Has someone in your household complained that you snore? Snoring may be a minor issue, or it may indicate that you are not breathing to your full capacity and that you may not be getting deep, restorative sleep. Are you frequently tired during the day, despite going to bed early enough? If these symptoms are present in your life, you may be suffering from a condition known as obstructive sleep apnea, or OSA.

What causes snoring?

As you inhale during sleep, the soft palate and the uvula may vibrate against the back of your throat or base of your tongue, resulting in snoring. Muscles in your mouth (including your tongue) relax during sleep, causing the airway to narrow. This narrowing may increase pressure in the airway and result in harder breathing, which in turn yields loud snoring. Other factors that contribute to snoring are:

  • Alcohol consumption
  • Certain kinds of sleep aids or sedatives
  • Excess body weight
  • Obstructive sleep apnea

How serious is snoring?

snoring-sleep-apnea-stockBecause snoring reduces air supply to the brain, it could result in a serious health issue. Please schedule an appointment with us if you regularly snore or experience symptoms of sleep apnea (listed below), or if you are consistently tired despite getting enough hours of sleep every night.

 

Snoring does not always indicate obstructive sleep apnea, but OSA is a potentially fatal condition. Snoring itself reduces an individual’s air supply, but when an individual suffers OSA, air cannot flow to the sufferer’s lungs at all because the soft tissues at the back of the throat completely close off the airway. When the sleeping individual’s brain becomes aware of the blockage, he or she may gasp loudly and then resume breathing and snoring. There is a correlation between snoring and sleep apnea and other serious health conditions such as cardiovascular disease, high blood pressure, hypertension, and stroke.

Although snoring is not always a symptom of sleep apnea, it can interfere with a snorer’s ability to get sufficient restorative sleep. It is therefore important for individuals who snore to seek a professional evaluation and receive a formal diagnosis.

How common is sleep apnea and what are the risk factors?

According to the National Sleep Foundation, sleep apnea affects more than 18 million American adults. The National Sleep Foundation identifies risk factors that include:

  • age (40 or older)
  • ethnicity (sleep apnea is more common in African-Americans, Pacific Islanders and Hispanics)
  • excess weight
  • large neck size (17 inches or greater in a man, and 16 inches or greater in a woman)
  • recessed chin
  • small jaw or large overbite
  • small upper airway (or large tongue, tonsils or uvula)
  • smoking and alcohol use

It is important to remember that sleep apnea can affect anyone at any age, even children. Among the public and healthcare professionals, awareness of sleep apnea is still growing, and many sleep apnea sufferers remain undiagnosed and untreated. Because of the potentially significant consequences of this disorder, knowledge and evaluation are crucial.

What are the symptoms of sleep apnea?

  • Excessive daytime sleepiness, despite getting enough hours of sleep
  • Difficulty staying awake during meetings, conversations, etc.
  • Headaches
  • Impaired ability to concentrate
  • Impotency
  • Problems with memory
  • Weight gain

What should I know about sleep disorder symptoms in children?

Similar to adults, children may also experience the inability to get a full night’s rest on a consistent basis. Many children experience problems sleeping at some point, and while there are many disorders of sleeping and waking, many of these may not be classified sleep disorders. However, it is extremely important to seek a formal diagnosis, because obstructive sleep apnea left undiagnosed can not only become worse as a child grows older, it can become life-threatening. Some of the most common sleep disorders and problems are:

  • Bedwetting
  • Childhood insomnia
  • Nightmares and night terrors
  • Sleep apnea
  • Sleepwalking
  • Snoring

Awareness is growing around the correlation between obstructive sleep apnea in children and problems affecting their attention, behavior, development, and learning. If your child snores, or if you suspect that he or she may have a sleep disorder, please call our office and make an appointment for an initial evaluation. If we determine that a sleep study is necessary, we will make the appropriate referral.

What is your screening process for snoring and sleep apnea?

IMG_20160202_170040We use our in-office cone beam computer tomography (CBCT) unit to help us evaluate your airway. This unit allows us to screen patients for snoring and possible sleep apnea by creating 3D images of the airway to measure its diameter. The imaging process takes only a few minutes, and is safe, non-invasive, and painless. Through this screening, we can identify any problem areas. Based on the screening results, we may then refer you to a sleep specialist for further evaluation and diagnosis.

If a sleep study determines that further steps are needed, we will identify the jaw position that will provide maximum air intake. We will then design a customized oral appliance to retrain your jaw to that position.

 

What is oral appliance therapy?

dna-appliance-stock-photoOral appliance therapy is a general term for a treatment method involving the use of a customized oral appliance—in this case, for snoring and sleep apnea. At Winchester Dental, we specialize in treating sleep disorders through the use of such appliances. To meet your needs, we will work with you to determine the best treatment option.

 

What kinds of appliances are available?

We may recommend a Daytime-Nighttime-Appliance® (DNA). This appliance gently and gradually remodels your airway so that your dental arches widen and your oral cavity reshapes and expands. Without any need for surgery or a CPAP device, your breathing will gradually improve. Many patients report a tremendous improvement in their quality of sleep and a significant reduction in their apneic episodes.

dna-airway-before-and-afterAs these before and after images show, using a DNA can help your upper mid-facial volume to increase permanently for better airway exchange.

 

Are DNAs comfortable?

DNAs are very comfortable, specifically designed to allow you to sleep without even noticing you’re wearing one. A DNA allows to you breathe with your mouth open, and for patients with sinus congestion or allergies, it can even eliminate snoring. For the first few mornings you awake with the DNA, you may experience some slight stiffness in your jaw. This stiffness will go away after you remove the appliance.

Which other appliances are available?

For some sleep disorder patients, a solution may be a mandibular advancement device (MAD). A MAD is a small oral appliance, made of plastic and similar in appearance to an orthodontic retainer or sports mouthguard. We frequently recommend that patients wear MADs at night. MADs work by gently repositioning the lower jaw (mandible) to a forward position. They also lift the soft palate to allow the airway to remain unobstructed throughout the night. Some devices also prevent the tongue from falling back and obstructing the windpipe.

We custom-design each appliance to meet the individual needs of each patient, based on the severity of the patient’s condition. While oral appliances are frequently used alone, they may also be used in combination with other sleep apnea solutions such as CPAP or OPAP machines.

We design many removable oral appliances to treat snoring and sleep apnea. Examples of some of these are pictured here. Our team will thoroughly evaluate each patient so we can make the best recommendation in each case.

MAD-ema
EMA

MAD-herbst
Herbst

MAD-narvel
Narvel

MAD-oasys
Oasys (with nasodilators)

MAD-on6
ON6 (with nasodilators)

MAD-somnomed
Somnomed

Which symptoms indicate sleep apnea?

If you snore and believe you may need to seek evaluation and/or treatment for obstructive sleep apnea, take this short assessment.

Oral Sleep Apnea Assessment
Sending

Each “yes” response is worth one point. If your assessment score is 1 or more, continue to the Epworth Sleepiness scale below.

Epworth Sleepiness Scale

The Epworth Sleepiness Scale is used to determine the level of daytime sleepiness.

How likely are you to fall asleep in the following situations?

0 = Would never doze
1 = Slight chance of dozing
2 = Moderate chance of dozing
3 = High chance of dozing

Activity Score

Epworth Sleepiness Scale
Sending

A score of 9 or more is considered sleepy. A score of 18 or more is very sleepy. If you score 9 or more on this test, you should consider whether you are obtaining adequate sleep, need to improve your sleep hygiene, and/or need to see a sleep specialist. Discuss these issues with a sleep professional. Our office will provide you with a referral for further diagnosis.