I have already had a copy of questions sent to me about snoring and sleep
apnea.  This is long but I am hoping it may save some lives or at least
answers some of the reasons why people are sick and unhealthy.  Prevention
and early treatment are essential.  Since I am not a physician, I cannot give
medical advise, but I can share some of my understanding of sleep apnea.  The
only ABSOLUTE diagnosis of sleep apnea at present must be obtained by having
a polysomnograph sleep study done at a hospital.  Following is a article I
put in one of my newsletters I sent to my patients:

I am writing this article on the night I was told my brother, only five years
my senior, had a massive stroke.

For 20 years I have been studying and researching the reasons for the
collapse of the oral cavity and the airway.  I have combined that information
with the materials I have received from the physicians who specialize in
sleep, and now work in co-operation with them, in the treatment of snoring
and sleep apnea.

What is so serious about snoring and sleep apnea?  If you snore loudly and
often, you may be accustomed to elbow thrusts in the middle of the night and
a lot of bad jokes.  But snoring is no laughing matter.  It is a signal that
something is wrong with breathing during sleep.  It means that the airway is
not fully open.  The "log sawing" noises come from efforts to force air
through narrowed passageways.

Perhaps 4 in every 10 adults snore and for most, snoring has no serious
medical consequences.  However for some, habitual snoring is the first
indication of a potentially life threatening disorder called "Obstructive
Sleep Apnea (OSA)".

Sleep apnea is a multi-factorial sleep disorder that is gaining greater
recognition among physicians and the lay public.

What is Sleep Apnea?  Obstructive sleep apnea is the stoppage of airflow for
at least 10 seconds because of an upper airway obstruction in the presence of
a respiratory effort .  The respiratory effort continues despite the
obstruction until the individual is aroused from sleep.  Many times the end
of an apnea event ends in a "snort".  The individual, although aroused, may
not be aware of awakening - and that is why he/she has some of the symptoms I
will discuss later.  The severity of the apnea is usually categorized by the
frequency of the episodes.   Under 5 blockages or "episodes" per hour is
considered normal.  More than 20 apnea episodes per hour of sleep can
increase the risk of a heart attack 23 times!   In my brother's case, it
increased his blood pressure, which caused the stroke.  Duration, or length
of the blockage is also a significant factor.  Blockages can last from 10 to
120 seconds and in very severe cases, longer than that.  As you are reading
this, some of you are thinking that your spouse or someone else you know, may
be suffering from just what I am discussing.  That is why I am writing this
article.

During sleep, muscles in the throat and neck relax much more than they do
during waking hours.  In most people this normal process causes no problems;
sleep is a time of rest.  However, for some people muscles relax excessively,
compromising breathing and making sleep a time of danger.  A collapse of the
airway walls blocks breathing.  When breathing stops, a listener hears the
snoring broken by pauses.  With each gasp the sleeper awakens, but so briefly
and incompletely, that he/she usually does not remember doing so.

Because the etiology of obstructive sleep apnea is multi-factorial and the
treatment options are varied, proper diagnosis and treatment are best handled
by a team approach.  The only way a definitive diagnosis of obstructive sleep
apnea can be obtained is by having a sleep study.

Some of the symptoms of Obstructive Sleep Apnea include:
Heavy snoring -- Excessive daytime sleepiness (rule out hypothyroidism) --
High blood pressure --Morning headaches --Depression -- Severe anxiety --
Intellectual deterioration -- Temperamental behavior -- Poor job performance
--Dry mouth upon awakening --Mouth breathing -- Restless sleeps - lot of
tossing, turning or jerks --Difficulty breathing through the the nose --
Impotence

Some of the physical signs of Obstructive Sleep Apnea include:
Poor muscle tone in the soft palate and the back of the throat -- Enlarged
tonsils, adenoids, or a large uvula -- Blocked nasal air passages common with
cold or allergies -- Obstructed nasal airways, caused by polyps, cysts, or
deviated septum -- Being overweight , and / or having a thick and bulky neck
-- Having a lower jaw that is dropped back or small --Having a large tongue
-- An increase in OSA is directly related to an increase in weight and age.
 Men are a little more likely to be affected than women.

Symptoms of Obstructive Sleep Apnea in children:
Snoring -- Bed wetting -- Hyperactivity -- Headaches -- Restless sleeps --
Developmental delay -- Nightmares -- Night terrors -- Poor concentration --
Obesity -- Chronic runny nose -- Noisy breathers -- Frequent upper airway
infections.

What are the treatments for snoring and OSA:

1)  Miscellaneous treatments - Try weight loss and muscle toning  -  Sleep on
your  side rather than on your back (put tennis balls in a sock and sew it to
the back of  your pajamas) -  Elevate the head of the bed  -  Avoid smoking -
Avoid tranquilizers, sleeping pills or antihistamines before going to bed -
Avoid alcohol within 3 hours of bedtime - Avoid heavy meals within 5 hours of
going to bed.  Going to bed exhausted also increases the chance of snoring.

2)  Continuous Nasal Airway Pressure - CPAP.  The individual wears a mask
over the  nose while sleeping.  Air under pressure is forced past the
obstruction in the airway.

3) Surgery - Some of the nasal passage, throat, or tongue, may have to be
removed.  Sometimes the jaw or tongue may need to be advanced, or the hyoid
bone raised.

4) Oral Appliances - The appliances are designed mainly to advance the jaw or
  tongue while the individual sleeps.  The appliances are much like those
worn after orthodontic appliances (braces) are removed.

What should you do if you think you have Obstructive Sleep Apnea?

If the physician thinks you may have sleep apnea, he/she will probably
recommend a sleep study be done at the hospital.  This involves sleeping at
the hospital one night while you are being monitored.  If you have
significant sleep apnea, the CPAP as mentioned above, is usually the first
treatment of choice.  If for some reason the CPAP is not effective, other
options are discussed - either surgery or an oral appliance.  Surgery is non
reversible.  Dental appliances are a non invasive, reversible treatment.

I hope this was informative for you.

Brian Palmer D.D.S.
4400 Broadway, Suite 514
Kansas City, MO 64111

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