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Sleep Apnea

What is it?

We all know sleep, but what about apnea?   Apnea means to pause or stop breathing.  Breathing may partially or completely stop for a moment.  Thus, sleep apnea means to pause or stop breathing during sleep.  Sometimes you may snort loudly to open your airway after you have stopped breathing.

I snore! Do I have sleep apnea?

Not necessarily.  You may “rattle” your airway as you breathe through a narrowed breathing passage.  If you are just snoring, but otherwise breathing normally, then you do not have sleep apnea.  You may desire treatment for snoring, and there is a variety of surgical and non-surgical options available.  Non-surgical choices may include a dental device, positive airway pressure device and a variety of “over the counter” devices.  We give two strong precautions:

  • Never use a dental device for snoring except as fitted by a dentist.  The reason is that the dental device may cause tooth movement disrupting your bite and leading to costly orthodontic correction or jaw discomfort.
  • Never use any commercial device for the treatment of snoring without consulting a physician, preferably a sleep specialist, because these devices may reduce snoring without correcting sleep apnea leaving you with increased risk of high blood pressure, heart disease or stroke.

Why do I snore at night but not during the day?

When evaluated for snoring, the physician may look at your nasal passages and the back of your mouth to assess how narrow your breathing passages may be.  If your breathing passages are narrow, then what might happen when you lie down?   I suspect you guessed it.  Your breathing passages begin to collapse as the result of gravity.  Now as you go to sleep, the breathing passages relax further and collapse even more.  As a human, you must breathe!  Now you are breathing through a relaxed and partially closed airway, which may “rattle”.  That is snoring!

There are two types of sleep anea; although more complex breathing problems may occur in sleep.

  • Obstructive sleep apnea.  The airway partially or completely closes which obstructs breathing.  This is the most common type of sleep apnea.
  • Central sleep apnea.  The airway is open but breathing is not “triggered” properly which results in pauses in breathing.  This type of sleep apnea is often associated with congestive heart failure or usage of pain medication.

Why is sleep apnea important?

  • Drowsiness may occur because of brief arousals as you struggle to breathe. The result is fragmented and poorly restorative sleep.     I think of sleep very much like time with a child.  It’s important how much time I spend with the child; but the quality of the time is equally important.  Likewise, it’s not just how long you were unconscious on a mattress; but what was the architecture, quality and restorative value of the sleep?
  • Poor attention.  Attentiveness, work productivity and enjoyment of leisure activities suffer because of fragmented sleep associated with sleep apnea.
  • Increased risk of motor vehicle crash. Multiple studies show increased occurrence of motor vehicle crash in people with sleep apnea.  Treatment substantially reduces that risk.  Sleep apnea in commercial drivers has been a hot topic for years; however, increasing pressure for consistent regulations has emerged in recent years.  Most Department of Transportation (DOT) examiners screen patients according to the severity of obesity or neck circumference, as well as other symptoms, to determine which commercial drivers must have a sleep study to assess for possible sleep apnea.
  • High Blood Pressure. Sleep apnea is a primary cause of high blood pressure.  If you have high blood pressure for other reasons, sleep apnea may increase your blood pressure making it harder to control or requiring additional medication to control.   Sleep apnea causes high blood pressure because of increased adrenalin when struggling to breathe at night. 
  • Heart Attack, Coronary Artery Disease, Stroke. A clogged artery to the heart leads to heart attack.  A clogged artery to the brain leads to stroke.  Sleep apnea with repeated struggles to breathe during the night decreases blood oxygen levels and causes the release of “inflammatory factors”, some of which damage the artery and lead to atherosclerosis (clogged arteries). The risk of heart attack or stroke may double in 10 years.  Death does not scare me nearly as much as a disabling stroke or heart attack.
  • Heart Rhythm Disturbance. Sleep apnea leads to a variety of irregular heart rhythms of variable risk to you.  These are likely the result of circulating stimulants or low oxygen levels associated with sleep apnea.  Atrial fibrillation is a particular irregular heart rhythm associated with sleep apnea.  If you have never heard of atrial fibrillation, then you probably do not have it.  Ask your doctor, if you have irregular heart rhythm.
  • Congestive Heart Failure. As many as 2/3 of congestive heart failure patients have sleep apnea.  The sleep apnea may be more complex and consist of obstructive and central sleep apnea.  Sleep apnea associated with congestive heart failure is tricky and best treated by an experienced sleep specialist.
  • Diabetes.  Sleep apnea causes elevated blood sugars in diabetic patients.  Sleep apnea may speed the time of conversion from pre-diabetes to diabetes.
  • Kidney Disease. Sleep apnea may worsen kidney disease because of the elevated nighttime blood pressure and “inflammatory factors” described earlier.  Evidence suggests that early treatment of sleep apnea may decrease the progression of kidney disease and perhaps delay the time to require dialysis.  Many people with high blood pressure or diabetes have early kidney disease.

The Good News!  Treatment actually works!

Multiple studies over many years have shown the positive effect of treating sleep apnea.    Just like snoring, there are multiple potential treatments for mild sleep apnea.  However, CPAP is the initial treatment choice as sleep apnea becomes more prominent since it is considerably more likely to be effective in control breathing difficulty.

What is CPAP?

Continuous Positive Airway Pressure.  It is the same principle as inflating a balloon.  The air causes the balloon to expand.  If you had a mask with a hose attached to a device that gently blew air, then it would gently open your breathing passages so you could breathe.

Positive Effects of CPAP therapy

  • Improves daytime alertness and attention.
  • Reduces motor vehicle crashes and saves lives.
  • Reduces blood pressure, irregular heart rhythms and risk of heart attack or stroke.  
  • Improves the symptoms of congestive heart failure.
  • Decreases blood sugar levels in diabetics. The time of conversion from pre-diabetes to diabetes may be prolonged.
  • Appears to preserve kidney function if you have early kidney disease. CPAP improves daytime function in dialysis patients.

Dental devices are custom designed to position the lower jaw forward and thus provide more breathing room.  These devices, sometimes called “mandibular advancement splints” are generally used for mild to moderate sleep.  In certain circumstances, a variety of surgical interventions may be considered which require further discussion with your physician.

Commercial drivers, or others in safety sensitive positions, may be required to use PAP therapy to continue in their occupations.  If you are a commercial driver, inform your physician for further education and instruction.