by Dr. Manniko, DDS |
The incidence of airway obstructions causing a stoppage of breathing during sleep, affects some 15 million people in this country, and 90 percent have not been diagnosed. Harvard-trained physician John Remmer, MD believes that sleep apnea will become the most chronic disease in all industrialized countries. Consider some of these facts about Obstructive Sleep Apnea (OSA):
- 65-85 percent of all stroke victims suffer OSA.
- Systemic inflammation is increased with OSA and platelets are more likely to adhere, accelerating the process of atherosclerosis.
- An OSA is responsible for a 10-point drop in IQ of children.
- Untreated OSA results in a 20 percent drop in life expectancy.
- OSA person is 23 times more likely to have a heart attach (MI) than a healthy person.
- 60-80 percent of snorers will test positive for OSA.
- A person does not need to snore to have OSA.
- There are more persons with OSA that are not overweight.
Many people are walking around unaware of what may be happening. The most common type of sleep apnea occurs when the airway is actually obstructed during sleep. As air intake is interrupted, the body struggles to function due to lack of oxygen in the blood. Symptoms can be very subtle, with periods of drowsiness often present. Additionally, an affected person may notice heartburn or GERD (gastroesophageal reflux disease), or a persistent cough for no apparent reason.
The gold standard in Medicine for unraveling the mysteries that occur when we sleep is a “sleep study,” or polysomnogram (PSG). The PSG provides information enabling a sleep physician to diagnose OSA as mild, moderate, or severe. Diagnosis of any level of OSA is typically treated with the Continuous Positive Airway Pressure, or CPAP. This device provides a constant flow of oxygen past the obstruction to keep oxygen levels from falling. Unfortunately, while effective, the CPAP is obtrusive, noisy, and can create loss of intimacy in a relationship, as well as irritations of the face and throat. As a result of these drawbacks, compliance typically decreases over time.
Under the new guidelines of the American Academy of Sleep Medicine, oral appliances are now considered to be the first line of defense for mild to moderate sufferers. Oral appliances maintain an open airway during sleep by not allowing the lower jaw to fall back and block the airway. According to published studies, the percentage of patients who continue using a CPAP device is fairly low, in the 23-45 percent range, while the percentage of patients who continue using the much more comfortable oral appliance is in the 90-95 percent range.
Oral appliances have their own challenges and are often easy to fix. Excessive salivation appears to be the number one problem. Tooth movement can also come with short and long-term wear, due to improperly fitting appliances. Changes in the bite are more common. As the person wears the appliance, it holds the jaw in an improved position, often improving the health of joints and muscle comfort.
The physiologic cost of living with an untreated sleep disorder is high, and its role in causing or compounding other health issues often goes unchecked. A visit with a neuromuscular, TMJ, or sleep-apnea trained dentist can ease your mind and possibly even save your life if you suspect you suffer from sleep-disorders such as sleep apnea.
References:
Sleep and Health Journal, Shapira, I, 7/09
Mcardle N et al. AJBCCM 1999
Gozal D, MD, lecture Univ of Louisville
Remmers J, MD, lecture
Smith, K DDS, lecture Sleep Disordered Breathing, 2008
For more info, contact Dr. Manniko at (775) 825-8366.
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