Obstructive sleep apnoea is a common sleep disorder in which you have one or more pauses in breathing or you take shallow breaths while you sleep. The airway repeatedly becomes blocked, limiting the amount of air that reaches your lungs. When this happens, you may snore loudly or make choking noises as you try to breathe. So despite your body’s effort to breathe, oxygen can no longer get to your brain. This may happen a few times a night, or in more severe cases, several hundred times a night.
Causes for blockage of the airway
The muscles of the upper airway relax when you fall asleep, thus causing the tissue in the back of the throat to collapse and so a blockage or temporary pause in breathing occurs. Sleeping on your back too can cause the tongue to fall back. This narrows the airway, which reduces the amount of air that can reach your lungs. The narrowed airway causes snoring by making the tissue in back of the throat vibrate as you breathe.
Consequences of not having sound sleep
Sleep apnoea can make you wake up in the morning feeling tired or not refreshed. During the day, you may feel fatigued, have difficulty concentrating or you may even unintentionally fall asleep. This is because your body is waking up numerous times throughout the night, even though you might not be conscious of each awakening.
Negative long term consequences
The lack of oxygen your body receives can have negative long-term consequences for your health. This includes:
- High blood pressure
- Heart disease
- Pre-diabetes and diabetes
Action plan if undiagnosed
There are many people with sleep apnoea who have not been diagnosed nor received treatment. A sleep medicine physician can diagnose obstructive sleep apnoea using an in-lab sleep study or a home sleep test. Sleep apnoea is manageable using CPAP (Continuous Positive Airway Pressure), Oral Appliance Therapy or surgery.
Obstructive sleep apnoea in adults is considered a sleep-related breathing disorder. Causes and symptoms differ for Obstructive Sleep Apnoea in Children, and Central Sleep Apnoea.
Symptoms of Sleep Apnoea
- Loud snoring
- Stopping to breathe at night
- Waking up chopping or gasping for breath
- Morning headaches
- Dry mouth or sore throat in the morning
- Difficulty concentrating
- Poor memory and poor learning
- Moodiness irritability or depression
- Frequent trips to the toilet at night
- Not refreshed on waking up
- Tiredness or sleepiness during the day.
- Frequent napping during the day
- Medial problems especially high blood pressure that is not being controlled by medication
- Gagging when things touch your tongue
- Requiring several pillows to sleep at night and preferring to sleep upright
There are several risk factors for Sleep Apnoea
- Age >40 years in males and >50 in females
- Being male doubles the risk
- Being postmenopausal in females
- Being overweight BMI >30
- Increased neck circumference >40cm in men
- Family history of Sleep apnoea
- Retruded facial profile and small jaws.
- Being a smoker
The Diagnosis of Sleep Apnoea
The presence of risk factors can be easily identified by your dental professional and your medical practitioner. A suitable referral to a Respiratory physician is required to determine the ideal diagnostic tests necessary. A sleep study is vital to confirm a diagnosis of Obstructive Sleep apnoea and this can be done in 2 ways:
- Home based Sleep study for patients with high risk factors from moderate to severe Obstructive sleep apnoea. This can be done at home in the comfort of your own bed. The main disadvantage it that the patient is not being monitored during the sleep and sometimes there can be missing information, for example, a detached lead or some other reason. It is cheaper to perform.
- In-Lab sleep study: This is the gold standard for diagnosis of all sleep disorders. The patient sleeps overnight in a sleep lab and is monitored via video link to ensure that the information gathered is accurate. Other sleep disorders are easily identifiable like insomnia, REM sleep disorders and other parasomias. The cost of an in-lab study and the waiting period for a hospital admission is the main deterrent to this investigation.
Once the diagnosis is made the Respiratory Physician triages the patient into what therapy is ideal, based on the severity of the sleep disorder.
The treatment of Sleep Apnoea:
Lifestyle changes: The first line of treatment of Sleep apnoea should look at lifestyle changes to modify and reduce the risk factors. This includes
- Modify diet to reduce weight
- Increase exercise
- Reduce alcohol
- Change sleeping position
- Manage allergies to ensure you have a clear nasal airway
CPAP Therapy: This is the gold standard of treatment Snoring and Obstructive Sleep apnoea. It is the use of a device that delivers air under pressure through a hose and mask that covers your nose. Like blowing air into a balloon, the pressurised air can help to open the airway in the throat. Results are immediate and predictable when used.
Studies show CPAP is the most effective treatment to reduce obstructive breathing. However it has been shown that 25-50% of patients are unable to tolerate or comply with treatment for a variety of reasons. Some of these reasons are claustrophobia, irritation of the mask, being unable to sleep with it comfortably, the device being cumbersome and noisy and inability to tolerate the sensation of the pressurised air.
Dental Appliance Therapy: Dental appliances or MAS devices are custom made devices that fit accurately over the upper and lower teeth. They are aimed at repositioning the lower jaw, tongue; soft palate and uvula in a forward direction. They help prevent collapse of the tongue and soft tissues in the back of the throat by stabilising the lower jaw and tongue and increasing the muscle tone of the tongue. These keep the airway open during sleep and promote adequate oxygen intake.
Surgery: There are multiple surgical options for the treatment of sleep apnoea either on their own or as an adjunct to other therapies. These include
- Removal of adenoids and tonsils
- Correction of a deviated nasal septum
- Reduction of the turbinates in the nose to improve nasal airflow
- Modification of the palpate and the uvula (UPPP)
- Maxillo-mandibular advancement surgery: to move the upper and lower jaws forward to improve the airways
- Reduction of the tongue size
- Moving of the tongue forward
- Gastric banding to help with weight loss that would help with reducing Sleep apnoea risk factors.
If you or someone you know has obstructive sleep apnoea and would like to have a local dentist in Point cook to evaluate your suitability for a dental sleep appliance, book an appointment with Dr Nomita Gonsalvez at the Dental Gallery or download a copy of “A Guide to Oral Appliance Therapy at the dental gallery” here.
Download a copy of “A Guide to Oral Appliance Therapy at the dental gallery” here.