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Sleep Apnea

Serving Salt Lake City, Park City and surrounding Utah communities

Sleep apnea is a potentially life-threatening medical condition that affects more than 20 million Americans. Though they may not be aware of it, their snoring is an indicator that their sleeping patterns are adversely affected. This leads to many factors that reduce a person's quality of life. Quality sleep and its restorative properties are essential.

The Greek word "apnea" means "want of breath." Sufferers of sleep apnea experience stoppage of breathing for a period of at least ten seconds more than five times in the course of one hour. Some patients will stop breathing as many as 100 or more times a night. This disrupts the healing powers of quality sleep, is dangerous and poses many long-term health risks. Sleep is just as important for a person as eating right and being physically active.

These breathing stoppages are frequently accompanied by snoring, but not everyone with sleep apnea snores. It is important that sleep apnea is recognized early because it has been linked with irregular heartbeat, high blood pressure, heart attacks, and strokes.

Symptoms of Sleep Apnea

Increased daytime sleepiness
Continual morning headaches/migraines
Short term memory issues
Inability to lose weight, even if the person is physically active
Concentration and memorization difficulties
Poor performance on the job or in school
Tossing and turning during the night and waking up
Heavy, loud snoring
Difficulty staying asleep

If untreated, over the course of time sleep apnea can be the root cause of many health issues. Heart ailments, hypertension, muscle pain, strokes, morning headaches and excessive drowsiness are all potential problems caused by sleep apnea. Reduced alertness and sleepiness could lead to other problems, like falling asleep while driving or working. In children, sleep apnea can inhibit their ability to learn at school.

When to see a doctor

You should consult a medical professional if you experience, or if your sleep partner observes the following:

Snoring loud enough to disturb the sleep of others or yourself
Shortness of breath that awakens you from sleep
Intermittent pauses in your breathing during sleep
Excessive daytime drowsiness, which may cause you to fall asleep while you are working, watching television or even driving. You can take the Epworth sleepiness test to see if you have daytime drowsiness.

Many people don’t think of snoring as a sign of something potentially serious, and not everyone who has sleep apnea snores. But be sure to talk to your doctor if you experience loud snoring, especially snoring that’s punctuated by periods of silence.

There are many reasons for interrupted sleep and sleep apnea cannot be diagnosed by just the symptoms or complaints of the patient. There are a number of tests that are available for assessing a person for sleep disorders. The most accurate of all tests that exist is a polysomnograph, or a “sleep study.” Sleep studies record an assortment of body functions during sleep. These functions can include eye movement, electrical activity of the brain, muscle activity, heart rate, respiratory effort, air flow, and blood oxygen levels. Polysomnographs are used to diagnose sleep apnea and to determine its severity. Another test is the Multiple Sleep Latency Test, which measures how long it takes you to fall asleep and whether you enter REM sleep.

Causes of sleep apnea

The main problem with sleep apnea is that a person's airway collapses inward during episodes of sleep apnea. This cuts the lungs' ability to take in air from the normal 95% to levels that could dive to around 50%. Even fairly short periods of just a couple of seconds of this disruption can create damaging effects in the long term. This often happens during nourishing, restorative REM sleep. When it does, it jolts the person out of this sleep state as their body eventually forces air into the lungs.

Over the course of time, this oxygen interruption can take its toll, leading to elevated chances of heart disease or strokes. Also, during healthy sleep, growth hormones are secreted into the body and act as regenerative agents. Sleep apnea disrupts this process and inhibits the body's ability to heal minor ailments.

During the days that follow this chaotic sleep, many people experience difficulty when trying to concentrate on their day-to-day tasks. Productivity and alertness are also affected and many sleep apnea sufferers are drowsy throughout their workdays.

Other Dangers of Sleep Apnea

Besides elevating the risks of heart disease and stroke, as well as impeding one's quality of life due to lack of quality sleep, sleep apnea can also contribute to:

Depression
Increased muscle pain
Fibromyalgia
Short-term memory loss
Diabetes
Gastric reflux
Impotence
Anxiety
Insomnia

Impact of sleep apnea on the economy

It is estimated that 25 million Americans suffer from sleep apnea. Of these, more than 200,000 people are involved in motor vehicle accidents each year because of sleepiness problems. At least 38,000 die each year from complications of sleep apnea (i.e. heart attack, stroke etc.)

The cost of health care for sleep apnea patients in the emergency room or ICU is in excess of $50,000 per patient. The total estimated cost in the United States alone is $1.9 billion.

The productivity ratio in people who suffer from sleep apnea is estimated to be at least 10% less than in those who receive a quality night’s sleep. This can cost the U.S. economy around $75 billion each year in lost work.

Risk factors for sleep apnea

Sleep apnea may occur if you're young or old, male or female. Even children can have sleep apnea. But certain factors put you at an increased risk:

Excess weight. Fat deposits around your upper airway may obstruct your breathing. However, not everyone who has sleep apnea is overweight. Thin people develop the disorder, too.
Neck circumference. The size of your neck may indicate whether or not you have an increased risk of sleep apnea. That's because a thick neck may narrow the airway and may be an indication of excess weight. A neck circumference greater than 17 inches in men and 15 inches in women is associated with an increased risk of obstructive sleep apnea.
High blood pressure (hypertension). Sleep apnea is very common in people with hypertension.
A narrowed airway. You may inherit a naturally narrow throat or your tonsils or adenoids may become enlarged and these can block your airway.
Being male. Men are twice as likely to have sleep apnea as women. However, women increase their risk if they're overweight. The risk also appears to rise after menopause.
Being older. Sleep apnea occurs two to three times more often in adults over the age of 65.
Family history. If you have family members with sleep apnea, you may be at increased risk.
Use of alcohol, sedatives or tranquilizers. These substances relax the muscles in your throat and may lead to blockages of the airway.
Smoking. Smokers are three times more likely to have obstructive sleep apnea than are people who've never smoked. Smoking may increase the amount of inflammation and fluid retention in the upper airway. This risk may drop after you quit smoking.

Complications with Sleep Apnea

Sleep apnea is considered a serious medical condition. Complications may include:

Cardiovascular problems. Sudden drops in blood oxygen levels that occur during sleep apnea increase blood pressure and strain the cardiovascular system. If you have sleep apnea, your risk of high blood pressure (hypertension) can be as much as two to three times greater than if you do not have sleep apnea. The more severe your sleep apnea, the greater the risk of high blood pressure. If there is underlying heart disease, these multiple episodes of low blood oxygen can lead to sudden death from a cardiac event. Sleep apnea also increases the risk of stroke, regardless of whether you have high blood pressure.
Daytime fatigue. The repeated awakenings associated with sleep apnea make normal, restorative sleep impossible. People with sleep apnea often experience severe daytime drowsiness, fatigue and irritability. You may have difficulty concentrating and find yourself falling asleep at work, while watching TV or even when driving. You may also feel irritable, moody or depressed. Children and adolescents with sleep apnea may do poorly in school or have behavioral problems.
Sleep-deprived partners. Loud snoring can keep those around you from getting good rest and eventually disrupt your relationships. It is not uncommon for a partner to go to another room, or even on another floor of the house, to be able to sleep. Many bed partners of people who snore are sleep deprived, as well.

People with sleep apnea may also complain of memory problems, morning headaches, mood swings or feelings of depression, a need to urinate frequently at night (nocturia), and impotence. Gastroesophageal reflux disease (GERD) may be more prevalent in people with sleep apnea. Children with untreated sleep apnea may be hyperactive and may be diagnosed with attention-deficit/hyperactivity disorder (ADHD).

What treatment options are there for sleep apnea?

In many cases, self-care may be the most appropriate way for you to deal with obstructive sleep apnea and possibly central sleep apnea. Try these tips:

Lose excess weight. Even a slight loss in excess weight may help relieve constriction of your throat. Sleep apnea may be cured in some cases by a return to a healthy weight. If you don't already have a weight-loss program, talk to your doctor about the best course of action for weight loss.
Avoid alcohol and medications such as tranquilizers and sleeping pills. These relax the muscles in the back of your throat, interfering with breathing.
Sleep on your side or abdomen rather than on your back. Sleeping on your back can cause your tongue and soft palate to rest against the back of your throat and block your airway. To prevent sleeping on your back, try sewing a tennis ball in the back of your pajama top.
Keep your nasal passages open at night. Some patients have had good luck with Breathe Right® strips to help keep the airway open at night.

Medical options

Continuous positive airway pressure (CPAP). If you have moderate to severe sleep apnea, you may benefit from a machine that delivers air pressure through a mask placed over your nose while you sleep. With CPAP, the air is gently forced into your lungs with enough pressure to open collapsed structures in the throat. There are a number of variations of CPAP machines to help your doctor find the best fit for you.

Although CPAP is a preferred method of treating moderate to severe sleep apnea, some people find it cumbersome or uncomfortable. Unfortunately, a significant number of people cannot tolerate a CPAP machine.
Oral appliances. Another option is wearing an oral appliance designed to keep your throat open. CPAP is more effective than oral appliances, but oral appliances are much better tolerated by most people. There has been great progress recently in the options available for oral appliances. They function by bringing the jaw forward while you sleep, which can usually relieve snoring and mild to moderate sleep apnea.

Dr. Johnson has been certified to offer a number of different devices and will be able to discuss what would be the best option for you.
Surgery. If nothing else is able to take care of the problem, sometimes surgery is considered. It is obviously a much more invasive option and usually looked at as a last resort. The goal of surgery for sleep apnea is to remove excess tissue from your nose or throat that may be vibrating and causing you to snore, or that may be blocking your upper air passages and causing sleep apnea. Surgical options may include:
- Uvulopalatopharyngoplasty (UPPP). UPPP is the most common procedure and removes excess tissue at the back of the throat such as the tonsils, uvula, and part of the soft palate. The long-term success of this procedure ranges from 30 to 50 percent. Long-term side effects and benefits are not known and it is difficult to predict which patients will do well with an individual surgical procedure. Other surgical interventions are done with lasers or radioablation (e.g. somnoplasty™), but these are less effective treatments than those done in an operating room.
- Maxillomandibular advancement. In this procedure, the upper and lower parts of your jaw are moved forward from the remainder of your face bones. This enlarges the space behind the tongue and soft palate, making obstruction less likely. This procedure may require the cooperation of an oral surgeon and an orthodontist, and at times may be combined with another procedure to improve the likelihood of success.

Removing tissues in the back of your throat with a laser (UPPP) or with radiofrequency energy (radioablation) are procedures that doctors sometimes use to treat snoring. Although sometimes these procedures are combined with others, they aren't usually recommended as sole treatments for obstructive sleep apnea.

Other types of surgery may help reduce snoring and contribute to the treatment of sleep apnea by clearing or enlarging air passages:

Nasal surgery to remove polyps or straighten a crooked partition between your nostrils (deviated nasal septum)
Surgery to remove enlarged tonsils or adenoids

To learn more about what cosmetic dentist Dr. Kent M. Johnson can do to help you relieve your sleep apnea, please contact our office today to schedule your consultation.