.

Surgery

Generally, surgery is indicated only when conservative therapies have been unsuccessful or intolerable.  It is necessary to work with an ENT in addition to a Sleep Physician to determine if surgery is indicated, and if so, what type.