Thank you for your interest in the Sleep Apnea Report 2017: The “Not So Silent Killer”. This report will help you understand sleep apnea and the related health risks, how to recognize the symptoms, and your options to manage this disorder. More importantly, this report will provide information to improve your health and your personal relations through better sleep. It just might save your life and those of your loved ones.
If you have any questions, please call SleepMatters, PLC, our Oro Valley/Tucson location at 520.848.3889. We’ll be happy to help you Sleep Better and Live Longer.
WHAT IS SLEEP APNEA?
Snoring is NOT cool! We all have stories about someone we know who rattles the walls (maybe it’s you). What you may not know is that it can be deadly. That classic snoring sound is caused by a partial obstruction of the airway in the back of the throat. If you have heard a snoring person suddenly stop breathing, then gasp for air, you have witnessed an ‘apnea’.
These partial airflow restrictions and complete pauses typically last between 10 and 30 seconds. These pauses can happen hundreds of times a night, leading to abrupt reductions in blood oxygen levels. This increases the heart rate, the blood pressure, and load on the heart. Now it has progressed from snoring to sleep apnea and is potentially life-threatening. Also, the brain alerts the body to its lack of oxygen causing a brief arousal from sleep in an effort to restore normal breathing. The result is a fragmented quality of sleep, hence fatigue.
WHAT ARE THE HEALTH RISKS?
Obstructive sleep apnea has been shown to increase the risk of heart attack and stroke by 300-400%, increases blood sugar and complicates diabetes control, increases blood pressure, and has been shown to decrease life expectancy by 10-20 years. It can result in sudden death during sleep. Sleep apnea is also correlated with cardiac arrhythmia, dementia, and other serious health issues.
These individuals are at a higher risk of heart attack and stroke due to the fact that the entire body, especially the heart, is under high levels of stress during sleep, working overtime to pump more blood to the brain to compensate for the loss of oxygen. This generally results in high blood pressure and the body generating two to three times the amount of plaque in veins and arteries, significantly increasing the risk of heart attack and strokes due to additional blockage caused by the plaque.
Additionally, the disrupted sleep pattern caused by apnea prevents a person from achieving recuperative sleep, which results in excessive daytime sleepiness, increased incidences in work and driving-related accidents, chronic fatigue, and in some cases, depression.
WHO’S AT RISK?
Sleep apnea is a common, progressive disease, which affects a large segment of our population. According to the Institute of Medicine, nearly 70 million people in the United States, including children, suffer from chronic sleep disorders and approximately 20 million have Obstructive Sleep Apnea (OSA). Over 80% of these people are either undiagnosed or in denial. Sleep apnea impacts both women and men, although it is more common with men. It gets worse as we grow older…if you get a chance to grow older. The number of people with apnea increases with age and for people 65 and older, apnea affects as many as 65%!
WHAT ARE THE SYMPTOMS?
There are a number of symptoms to look for, but the most common is moderate to severe snoring. Nearly 50% of people who snore loudly have sleep apnea. Sleep apnea often results in a feeling of excessive daytime sleepiness, fatigue and a general lack of energy. It is also highly correlated with morning time headache, migraine headache, depression, acid reflux disease and tooth grinding. It has even been shown to decrease cognitive thinking ability over time.
Symptoms Associated with Sleep Apnea
- Snoring High blood pressure
- Non-restful sleep Heart attack
- Excessive daytime fatigue Stroke
- Morning headaches Depression
- Migraine headaches Diabetes
- Clenching/grinding teeth Memory loss
- Acid reflux disease Obesity
- Decreased sex drive
- Neck sizes of 16” or greater in women (increased risk)
- Neck sizes of 17” or greater in men (increased risk)
The American Academy of Dental Sleep Medicine is raising awareness about the dangers of untreated obstructive sleep apnea. This sleep disorder has alarming healthcare and economic risk which requires attention. Excessive daytime sleepiness is a common symptom of OSA. It can increase a person’s risk for deadly motor vehicle accidents by 15 times!
Motor vehicles accidents due to “drowsy driving” account for $48 billion in medical costs each year. Sleepiness in today’s workplace causes another $150 billion in lost productivity and mistakes.
Drowsy driving can be as dangerous as drunk driving. Pending legislation recommends that commercial drivers be screened and treated for sleep apnea. But, there are many non-commercial drivers at risk as well.
Snoring occurs when the soft tissue structures of the upper airway collapse during sleep. This partial collapse can occur during any stage of sleep. When the throat tissues vibrate against each other, it produces the sound known as snoring. The sound is a sign that the airway is partially blocked. It can come through the nose, mouth or both. Usually, the narrower the airway space, the louder the snoring sounds. A narrow airway can be caused by a large tongue, tonsils or excess fat in the throat.
Snoring can affect almost anyone. Habitual snoring has been found in an estimated 24% of adult women and 40% of adult men. Both men and women are more likely to snore as they age. Men however, become less likely to snore after age 70.
Snoring is more common in people who are overweight. Excess weight can press down on the airway. Pregnancy can also increase a women’s chance of snoring. Snoring also affects 12% of children.
Even though snoring appears to run in families, there are ways to reduce the likelihood of snoring. Alcohol, drugs, muscle relaxers and tobacco products can all contribute to snoring. Snoring itself does not endanger one’s health but can be a sign of sleep apnea. To reiterate, 50% of people who snore loudly have sleep apnea. If you or your loved one has moderate to loud snoring, with or without other symptoms, you should contact your physician or a sleep apnea specialist for further testing.
SCREENINGS & DIAGNOSTIC TESTING
People who may have obstructive sleep apnea should first have a screening and consultation with a sleep apnea specialist. Our offices can provide screening examinations and testing services, including a take-home sleep monitor worn at night to screen for sleeping disorders. Among other indicators, the take-home sleep monitor determines the amount of oxygen saturation in the blood, which can be indicative of a sleep disorder or some form of breathing obstruction.
It’s necessary for a physician to provide a final diagnosis prior to treatment. This diagnostic testing is done by an overnight polysomnography, commonly known as a sleep study. These tests are generally performed at a sleep center, but, can often be performed at your home. The study measures the average number of partial and complete breaks in breathing that occur per hour of sleep and is called the apnea-hypopnea index or AHI. Ultimately, an AHI ‘score’ is determined to measure the degree of apnea.
Different AHI numbers indicate different levels of sleep apnea:
- Mild OSA: AHI of 5-15
- Moderate OSA: AHI of 15-30
- Severe OSA: AHI of more than 30
Although dentists cannot diagnose sleep apnea, they can consult and provide screening examinations including take-home sleep monitors. After an individual has been diagnosed with sleep apnea by a physician, a dentist specializing in dental sleep medicine can participate in apnea management therapy and can customize oral devices as an alternative for breathing machines. This technique is generally employed in mild to moderate cases of OSA or when severely apneic patients are not in compliance with pressure breathing machines such as CPAP.
It is important for a dentist to be properly trained in the field of dental sleep medicine, which can include membership in academies such as the American Academy of Dental Sleep Medicine, the American Sleep and Breathing Academy, and the Academy of Clinical Sleep Disorders Disciplines.
It is important to know there is no cure for sleep apnea. However, there are a variety of options for effective sleep apnea management to control sleep apnea. Consult with your healthcare provider as to which options are best suited for you.
MANAGING OBSTRUCTIVE SLEEP APNEA
Historically, sleep apnea has been managed by the use of a pressurized breathing machine called Continuous Positive Airway Pressure (CPAP), bi-PAP, or other names. They typically involve the use of a compressor, a humidifier, a hose, and a mask, which delivers air under pressure to help keep the airway from collapsing. It has been shown to be very effective at controlling obstructive sleep apnea and snoring, and absolutely if you have severe apnea and can tolerate it, you should use it. However, the list of reasons why many people don’t use the machine is quite long and includes inconvenience, discomfort, noise, claustrophobia, lifestyle and more.
Alternative apnea management may include the following:
For people that experience snoring and perhaps have mild OSA, weight loss can decrease the severity of snoring or apnea. Weight loss alone may help in some cases, but not all. Avoiding alcohol, drugs, muscle relaxers, and tobacco products can also help reduce or eliminate the presence or severity of the apnea.
Positional Therapy involves side-sleeping instead of sleeping on one’s back. This shift keeps the weight of a person’s neck from collapsing on his or her airway. It may help some, but not all people with snoring and apnea.
Surgeons, including dentists who are oral and maxillofacial surgeons, can use a variety of methods to treat upper airway obstruction. These specialists can treat snoring and apnea causes using minimally invasive procedures as well as more complex surgery. Additionally, an Ear, Nose, and Throat specialist may remove any excess tissue in the throat or nasal passages. It may be necessary to remove tonsils and adenoids, the uvula, or even parts of the soft palate and the throat.
Oral Appliance Therapy
The good news is that there is an alternative therapy that has been shown to be nearly as effective in managing sleep apnea and snoring as pressure machines without the inconveniences. A dentist with specialized training and education in dental sleep medicine can provide you with a custom oral airway dilator for use at night. Similar in appearance to orthodontic retainers or a sports mouth guard, they fit over your teeth and work by moving your lower jaw forward slightly. The American Academy of Sleep Medicine now recommends this concept as first line therapy for anyone diagnosed with mild or moderate obstructive sleep apnea, or even for severe cases when a person is not tolerant of CPAP. Oral appliance therapy (OAT) involves the selection, customized design, fitting, and follow-up adjustments of an oral appliance. Every OSA patient has specific needs. Sleep medicine dentists are trained to select which oral appliance is right for his or her patient and adjust it for the best results. At SleepMatters a number of different oral appliances are available providing the patient the broadest range of oral appliance options. The healthcare providers at our offices may ask their patients to have a follow-up sleep study to ensure the apnea therapy and management is working.
Oral appliances are a safe and effective alternative to CPAP and other pressure breathing machines. This is important to know as nearly 70% of people with apnea cannot tolerate breathing machines like CPAP.
Most insurance companies, including Medicare, provide coverage, at least in part, for apnea screening, diagnostic testing and treatment including oral appliances. Our Billing Administrator can help you determine what coverage your insurance company may provide.
ABOUT SLEEPMATTERS, PLC
SleepMatters, PLC, in Oro Valley near Tucson, is a dental-based practice dedicated to helping patients manage snoring and obstructive sleep apnea. Both offices offer therapy that includes take home sleep monitoring devices and custom dental sleep apnea appliance selection and fabrication.
SleepMatters, PLC differs from traditional apnea management techniques in that these centers utilize oral appliance therapy as an alternative for people who cannot tolerate forced air breathing machines, or have not been successful with or wish to avoid surgery. For people who cannot tolerate breathing machines, our therapy programs may be the only feasible option to continue with apnea therapy management, which is critically important to a patient’s long-term wellness.
J.C. Goodwin, D.M.D., has practiced dentistry in the Prescott area since 1987, began providing sleep apnea management full time in 2011, and has been serving Tucson since 2016. He has participated in specialized training and education for sleep apnea management. He holds Diplomate credentials from both the Academy of Clinical Sleep Disorders Disciplines and the American Board of Dental Sleep Medicine, and he is a member of the American Academy of Dental Sleep Medicine. He is passionate about his practice and is supportive of his community, including civic, business, and charity involvement. He has treated thousands of sleep apnea cases to date.
We offer complimentary consultations for people concerned that they may be suffering from obstructive sleep apnea or those who have been diagnosed with the disorder but are non-compliant with pressure breathing machines. To schedule a complimentary consultation, mention this report when calling SleepMatters, PLC at 520.848.3889.
J.C. Goodwin, DMD J.C. Goodwin, DMD
10134 N Oracle Rd, #170
Oro Valley, AZ 85704