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Sleep Disordered Breathing

 

What is Sleep Disordered Breathing?

Did you know you spend one-third of your life asleep? Yes, it's true, which means the quality of your sleep has a very real impact on the quality of your life.

Sleep Disordered Breathing (SDB) comprises two key areas:

  1. Snoring
  2. Obstructive Sleep Apnea

SDB affects more than 40 percent of the population, with that percentage increasing for people over the age of 50. Fortunately, Sleep Disordered Breathing can be treated with a variety of dentist-prescribed anti-snoring devices.

Quality of sleep and sleep medicine are two relatively new areas within medicine, with growing awareness of the serious health consequences associated with snoring. With the ability to now diagnose and treat sleep-related conditions, many people are experiencing a greatly enhanced quality of life.

Dentists and physicians will meet many people with SDB. These patients could have chronic medical conditions, which are in part related to sleep disorders. Therefore, each patient should be screened and issued practical advice for the treatment of their individual sleep disorder.

What causes snoring?

Apnea is Greek for "without breath," where the tongue is completely sucked against the back of the throat and blocks breathing.

Snoring is caused by a narrowing of the upper airway during sleep. This can be due to large tonsils, a long uvula (the small piece of soft tissue that dangles from the soft palate over the back of the tongue) or excessive flabby tissue in the throat. All of these areas relax during sleep.

In other cases, nasal congestion from allergies or deformities of the cartilage between the two sides of the nose can contribute to narrowing of the airway.

However, the most common cause of narrowing of the upper airway is a tongue muscle that becomes too relaxed during sleep. When relaxed, the muscle is sucked into the back of the throat with each breath taken.

Snoring occurs when air travels faster through a narrow tube than through a broad one. This rapidly moving air causes the relaxed soft tissues of the throat to vibrate. It is this vibration that creates the sound of snoring.

By keeping the airway open, air travels more slowly, reducing throat vibrations and thus reducing or stopping snoring. One of the most effective ways to keep the airway open during sleep is by holding the tongue forward.

Common causes of snoring & sleep disordered breathing

  • Supine body position (lying face up)
  • Large tonsils, long uvula, excessive flabby tissue in the throat
  • A tongue that becomes too relaxed during sleep
  • Being overweight: A recent study showed that a 10 percent weight gain is associated with a six-fold increase in the odds of developing OSA.5
  • Nasal congestion from colds, allergies or deformities of cartilage within the nose
  • Menopause: Postmenopausal women were shown to have more than twice the risk for SDB and three times the risk for severe SDB.
  • Consumption of alcohol, medication or tobacco
  • Hypothyroidism: Due to lack of thyroid hormone, sufferers tend to have a larger tongue, as well as increased fat deposition in the tissues of the upper airway.

Health consequences of Sleep Disordered Breathing

Sleep apnea occurs when the tongue falls back into the throat and obstructs the airway. Apnea episodes, in which the snorer gasps for breath, can happen hundreds of times per night.

Snoring and sleep apnea reduce deep, restorative sleep. This results in extreme tiredness through the following day, which can negatively affect personal, intellectual and physical performance and quality of life.

Obstruction of the airway causes the heart rate to fall below normal, with decreases in blood oxygen levels. The obstruction will not clear until blood oxygen levels fall low enough to trigger the brain to send a signal for a release of adrenaline to prevent suffocation. The airway obstruction is usually (but tragically not always) broken with a gasp for air and, due to the adrenaline release, an increased heart rate.

Reduced blood oxygen levels during the night also cause the brain to send signals through the nervous system to protect vital organs, the heart and the brain. To compensate for the low blood oxygen levels, blood vessels are instructed to tighten up to increase blood flow, to ensure the heart and brain get the required amount of oxygen.

This tightening of the blood vessels causes hypertension and high blood pressure. Night-induced blood pressure continues into the day, even with normal breathing.

Reduced blood oxygen levels can also stimulate the production of red blood cells. This thickens the blood and slows circulation, worsening the overall situation.

Apnea episodes cause disrupted sleep, leading to excessive tiredness and sleepiness during the day, thus increasing the risk of car accidents.7,8

A study released in November 2006 and published in the Journal of the American Academy of Physician Assistants linked OSA, and therefore snoring, to cognitive dysfunction and vascular dementia. Due to cyclical oxygen desaturation from recurring asphyxia, stopped-breathing episodes during sleep reduce oxygen to local brain tissue, causing an infarct and tissue damage with permanent neuropsychological dysfunction.

Direct negative effects of Sleep Disordered Breathing

  1. Hypertension/high blood pressure: 30 to 80 percent of patients with hypertension have sleep apnea.9,10,11
  2. Strokes
  3. Cardiovascular disorders12,13,14
  4. Diabetes
  5. Obesity-altered body chemistry/glucose levels affect the body's metabolism.17
  6. Dementia/memory problems due to starved oxygen to the brain
  7. Depression16
  8. Reflux/heartburn/GERD: 85 percent of sufferers have SDB; in many cases, treating SDB also treats reflux/heartburn.15
  9. Nocturia
  10. Insomnia
  11. Nocturnal asthma/COPD
  12. Impotence

Social and health consequences of snoring

  • Snoring is No. 3 on the list of reasons for divorce in married couples. Only infidelity and finances are blamed before snoring.4
  • Snoring can be very distressing for sleep partners, with banishment from the bedroom for the snorer.
  • Sleep disturbance/deprivation to sleep partners is very real, with a negative impact on well-being and quality of life.
  • Snoring can be the cause of embarrassment/humiliation when traveling with others.
  • Snorers experience tiredness, morning headaches, dry mouth, relationship difficulties, lower blood oxygen levels and other associated consequences.
  • New research has shown that loud snoring poses health risks similar to OSA.6

Signs of Sleep Disordered Breathing

  1. Snoring
  2. Gasping, choking, stopped or irregular breathing during sleep
  3. Frequent nocturnal urination
  4. Hypertension/high blood pressure
  5. Reflux/heartburn/GERD
  6. Morning headaches
  7. Extreme daytime sleepiness
  8. Memory deficit
  9. Depression

Anti-Snoring Products We Offer

 

Silent Nite sl is a custom-fabricated dental device that moves the lower jaw into a forward position, increasing space in the airway tube and reducing air velocity and soft tissue vibration. Special connectors are attached to transparent flexible upper and lower forms. The forms are custom laminated with heat and pressure to the dentist's model of the mouth. The fit is excellent and comfortable, permitting small movements of the jaw (TMJ) and allowing uninhibited oral breathing.


 

The EMA (Elastic Mandibular Advancement) is a custom-made removable intraoral appliance created for noninvasive treatment of snoring and obstructive sleep apnea (OSA). The appliance is designed to both advance the lower jaw (mandible) and open the bite to allow for less restricted airflow during sleep.

EMA appliances help promote a deeper, more restful sleep by preventing snoring. The EMA does not interfere with breathing through the mouth, even in cases of congested nasal passages. The EMA has many options for patient advancement with 9 strap lengths and 4 different elastic tension options. Non-restricted side-to- side (lateral) or front-to-back (protrusive) movements of the jaw are possible while wearing the appliance due to varying elastic bands.