Download Our Sleep Apnea Booklet

Contributing Authors
THEODORE M. BERMAN, M.D.
is a board certified medical
specialist in sleep disorders medicine and pulmcnary medicine. Dr. Berman is a partner of the
Minn sota Sleep Institute and practices in Edina,
Plymouth, Fridley, and Minneapolis, Minnesota.
JOAN FOX, M.D.
is a sleep disorders and pulmonary medicine specialist board certified by
the American Board of Sleep Medicine and
American Board of Internal Medicine. Dr. Fox
practices at the Minnesota
Sleep Institute,
Abbott Northwestern
Sleep Center, and the
Minnesota Lung Center.
JONATHAN A. PARKER, D.D.S.
is the director of the
Snoring and Sleep Apnea Dental Treatment
Center in Minneapolis, Minnesota. He is an
Assistant Clinical Professor of Dentistry at the
University of Minnesota. Dr. Parker is on the
consulting staff of six sleep disorders centers
in the Minneapolis- St. Paul area. He has
lectured throughout the U.S. on evaluation and
treatment of snoring and sleep apnea.
The Importance of Restful Sleep
4
Normal Breathing During Sleep
5
The Impact of Snoring on Sleep
6
Causes of Snoring
7
Factors That Affect Snoring
8
Obstructive Sleep Apnea
10
Five Negative Effects of Snoring
and Obstructive Sleep Apnea
11
Evaluation by a Doctor
12
Testing for Sleep Problems
13
Four Strategies to Minimize Snoring
14
Medical and Dental Treatments
for Snoring and Sleep Apnea
15
A Summary of Treatment Options
19
OTE: This booklet is intended to help individuals manage their snoring and/or sleep apnea.
It is not to be used as a guide for self-diagnosis or to recommend a particular treatment.
Innovative Sleep Products, Inc. recommends
consulting a physician for appropriate
diagnosis and treatment.
The Importance of Restful Sleep
•
Most adults need
7-8 hours of sleep
for peak alertness
and energy.
A good night of sleep is very important
to our overall health and ability to function
effectively throughout the day. However,
when our lives become busy, sleep
becomes less of a priority for many of us.
William C. Dement, MD, PhD, the Dean
of Sleep Disorders Research and Professor
of Medicine at Stanford University, states:
"Americans have gotten the message that
good nutrition and plenty of exercise are
important for health, but we have not paid
enough attention to the third pillar of
good health, which is adequate sleep."
You can improve the quality of your
sleep by following these recommendations:
• 23 % of adults reported
that they fell asleep
at the wheel of their
car during the past year.
• Establish relaxing pre-sleep routines.
It is important to incorporate time to
• 67% of adults said
that sleep deprivation
affected their work,
which translates
into a $70 billion
loss jn productivity.
• Avoid large meals just before bedtime. Small
"wind down" from your daily activities.
• Minimize light, noise, and temperature
extremes in the bedroom.
snacks are not a problem, but large
meals keep the digestive system active
and can disrupt leep.
• Avoid strenuous exercise within two
to three hours of bedtime. Strenuous exer-
cise can elevate body temperature and
cause difficulty falling asleep at
bedtime.
• Avoid caffeine, nicotine, or other
stimulants within four hours of
bedtime.
4
Normal Breathing During Sleep
Keeping the air passages open during
sleep is critical to normal breathing. As
you breathe, air passes through the nose
and mouth and inward into your lungs,
moving past the following structures in
the nose, mouth, and throat:
o
Soft palate: Soft curtain of tissue which
is an extension of the palate at the back of
the throat. This palatal
tissue blocks the
opening between
the mouth and nose
during swallowing.
fl Uvula: Floppy
finger-like projection
of tissue that hangs
from the middle of
the soft palate.
8 Tonsils: Sack-like structures along
the side walls at the back of the throat.
These tissues are part of the body'S
immune system.
D Tongue: Large muscle at the floor
of the mouth that is important for taste,
speech, chewing, and swallowing.
While you are awake, throat muscles
actively maintain an open air passage so
you can breathe easily. During sleep, these
structures relax. For non-snorers, the
airway stays clear so air can move easily
into the lungs. But for snorers, this is not
the case, and it can have a significant impact
on their sleep.
5
The Impact of Snoring on Sleep
A calm, quiet setting is important
to restful sleep. Snoring interrupts that
restful quiet. Usually people do not hear
themselves snore, but snoring can cause
disrupted sleep for both the snorer and
the snorer's sleeping partner. It can
lead to daytime sleepiness and fatigue,
which can affect the ability to function .
effectively at home and at work, and
could lead to health problems. It is
important to eliminate snoring so
everyone can get a re tful night's
sleep and maintain good health.
If you snore, you are not alone in your
struggle to find a solution to this problem.
Statistics indicate that approximately 67%
of adults snore and that number will
continue to grow, because the factors that
cause snoring continue to be prevalent
in our population.
Normal, smooth, unobstructed breathing
is a key to getting a restful night's sleep.
The information in this booklet will help
you learn about snoring and related
complications so you can find a solution
to your sleep problems.
Normal Airflow
~
Airflow
['l Soft palate
D
rn
6
Base of the tongue
Uvula
Causes of Snoring
Snoring is the harsh sound you hear
when a snorer inhales during sleep. The
noise occurs when the soft palate and
uvula vibrate against the back of the
throat or the base of the tongue.
As you fall asleep, the soft tissues at
the back of the throat, the muscles that
line the airway, and the tongue muscle
all relax. As this occurs, the tongue drops
back into the airway which cau es it
to narrow. As air passes through this
narrower airway, it moves faster and
causes the tissues to vibrate against each
other, which creates a rattling or snoring
sound. As the air passage continues to
narrow, pressure increases in the airway
and snoring becomes louder.
The three primary causes of
narrowing of the air passage are:
• Larger soft tissue size,
• Increased relaxation of the
soft tissues, and
How loud is snoring
compared to other noises?
Jackhammer
85 decibels
lawn mower
95 decibels
Airplane
118 decibels
loudest
recorded
snoring
87 decibels
• Increased resistance in the airway.
Airflow During Snoring
Narrowing of
the air passage
leads to increased
pressure in the
airway and labored
breathing, which
causes loud snoring.
7
Factors That Affect Snoring
The most common factors that cause
increased snoring are:
• Sleeping on your back. In this
Alcohol and certain
medications (valium,
antihistamines, and
others) can cause
or worsen snoring.
position gravity pulls the jaw and
tongue down and back. This causes
the mouth to open and the tongue
to drop back into the airway, and
leads to narrowing of the air passage.
Sixty percent of all snorers will snore
only or most often while sleeping
on their back.
• Difficulty with nasal breathing.
Breathing through the nose is a more
efficient way to bring air into the lungs
than mouth breathing. A deviated
septum, allergies, pregnancy, or a
cold can cause the blood vessels in
the nasal area to swell, which can
lead to congestion or stuffiness in
the nose. This can cause mouth
breathing and increased resistance
in the air passage.
•
8
Obesity. In overweight individuals,
excess fat deposits in the area of the
neck and throat cause an increase in
the size of the tissues or increased
pressure on the tissues that surround
the air passage. This leads to narrowing
of the airway. Obesity is a major
predisposing factor to snoring.
•
Enlarged soft tissues in the throat area.
Snoring is much more prevalent in
people who have a large tongue, long
soft palate, large uvula, or large
tonsils. \"V'henthose tissues are enlarged,
there can be a decrease in airway space.
Enlarged tonsils and adenoids are the
primary cause of snoring in children.
• A small lower jaw. People who have a
receding chin related to a small lower
jaw are more likely to snore because
there is less room in the back of the
throat for the soft tissues and tongue.
This reduction in space decreases the
size of the au' passage and causes
increased snoring.
•
Certain medications
and alcohol
Some drugs (particularly
certain tranquilizers and antihistamines)
and alcohol can cause greater relaxation
in the soft tissues and muscles in the
throat. This can lead to narrowing of
the air passage during sleep, which
increases the chance of snoring.
consumption.
•
Cigarette smoke and other irritants.
These irritants can cause increased
nasal congestion and mucous in the
throat area, which can lead to
increased snoring.
9
Obstructive Sleep Apnea (OSA)
The most common symptoms of obstructive sleep
apnea are:
• loud snoring
• Periodic stoppages
in breathing
• Significant daytime
sleepiness
•
Restless sleep
• Difficulty concentrating
and poor memory
• Irritability Dr
personality change
Obstructive sleep apnea is an illness
in which the soft tissues at the back of the
throat completely close off the airway so
that air cannot flow into the lungs. This
airway blockage can reduce the amount
of oxygen reaching the brain and body.
When that happens, the brain alerts the
muscles in the airway to tighten up and,
unblock the air pas age. As this occurs,
a loud gasp or snort is heard, and then
breathing (and many times snoring)
begins again. This process of blocking
and unblocking the airway causes
significant disruption of sleep.
People who suffer from obstructive
sleep apnea frequently complain of
daytime sleepiness, which can cause
difficulty staying awake during meeting ,
conversation, while reading, watching
television, or driving. Daytime sleepiness
can also impair the ability to concentrate,
both at work and at home.
OSA is a health problem that can be
associated with high blood pressure, heart
problems, and stroke. It is important to
see your physician or a sleep disorders
specialist if you are experiencing snoring
and daytime sleepiness.
Obstructive Sleep Apnea
Air flow is
completely
blocked.
10
Five Negative Effects of Snoring
and Obstmctive Sleep Apnea
Snoring and obstructive sleep apnea
can lead to increased risk of:
1. Relationship
and marital discord.
Loud snoring noises can disrupt the
sleep of not only the snorer but also
the snorer's bed partner and others in the
household. This can be a source of great
frustration and anger in their relationship.
2. Heart attack, atrial fibrillation, stroke,
or even death. Research confirms that
people with sleep apnea have a higher
incidence of high blood pressure, atrial
fibrillation, heart attack, and stroke.
It is estimated that 38,000 people in the
United States die each year from the
effects of obstructive sleep apnea.
4% of men and 2%
of women between the
ages of 30 and 60 have
obstructive sleep
apnea that is severe
enough to require
treatment.
3. Industrial and traffic accidents caused
by daytime sleepiness and fatigue.
People with obstructive sleep apnea have
a three times greater risk of having an
automobile accident than the general
population and a seven times greater risk
of multiple accidents. The snorer's bed
partner also has an increased risk of traffic
accidents because of fatigue from
disrupted sleep.
4. Lost productivity at home and work
from daytime sleepiness due to lack
of restful sleep.
5. Depression as a result of lost
productivity, relationship discord,
accidents, and health problems.
11
Evaluation by a Doctor
All snorers should be evaluated by
a physician or sleep disorders specialist
before pursuing treatment, especially
if they:
• Wake unrefreshed in the morning,
• Fall asleep easily during the daytime
at inappropriate times (while watching.
TV, reading, driving, or in meetings.)
Typical questions asked:
• How often do you snore?
•
Is your snoring loud
enough to disturb the
sleep of others?
• Are there periods of time
when the snoring and
your breathing stop?
• Do you ever gasp or
snort during sleep?
• How many hours do
you usually sleep?
• When you wake up,
do you feel refreshed?
• Do you etten feel
sleepy during the day?
• Have periodic stoppages of snoring
or breathing during sleep, as
observed by their bed partner.
Your doctor's evaluation will probably
include:
• A history of your snoring and related
symptoms. It is helpful if your bed
partner is present at this evaluation
to help answer the doctor's questions.
A tape recording of the sounds you
make while sleeping may also be
helpful to the doctor.
• A complete medical history and physical
examination to identify other health
problems (high blood pressure, heart
disease, stroke, diabetes, GI reflux,
headache, chronic pain) that may
be caused or aggravated by an OSA
condition. In addition, the physician
will identify other medical conditions
(allergies, rhinitis, sinusitis, obesity,
smoking) that may be a factor that
contributes to OSA.
• Additional testing of your sleep
may be necessary if the doctor
suspects that obstructive sleep
apnea is present.
12
Testing lor Sleep Problems
The testing for sleep problems,
including snoring and OSA, is completed
at a sleep disorders center that may be
located in a hospital or independent
center. This overnight sleep study
Cpolysomnogram) measures 16 different
factors throughout the night and is considered the most accurate testing
method. The patient arrives
at the center a few hours before their
normal bedtime and they are connected
to special monitors that will assess their
sleep and confirm their diagnosis before
the treatment is finalized.
In some cases,
the doctor may use
a testing system that
can be used to
evaluate your sleep
while you are at home
in your own bed. Some
of these home testing
devices have been
found to be very
accurate in assessing
OSA.
13
Four Strategies to Minimize Snoring
The strategies described below may
reduce or eliminate your snoring.
0
matter what treatment you pursue for
snoring or obstructive sleep apnea, the e
recommendations will have a positive
effect on its outcome.
1. Sleep on your side. leeping in this
position counteract the effects of gravity
and can reduce or eliminate snoring.
2. Normalize your weight. People who are
overweight can reduce snoring and apnea
symptoms by 10 ing weight. Proper diet
and exercise are the keys to losing and
maintaining an appropriate weight.
3. Relieve nasal congestion. Reducing nasal
congestion can help decrease
snoring. Nasal sprays can be prescribed
by your physician. ( Tote: Some of the
over-the-counter nasal prays should not
be used longer than a few days.) Nasal
strips which increase nasal air flow
may also be beneficial.
4. Avoid alcohol or sleeping pills within four
hours of bedtime. Consumption of alcohol
or sleeping pills will cause relaxation of
the soft tissues and muscles in the airway
and will make sleep apnea or snoring
worse. It should also be noted that alcohol consumption, even during the day,
can increase your risk of an OSA problem.
Medical and Dental Treatments for
Snoring and Sleep Apnea
If the strategies previously described
do not improve your snoring or OSA,
your physician or sleep disorders
specialist may recommend one of the
following treatments:
1. Positional device. Most bed partners
know that snoring is worse on the back.
In fact, research studies show that a high
percentage of snorers and about 49%
of people with mild sleep apnea have
symptoms only when they sleep on their
back. Therefore, treatments to keep them
on their side or stomach during the night
can be very effective in resolving the
problem. The device pictured is one of
a few that have been designed to keep
sleepers off their back. The
cushion is inflatable and is
worn like a soft, lightweight
backpack that is positioned
along the middle of the
back. It rests comfortably
in place when you are
sleeping on your side or
stomach and it will prevent
you from rolling onto your
back during sleep. The
cushion can be successful
when used alone or in
conjunction with other
treatments for snoring or
obstructive sleep apnea.
15
2. Continuous Positive Airway
Pressure (CPAP) Treatment. CPAPis
generally the primary treatment for people
with moderate or severe obstructive sleep
apnea. The device has an air blower
connected to a cushioned plastic mask
that cover the nose and sometimes
the mouth. The blower blows room air
through the hose and mask into the nose
and throat to keep the air passage open
during sleep. The air pressure from this
device prevents the collapse of the airway
and the pressure can be adjusted to
maintain the airway for people with all
severity levels of apnea. Research studies
show this treatment to be highly effective
in treating moderate or severe sleep apnea;
thereby significantly
improving quality of
sleep and, as a result,
quality of life.
Some patients may
initially experience
difficulty adapting to
the device. Often
these problems go
away as the patient
continues to use the
CPAP unit. The sleep
disorders center staff
can be very helpful in guiding patients
to u e the CPAP successfully.
16
3. Oral appliance therapy. An oral
appliance is a small acrylic device that
fits over the upper and lower teeth or
tongue (similar to an orthodontic retainer
or mouth guard). This device slightly
advances the lower jaw or tongue, which
moves the base of the tongue forward,
opens the airway, improves breathing
and effectively treats snoring and OSA.
The appliance is fabricated and customized for each patient by a dentist
experienced in the treatment of snoring
and obstructive sleep apnea.
Oral
appliances
are usually
well-tolerated
by patients.
This treatment
is effective
for treating
people with snoring and mild to
moderate obstructive sleep apnea.
It can also be effective for treating
certain cases of severe obstructive
sleep apnea.
Many different appliance designs
are available, so the appropriate device
can be customized to each patient's
situation.
Consult your primary
physician or sleep
medicine physician
for proper diagnosis
prior to making a
treatment decision.
17
4. Surgery in the throat area or jaw.
urgery is usually targeted at the ite of
the airway obstruction. There are several
surgical approaches that range from
treatments to the soft palate or uvula to
advancement of the upper and lower jaw.
• The most common surgical procedure
for treating snoring is the
Uvulopalatopharyngoplasty ( PPP).
This technique is done in the hospital
and removes all of the uvula and about
one-third of the soft palate. It requires
about two weeks of healing time, and
it can be effective in treating people
with snoring and mild sleep apnea.
It is less effective in treating moderate
or severe sleep apnea. A variation of
this technique uses a laser and is done
in the office with local anesthesia.
• Somnoplasty (radio frequency surgery)
is a minor surgical procedure completed
in the surgeon's office using local
anesthesia and a customized electrode
that delivers radio frequency energy
to stiffen the soft palate and/or tongue.
• The Pillar Procedure uses three
polyester strips that are inserted into
the palatal tissue that stiffens the palate
to reduce the vibration of snoring.
• Telegnathic surgery is jaw surgery that
advances the upper and lower jaw
to open the airway and manage
significant sleep apnea conditions that
have not been effectively managed by
non-surgical treatments. This treatment
can be effective for moderate or
severe sleep apnea.
18
A Summary of the Treatment Options
1. A thorough evaluation and accurate
diagnosis is the key to successful
treatment of snoring and sleep
apnea.
• See a sleep medicine physician
for a complete assessment
2. Treatments for snoring:
• Positional therapy
• Oral appliance therapy
• Palatal surgery
3. Treatments for mild OSA:
• Oral appliance therapy
• CPAP
• Palatal surgery
4. Treatments for moderate to
severe OSA:
• CPAP
• Oral appliance therapy
(if CPAP can not be tolerated)
• Oral appliance therapy
combined with CPAP
• Oral appliance therapy and CPAP
combined with palatal surgery
• CPAP and palatal surgery
• Telegnathic (jaw) surgery
(if non-surgical treatment
not successful)
19
For further information regarding diagnosis and treatment of
snoring and obstructive sleep apnea visit these web sites:
American Academy of Dental Sleep Medicine
www.aadsm.org
American Academy of Sleep Medicine
www.aasmnet.org
American Sleep Apnea Association
www.sleepapnea.org
National Sleep Foundation
www.sleepfoundation.org
For comments or que tions regarding the information
in this booklet, you may contact:
Innovative Sleep Products
: (888) 766-6607 (roll free)
Phone: (952) 345-0290
Fax: (952) 920-0105
E-mail: [email protected]
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