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Deborah A. Ferrer DMD, MS, PA 16223 Miramar Parkway Miramar, FL 33027 954-433-4544 Monday - Thursday 9-5:30, Saturday 9-2

Sleep Apnea

photo of mature man and woman smiling Are you drowsy during the day with no explanation? Do you snore loudly, or wake up breathless in the middle of the night? If so, you may be one of more than twelve million Americans affected by sleep apnea.

What is sleep apnea?

Sleep apnea is a condition in which breathing stops periodically during sleep, as many as 20-30 times per hour. ("Apnea" is the Greek word for "without breath.") If you suffer from sleep apnea, each time your breathing stops, the resulting lack of oxygen alerts your brain, which temporarily wakes you up to restart proper breathing. Because the time spent awake is so brief, most people with sleep apnea don't remember it - and many think they are getting a good night's sleep. However, the constant wake-sleep-wake-sleep cycle precludes the deep sleep that refreshes the body, and sufferers are frequently drowsy during the day.

What are the signs of sleep apnea?

The following symptoms can indicate the presence of sleep apnea. If you notice one or more of these, give us a call, and we can refer you to a sleep apnea specialist.
  • Insomnia or difficulty sleeping
  • Loud snoring at night
  • Waking up at night short of breath
  • Snorting or choking sounds during the night (indicating a restart of breathing)
  • Headaches upon waking in the morning
  • Falling asleep unintentionally during the day
  • Extreme drowsiness throughout the day

Are there different types of sleep apnea?

There are three categories of sleep apnea. The most common is called obstructive sleep apnea (OSA), and occurs due to a physical blockage, usually the collapsing of the soft tissue in the back of the throat. Less common is central sleep apnea (CSA), in which breathing stops because the muscles involved don't receive the proper signal from the brain. And some people suffer from "mixed" or "complex" sleep apnea, which is a combination of obstructive and central.

What are risk factors for sleep apnea?

Obstructive sleep apnea is more common in males than females, and more common in older adults (40 and up) than younger adults and children. However, anyone – regardless of gender or age – can suffer from sleep apnea. Other risk factors include obesity, smoking, drinking, use of sedatives or tranquilizers, high blood pressure, and family history. Central sleep apnea strikes most often in people with heart disorders, neuromuscular disorders, strokes, or brain tumors. It is also more common in males.

Is sleep apnea dangerous?

Sleep apnea is considered a serious medical problem and if left untreated can lead to high blood pressure, increasing the risk of heart failure and stroke. The ongoing state of fatigue caused by sleep apnea can lead to problems at work or school, as well as danger when operating cars or other heavy machinery. Sleep apnea can also cause complications with medication or surgery: sedation by anesthesia can be risky, as can lying flat in bed after an operation. If you know or suspect you suffer from sleep apnea, alert any doctors who prescribe medication or advise surgery.

How is sleep apnea treated?

Treatments range widely and depend on the severity of the problem and the type of apnea. Basic treatment can be behavioral - for instance, patients are instructed to lose weight, stop smoking, or sleep on their sides instead of on their backs. Beyond that, oral devices can be used to position the mouth in such a way that prevents throat blockage. In more severe cases, surgery may be the best option.

What should I do if I suspect that someone in my family suffers from sleep apnea?

Give us a call, and we can refer you to a sleep apnea specialist. The specialist may recommend a "sleep study" to diagnose the precise extent of the problem, and can prescribe appropriate treatment. Depending on your situation, treatment may involve an oral device that we can custom-create for you.

Snoring

Oral appliances can be a first-line treatment for snoring and mild- moderate obstructive sleep apnea (OSA). This is good news for the estimated 18 million OSA sufferers in the U.S., since it enables them to avoid the risks associated with surgery and the discomfort that can accompany other treatment methods.

Signs and symptoms

OSA causes snoring, airway blockage and sleep disruption. It occurs when the tongue and soft tissues in the back of the throat collapse to block the airway during sleep, producing pauses in breathing that can occur a few times or several hundred times a night, disrupting sleep. OSA can cause:
  • Excessive daytime sleepiness
  • An increased risk of high blood pressure
  • Higher rates of stroke, arrhythmias, heart attack and even death.
In fact, OSA reportedly contributed to the 2004 death of football great Reggie White. Experts also believe that it may be responsible for a high percentage of on-the-job injuries and motor vehicle accidents, as well. OSA can be life threatening: Treating it is important. “Oral appliances may help people who have tried other OSA treatments and been unsuccessful or who have not complied with their treatment,” added Lawrence Epstein, M.D., president, American Academy of Sleep Medicine.“OSA is a serious, life-threatening condition – but for many patients, alleviating its effects can be as easy as utilizing an oral appliance at night,” explains ADSM president, Kent Moore, M.D., D.D.S. “Oral appliances, which resemble sports mouth guards, may control mild to moderate OSA with minimal discomfort or disruption.” This practice parameter is based on an accompanying review of extensive evidence found in the scientific literature that was performed by an expert task force. While continuous positive airway pressure (CPAP) is still considered the most efficacious treatment for OSA, many patients find this form of treatment uncomfortable or intolerable, making an oral appliance often a more appropriate option. The new practice parameters (and accompanying review paper) validate the effectiveness of oral appliances as a viable treatment alternative for those patients with mild to moderate OSA who either prefer it to CPAP, or are unable to successfully comply with CPAP treatment. Until there is higher quality evidence to suggest efficacy, CPAP is indicated whenever possible for patients with severe OSA before considering oral appliances. According to Dr. Moore, oral appliances offer a safe, effective and non-invasive treatment option for the millions of Americans suffering from OSA and severe, chronic snoring. When utilized during sleep, they help maintain an open and unobstructed airway in the throat by repositioning or stabilizing the lower jaw, tongue, soft palate or uvula. There are many types of oral appliances, with some designed specifically for snoring and others intended to treat both snoring and sleep apnea.

What to do if you think you’re experiencing symptoms of OSA

Those who think they may suffer from a sleep-related breathing disorder should seek help from a qualified medical professional. A sleep clinician can assess the severity of the problem and, if appropriate, refer the patient to a dentist trained in the treatment of snoring and sleep apnea. The dentist will properly fit and adjust an oral appliance to meet the individual patient’s needs. Follow- up visits to the sleep clinician and dentist will help monitor the patient’s progress and assess the effectiveness of the treatment. Facts about snoring and obstructive sleep apnea:
  • An estimated 30 million – or one in
  • eight – Americans snore.
  • Individuals who snore have a high
  • likelihood of having (or developing)
  • obstructive sleep apnea
  • Approximately 18 million
  • Americans suffer from sleep apnea.
  • Some 28 percent of men over the age of 65 suffer from sleep apnea
  • Up to 50 percent of sleep apnea. patients have high blood pressure
  • Risk for heart attack and stroke also may increase among those who have sleep apnea.
  • Nearly 60 percent of Americans suffer from daytime sleepiness, a side effect of sleep apnea.
  • Snoring and mild-moderate apnea is improved and often eliminated in many patients who use oral appliances.
Each year, sleep disorders add an estimated $15.9 billion to the national healthcare bill.

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Deborah Ferrer