Sleep Apnea

Obstructive Sleep Apnea (OSA) is a potentially serious sleep disorder in which breathing repeatedly stops and starts during sleep. Several types of sleep apnea exist, but the most common type is Obstructive Sleep Apnea, which occurs when the throat muscles intermittently relax and block your airway during sleep.  - Mayo Clinic Definition

Danger Signs

There are many warning signs that may accompany OSA.  Snoring and sounds of gasping or chocking during sleep are often reported by bed partners. Other comorbidities which may occur as a result of Obstructive Sleep Apnea may include: High blood pressure (hypertension), acid reflux, insomnolence (sleepiness) with lack of restorative sleep, weight gain, daytime sleepiness and fatigue, and type 2 diabetes.  While many of these health concerns may not be caused by OSA alone, they are often exacerbated if the condition exists.

Treatment Options

Continuous Positive Airway Pressure (CPAP) is considered the "Gold Standard" for the treatment of sleep apnea.  The positive air pressure from the CPAP machine blows air through a nasal or full face mask and forces the relaxed muscles in the throat to remain open and allow air to pass more easily to the lungs.  There are various CPAP machines and face masks available to meet most patients personalized situation.  A Board Certified Sleep Physician (Pulmonologist or Neurologist) can help determine which mask and CPAP machine is most effective for the patient.  Unfortunately the drawback with CPAP therapy is low patient compliance.

Oral Appliance Therapy (OAT), sometimes referred to as Mandibular Repositioning Device (MRD) or "Mouthpiece", is an excellent alternative to CPAP for many patients with Mild to Moderate Obstructive Sleep Apnea that cannot comfortably use the CPAP machine.  Oral appliances work by advancing the lower jaw (mandible) forward and opening the bite (vertical dimension of occlusion).  This keeps the jaw protruded so that the relaxed soft tissues in the back of the throat and the tongue are pulled forward and held in a position so that they may no longer block air passage to the lungs during sleep. Jaw movement can still occur but the jaw cannot go all the way back to a resting position where the soft tissues can fall back and obstruct breathing.  With the lower jaw in this position the airway is opened to allow continuous air flow and breathing to occur without interruption.  It is important to seek this form of treatment with a dentist that has received qualifications and training in sleep disorders and so they may confirm whether this form of therapy is the right choice for your particular sleeping problem.  OAT is covered by medical insurance as it is an approved form of treatment for sleep apnea.  For many patients “mouthpiece” use is the preferred form of treatment for OSA and there is much greater patient acceptance and compliance.

Prescription drugs and alcohol are often looked to as an easy way to correct a sleeping disorder however they may actually cause additional problems.  Alcohol definitely can exacerbate the condition of sleep apnea by further relaxing the obstructing soft tissues in the back of the throat.  It is not a solution.  Prescription medications are an easy alternative to try and help sleep but they should be utilized with extreme caution and under the careful watch of a Board Certified Sleep Physician.  More often than not they are prescribed without careful investigation of the sleeping disorder and they may actually present further complications. Natural supplements (melatonin) can be helpful but their use should be in moderation and in an appropriate dosage. Herbal adjuncts such as lavender may also promote sleep.

Light Box Therapy and Blue blocking Sun glasses are simple and noninvasive forms of treatment to help correct Circadian Rhythm Disorder (an individual’s internal sleep clock) and disruptive sleep patterns.  These treatments work by giving signals to the brain based on the type of light it receives during certain hours of the day or night which may cause or abate stimulation. They may help serve as corrective measures to help shift the patients internal sleep mechanisms and allow the patient to function more effectively during the day.  New electronic devices recognize the importance of the type of light seen during certain hours and how they may stimulate the brain to an awakened state. These devices have methods to change the color of the light (reducing the blue light spectrum, eg. “Apple Night Shift”) during certain hours of the day to help coincide with the body’s internal wake and sleep clock.

Behavior Modification Therapy with the help of a Sleep Pschologist or Psychiatrist is another valuable option to pursue. Often times with the professional guidance of a behavioral therapist the implementation of certain protocols can help correct your sleeping disorder. We have very valuable referral sources that we can direct you to that can help behavioral modification for better sleep habits. Come in for a consultation and we will try to guide you to the appropriate treatment modalities.