WHAT IS SLEEP APNEA AND HOW DOES IT DIFFER FROM SNORING?
When someone makes a snoring sound during sleep, it is due to a vibration of some tissue or fluid in the air passage. That is why when you have a cold you may snore. Although snoring could be a symptom of obstructive sleep apnea, they are different. An apnic event is when the person is not getting outside air into their lungs for at least 10 seconds. They are trying to breathe, but something is stopping the air from reaching the lungs. This stoppage can be anywhere along the air passage; from a severely deviated nasal septum to polyps on the vocal cords. Another illustration of the difference between simple snoring and sleep apnea is to pinch your nostrils and at the same time try to breathe through your nose. At about the 8th or 9th second of doing this, most people will get a little light headed and feel pressure building up inside their chest. If this happens often enough, this can lead to excessive daytime tiredness (falling asleep while driving), cardiovascular disease, depression, and acid reflux to name just a few.
These apnea events, among other things, are what a sleep study determines. The number of events divided by the number of hours slept gives the number of apnea events per hour. Mild apnea is between 5 and 15 events per hour. Moderate is 15 to 30 and severe is above 30. The greater the number, the greater the deleterious effects this has on the heart, blood vessels, and brain. Thus, untreated obstructive sleep apnea shortens lives, besides reducing the quality of life.
The obstruction can be treated in four ways: weight reduction, surgery, CPAP (short for continuous positive air pressure), or an oral device. Although each has its place in treatment, oral devices for the majority of mild to moderate adult apnics is the most efficacious. The American Academy of Sleep Medicine recognizes this in their recent Parameters of Care 2006. The guideline gives the treating sleep physician the leeway to recommend either CPAP therapy or an oral device. Studies show that although both are effective, more patients use the oral device than CPAP on a consistent, long term basis.
Two simple illustrations will help illustrate the way an oral device works. First make a snoring sound. Next stick your tongue out and hold it in place with your teeth. In that position, try to snore. Either it will be lessened or you cannot do the snore. That is because for most mild to moderate apnea patients it is the ability of the tongue to engage part of the airway that causes the obstruction. You can also do this same trick by jutting your jaw forward and try to snore. This is why in CPR you perform a head tilt chin lift maneuver to open an unconscious patient’s airway.
There are over 70 FDA approved dental devices for snoring or sleep apnea disorders on the market. There is no “best” device. Dr. Mintz over the past twenty years clinically has used over two dozen. Currently, Dr. Mintz uses about ten different devices. The predominant ones are adjustable. Even these devices have different variations in mechanisms and materials.
No treatment is without its “side effects” and a patient needs to be aware. Our consent form clearly states these possible problems. Although poor dentition, TMJ problems, severe gag reflex are all potential hurdles to wearing an oral device, the main factor needed for success is motivation. These other physical problems in some cases can be overcome, but poor cooperation cannot.
Sylvan S. Mintz, DDS, MScD