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Sleep Apnea
Snoring is extremely common and, in many cases, relatively harmless. Nearly everyone snores at one time or another. Occasional light snoring, at worst, is a minor annoyance. Loud and habitual snoring can disrupt your sleep and may be a sign of a much more serious sleep disorder - obstructive sleep apnea.
Snoring is a sound that occurs in the upper airway as you breathe in air. The unmistakable sound is a sign that your airway is partially blocked, usually by soft tissue in your throat. The flow of air causes the soft tissue to vibrate, generating the noise, which comes out of your nose, mouth or both.
The volume of snoring depends on the person. You may snore so loudly you wake yourself up. Snoring may also cause you to have a dry mouth or to wake up with a dry mouth and a sore throat.
Obstructive sleep apnea frequently goes undiagnosed because people often mistaken the serious sleep disorder for snoring. About half of loud snorers have some form of sleep apnea.
Snoring and obstructive sleep apnea have similar causes. Sleep apnea happens when the tissue in the upper-airway blocks the entire airway, causing a pause in your breathing. The blockage keeps oxygen from reaching your organs including your heart and brain. When the blood-oxygen level drops low enough, the body momentarily wakes up. It
can happen so fast that you may not be aware you woke up.
Snorers who suffer from sleep may make gasping, choking or snorting sounds as they try to breathe and feel drained of energy during the day.
If you think you may have obstructive sleep apnea, get diagnosed by a board certified sleep physician at an AASM accredited sleep center.
There are several behavioral and medical treatments for snoring. Medical factors may affect treatment, so it is important to speak with a physician.
Oral appliances (OA) are a front-line treatment for patients with mild to moderate Obstructive Sleep Apnea (OSA) who prefer OAs to continuous positive airway pressure (CPAP), or who do not respond to CPAP, are not appropriate candidates for CPAP, or who fail treatment attempts with CPAP or treatment with behavioral measures such as weight loss or sleep position change. This small plastic device fits in the mouth during sleep like a sports mouth guard or orthodontic retainer. Oral appliances help prevent the collapse of the tongue and soft tissues in the back of the throat, keeping the airway open during sleep and promoting adequate air intake. Oral appliances may be used alone or in combination with other treatments for sleep-related breathing disorders, such as weight management, surgery or CPAP.
Download the Ins and Outs of Oral Appliance Therapy
Oral appliance therapy involves the selection, fitting and use of a specially designed oral appliance that maintains an open, unobstructed airway in the throat when worn during sleep. Custom-made oral appliances are proven to be more effective than over-the-counter devices, which are not recommended as a screening tool nor as a therapeutic option.
Dentists with training in oral appliance therapy are familiar with the various designs of appliances and can help determine which is best suited for your specific needs. A board certified sleep medicine physician must first provide a diagnosis and recommend the most effective treatment approach. A dental sleep medicine specialist may then provide treatment and follow-up.
The initial evaluation phase of oral appliance therapy can take several weeks or months to complete. This includes examination, evaluation to determine the most appropriate oral appliance, fitting, maximizing adaptation of the appliance, and the function.
Ongoing care, including short- and long-term follow-up is an essential step in the treatment of snoring and Obstructive Sleep Apnea with Oral Appliance Therapy. Follow-up care serves to assess the treatment of your sleep disorder, the condition of your appliance, your physical response to your appliance, and to ensure that it is comfortable and effective.
With so many different oral appliances available, selection of a specific appliance may appear somewhat overwhelming. Nearly all appliances fall into one of two categories. The diverse variety is simply a variation of a few major themes. Oral appliances can be classified by mode of action or design variation.
Tongue retaining appliances hold the tongue in a forward position using a suction bulb. When the tongue is in a forward position, it serves to keep the back of the tongue from collapsing during sleep and obstructing the airway in the throat.
Mandibular repositioning appliances reposition and maintain the lower jaw in a protruded position during sleep. The device serves to open the airway by indirectly pulling the tongue forward, stimulating activity of the muscles in the tongue and making it more rigid. The device also holds the lower jaw and other structures in a stable position to prevent the mouth from opening.
There are three primary ways to treat snoring and sleep apnea, in addition to lifestyle changes such as good sleep hygiene, exercise and weight loss. The most common treatment is Continuous Positive Air Pressure. CPAP keeps your airway open by providing a steady stream of air through a tube connected to a mask that you wear as you sleep. Another option is surgery performed by an AADSM member trained as an oral and maxillofacial surgeon. A surgeon can prevent airway collapses by eliminating tissue in the soft palate, uvula and tongue. More complex surgical procedures can reposition the anatomic structure of your mouth and facial bones.
Upper Airway Surgery
MMA is the most effective and acceptable surgical treatment of sleep apnea, with success rates ranging from 94 to 100 percent. The surgical procedure involves osteotomies (bony cuts performed by intraoral incisions) to advance the upper and lower jaws to pull forward and tighten the soft palate, tongue and other attached soft tissues. The process enlarges and stabilizes the entire upper airway. MMA requires an overnight hospital stay. Your jaw may be wired shut for several weeks, which may result in weight loss.
AIMO involves a chin bone osteotomy to pull forward the tongue and anterior neck muscles to enlarge and stabilized the airway behind the tongue base. The procedure is not as effective as MMA, but it will not change your bite and your jaw will not have to be wired shut. AIMO may be performed as an outpatient procedure or in combination with MMA and other procedures.
There are various operations of the soft palate that can treat snoring, upper airway resistance syndrome and sleep apnea. The most commonly performed procedure is an Uvulopalatopharyngoplasty, which involves the trimming of a bulky soft palate. The UPPP is often performed in combination with removal of enlarged tonsils or adenoids. A Laser-Assisted Uvuloplasty is a modified version of the surgery that involves scarring cuts to tighten the soft palate and sequential trimming of the uvula over several appointments. While LAUP is less painful and has fewer side effects, it is less effective than UPPP in treating sleep apnea. Radiofrequency Volumetric Tissue Reduction, sometimes called Somnoplasty, shrinks the soft palate and tongue base using energy waves similar to microwaves. Each surgical procedure of the soft palate comes with potential for adverse side effects including throat swelling, nasal reflux of air during speech and fluid during drinking. Throat swelling usually occurs immediately after surgery.
Nasal obstruction may be treated by several nasal surgical procedures. Septoplasty straightens a deviated septum. Turbinate Reduction removes or reduces large turbinates and polyps. While these procedures may be performed independently as outpatient procedures, they are often used in combination with other procedures to treat snoring and sleep apnea.
Procedure involves a wedge-shaped surgical reduction of the tongue base. It is not typically performed to treat sleep apnea and may have many potentially adverse side effects.
Bariatric surgery, such as gastric bypass, may be indicated as a last resort treatment of morbidly obese patients with sleep apnea. Cervicofacial liposuction is a relatively safe procedure that selectively removes excessive fatty tissue below the chin and anterior neck to reduce the weight against underlying soft tissues. Liposuction also helps minimize airway collapse behind the tongue base. It is usually in combination with other surgical procedures.
The operation bypasses the entire upper airway by creating an opening in the larynx or windpipe. Although tracheostomy has the highest therapeutic efficacy for sleep apnea, it has many psychosocial problems and is typically reserved as a last resort for the treatment of severe sleep apnea. Tracheostomy is particularly beneficial for patients with complicated medical conditions that prevent other above-listed surgical procedures.
Behavioral Techniques
Losing weight can decrease the severity of snoring, because excess fat tissue in the back of the neck worsens snoring. Weight loss alone may not help stop snoring for everyone.
Avoiding alcohol, drugs, muscle relaxers and tobacco products can also help reduce or eliminate the presence of snoring.
