What is Snoring?

What is Obstructive Sleep Apnea (OSA)?

What is the relationship between snoring and sleep apnea?

What are some of the reasons why a person would have a higher tendency to have OSA?

What are the signs and symptoms of having Obstructive Sleep Apnea (OSA)?

What is the common denominator of all of these health problems?

How does someone find out if he has sleep apnea?

What is a Sleep Study?

What information do you get from a Sleep Study (PSG)?

What are my treatment options?

What is the Pharyngometer?

What should I do?

What is Snoring?

Sounds made during sleep caused by breathing vibrations in the pharynx (air way in the back of your throat).  In the diagnosis of obstructive sleep apnea, snoring volume and frequency of occurrence often correlate with the severity of the condition.

What is Obstructive Sleep Apnea (OSA)?

Repetitive cessation of breathing during sleep for 10 seconds or more due to complete closure of the throat.  Usually characterized by snoring, excessive daytime sleepiness and other symptoms of fatigue.

What is the relationship between snoring and sleep apnea?

The more severe the snoring the more severe the chances are of having sleep apnea.

What are some of the reasons why a person would have a higher tendency to have Obstructive Sleep Apnea?

Overweight

Jaw Position

Tongue Position

Oversized Tonsils or Adenoids

Collapsed Pharyngeal walls (back of throat)

What are the signs and symptoms of having Obstructive Sleep Apnea (OSA)?

Snoring (85%)

Fatigue

Impaired Concentration

Hypertension (High Blood Pressure) twice as common with OSA

Diabetes twice as common with OSA

Impotence

Depression

GERD (Gastroesophageal Reflux Disease or Heartburn)

Associated with Cardiac Arrhythmias

Alzheimer's disease

What is the common denominator of all of these health problems?

Oxygen deprivation -- the body needs to get more oxygen to its cells!!

How does someone find out if he has sleep apnea?

The most definitive approach is to do a “Sleep Study”.

What is a Sleep Study?

A Sleep Study or Polysomnogram (PSG) is a multiple-component test, which electronically transmits and records specific physical activities while you sleep. The recordings become data, which will be "read" or analyzed by a qualified physician to determine whether or not if you have a sleep disorder.  This is done in a sleep center.  Most centers today are made to be quite comfortable; actually often set up to look like a nice hotel room.  Sleep studies can also be done in your own home.  Many insurance companies do not reimburse for these however.

What information do you get from a Sleep Study (PSG)?

1.  An Electrocardiogram - This is done to see if there is a correlation between the apneic event and arrhythmia.

2.  Oxygen saturation- This is a measure of oxygen carried by hemoglobin in the blood.  Normal values range from 90% to 100%.

3.  Length of apneic episodes- Sometimes these episodes can be as long as 90 seconds. 

4.  Several other vital signs are taken but the common summary measure used to describe respiratory disturbances during sleep is the Apnea-Hypopnea Index or AHI.  This the total number of episodes of apnea and hypopnea during sleep divided by the hours of sleep time.  Apneas are episodes when breathing stops for 10 seconds or longer.  Hypopnea is a partial blockage of airflow resulting in an arousal and possible drop in oxygen level.  An AHI greater than 5 is diagnostic of OSA.

What are my treatment options?

1.  Preventive

a.  Get to optimum weight

b.  Decrease alcohol consumption

c.  Exercise

2.  CPAP

CPAP (Continuous Positive Airway Pressure) is a medical device used to treat sleep apnea.  Air pressure is delivered through a hose to a mask that fits over the nose, or both the nose and mouth.  The mask is secured on the face by a headgear that is worn over the head.  The appropriate air pressure level is determined during the sleep study.

Pros of this treatment.

      Very high success rate (nearly 100% of the time) when used (see below).

Cons of this treatment

After 1 year there is only about a 20% compliance rate.

Some of the reasons for the low compliance rate are:

Straps bother patient

Can't move around

Difficult, if not impossible, to sleep on side

Noise of the pump

Air leakage

Pressure on nose

Don't want to wear it around bed partner

Feeling of claustrophobia

Creates problems when traveling

3.  Surgery

What is commonly recommended most is a surgical procedure called a Uvulopalatopharyngoplasty UPPP. Essentially it is the removal of the uvula (the thing that hangs down in the back of your throat) along with a portion of the back of your soft palate, and the widening of the back of your throat.

Pros

Usually prescribed for the morbidly obese

Cons

      Can be painful, particularly during recovery

Relatively expensive

      Down time from surgery

      Effective for 2-6 months; efficacy declines after 1 year.

4.  Dental Appliances

A.  Mandibular Repositioning Appliance

Moves the mandible (lower jaw) forward.  Moving the jaw forward can help open the airway.  This appliance typically has some type of device to allow the dentist to adjust the lower jaw forward 2 to 3 times.

Pros

Can travel with it

Can sleep on side

Handles about 70% of cases

Averages about 40% reduction of AHI

Cons

Upper and lower appliance makes bulkiness an issue

Difficult to place in mouth

Limited adjustability- typically only 2 to 3 adjustments

Adjustment is to bring jaw forward and for many

May be difficult on the TMJ (jaw joint).

Lower success rate than Full Breath Appliance©

Less reduction of AHI than Full Breath Appliance

Increased likelihood of causing TMJ problems

B.  The Full Breath Appliance©.

Dr. Bryan Keropian practiced as a TMJ specialist for over twenty years.  He had a TMJ patient who also had severe sleep apnea.  She became very depressed and pretty much demanded Dr. Keropian to figure something out.  He explained that she, being a TMJ patient would not be able to handle a Mandibular Repositioning Appliance.  She became very insistent.  He to this day does not know why he did it, but he put two wires across the back of her TMJ dental appliance and sent her home to see if would help.  She called to say the wires were cutting her tongue.  He then realized, it really isn't about the bite, it is about the tongue.  The CPAP works because it forces air down the airway and literally forces the tongue forward.  So if we could keep the tongue forward with a dental appliance, then we could achieve the same effects of the CPAP.  He saw the patient and coated the wire with smooth plastic, and sent her home.  She called back the next day to say "Best night's sleep I've had in 10 years".  He then made more appliances on other patients and had similar results.  He got patent on the designs and obtained  F.D.A. approval in August of 2006.  Dr. Keropian has now made over 3000 appliances and has a 95% success rate.

Pros          

Can travel with it

Can sleep on side

Smaller, upper only appliance.

More comfortable

Handles about 95% of cases

More ability to adjust

75% reduction of AHI

Less likely to cause TMJ problems

FDA approved

Uses Pharyngometer with treatment

Cons

With the Mandibular Repositioning Appliance we could only make 2 to 3 adjustments.  It would be to move the jaw forward.  If that didn't work we would move the jaw forward again.  If that didn't work we would move the jaw forward again. If that didn't work we were done.  With the Full Breath Appliance©, we have many adjustments we can make to help stop snoring and sleep apnea.  So there may be more visits with a Full Breath Appliance©, but this is also why the success rate is higher.

What is the Pharyngometer?

It is a computer program and device developed at Harvard that is allows one to measure the Volume of Air by sending sonic waves into the mouth from the opening of the mouth to the back of the throat.  It also measures the Minimum Width of space in the mouth.  With this instrument we can actually monitor the improvement of space made with the appliance.  The computer system is invaluable in treatment of OSA with a dental appliance.

What should I do?

Our recommendation is that you contact Dr. West’s office to set up an initial interview and testing.