Sleep Apnea

There are three types of sleep apnea: obstructive, central, and mixed. Obstructive sleep apnea (OSA) is caused by a blockage of the airway, usually when the soft palate in the back of the throat collapses and closes. Central Sleep apnea involves a failure of the central nervous system. The airway is not blocked, but the brain fails to signal the muscles to breathe. Mixed apnea is a combination of the two. Obstructive sleep apnea is the most common of all three types.

For those with mild to moderate sleep apnea, the patient will awaken between 5 and 30 times per hour, but for those with severe OSA, it can occur much more than 30 times per hour. When the airway is obstructed, the patient will awaken with a cough or gasping sound in an attempt to open the airway. Once normal breathing is restored and the person falls back asleep, the cycle continues.
Risk factors include:

• Nasal Obstruction
• Enlarged tonsils and adenoids
• Enlarged tongue
• Flabby soft palate
• Being overweight
• Large neck size
• Heavy alcohol consumption
• Smoking
• Continual stress
• Habitual taking of sleeping pills
• TMJ disorder

Testing for obstructive sleep apnea can be done by using a Home Sleep Test (HST) or by referral to a sleep center for a formal in lab sleep study called a Polysomnogram (PSG)). These tests measure many things such as oxygen saturation level in the blood, number of apneic episodes, unusual movements, and number of arousals associated with limited breathing and many other things.

For a preliminary test, Dr. Norman can send the patient home with a High-Res Pulse Oximeter. It is a test similar to a PSG but less in depth. This is typically done before treatment , to discover any sleep apnea symptoms. If any apnea is suspected, Dr. Norman then recommends either a Home Sleep Study or a formal Polysomnogram. Once treatment has started, the High-Res Pulse Oximeter study is often repeated to determine how the patient is responding.

Data from these tests allow Dr. Norman to evaluate your symptoms and recommend the best treatment for you. For those with snoring or mild to moderate obstructive sleep apnea, Dr. Norman often recommends Oral Appliance Therapy. The purpose of all treatments is to attempt to increase the airway size and ease the flow of air to the lungs during sleep.

Oral Appliance Therapy involves the selection, design, fitting and use of a specially designed oral appliance. When worn during sleep, it maintains an open, unobstructed airway. These appliances are not intended to cure sleep apnea. Their intention is to prevent the apnea and/ or snoring from occurring. The appliance must be worn every night.

The type of oral appliance for sleep apnea we use is a mandibular advancing device (MAD). Feel free to call our office and ask us about this type of treatment.

There are several advantages to oral appliance therapy. It is a non-surgical treatment, thus making it non-invasive, comfortable, less expensive and convenient for traveling.

Traditional treatments for Sleep Apnea include:

• Continuous Positive Airway Pressure (CPAP). This positive air pressure inflates the airway, thus preventing airway collapse and obstruction. The CPAP has proven successful for patients who can wear the device through the night. Some patients find it difficult to wear all night as it can be uncomfortable and very noisy.
• Surgery is an option for patients who have severe sleep apnea, and an obstruction has been found in the airway, or for whom conservative treatments have proven unsuccessful.
• Home remedies–Ask us about self-help recommendations that can improve the quality of your sleep and reduce your chance of snoring.

The common type of sleep apnea found in children is Obstructive Sleep Apnea, caused by an obstruction in the airway (such as enlarged tonsils and adenoids). Some symptoms and signs of OSA in children are:

• Snoring or audible breathing during sleep
• Labored breathing while sleeping
• Gasping for air
• Very restless sleep
• Sleeping in unusual positions
• Mouth breathing
• Bed wetting
• Behavioral problems
• Attention problems

Because OSA may disturb sleep patterns, these children may also show continued sleepiness after awakening in the morning or tiredness and attention problems throughout the day in school and other activities. Behavioral problems have been linked in some cases to OSA as well.

Treatment for OSA in children involves keeping the throat open to aid airflow. This can often be accomplished with a dental appliance which can expand and advance narrow dental arches. Sometimes, your physician may recommend surgical removal of the tonsils and adenoids.

If you feel your child may be suffering from OSA, please set up an appointment to discuss options with Dr. Norman.