FAQ'S-SNORING/SLEEP APNEA

Many people who are interested in snoring and obstructive sleep apnea are not very knowledgeable about either of them.  The following information will give you a brief overview about snoring and sleep apnea.

Q. Is snoring normal?

A.  Most people snore to some degree.  Generally speaking it is quite normal.  If snoring gets to the point where it becomes extremely loud and bothersome to others, then this degree of snoring is not considered normal.

Q. Do men snore more than women?

A.  Snoring is much more prominent in men than in women.

Q. What causes snoring?

A.  Snoring is most often caused by loose, weak, or excessive tissue at the back of the throat which collapses into the airway during sleep.  This tissue flutters or vibrates as air is breathed in.  This fluttering tissue, like a flag flapping in the a strong breeze, is the cause of the aggravating noise we know as snoring.

Q. Why does snoring occur during sleep?

A.  During sleep the soft tissues that cause snoring tend to relax.  The deeper we fall asleep, the more relaxed this tissue becomes.  This relaxed tissue will begin to cover the airway and thus the snoring sound begins  This is why we usually do not hear ourselves snore.  By the time we start to snore, we are in a deep enough sleep not to hear the noise.

Q. Why do some people snore more loudly than others?

A.  Some people are simply born with the characteristics that lend themselves to be snorers.  These characteristics are body structure and the anatomy of the mouth and surrounding structures.  Outside factors such as medications and alcohol can also make snoring worse.

Q. What about the people who really rattle the house?

A.  Snoring can be a "fire alarm" for more serious problems than just keeping others awake.  Snoring can signal the existence of Obstructive Sleep Apnea.

Q. Why does alcohol make you snore louder?

A.  Alcohol relaxes the tissue in the back of the throat.  Since it will now collapse into the airway and vibrate easier, the snoring sound will be easier to make and therefore louder.

Q. When does regular snoring become a nuisance?

A.  Whenever the sound of snoring creates a problem for the snorer, bedmate, roommate, or others in close proximity.  There really is no other criteria for this other than the tolerance within the household, apartment, tent, etc.

Q. Is it up to everyone else to tolerate the loud snoring?

A.  Quite frequently someone who snores loudly does not realize or believe that they do.  Even when an irrate partner complains about it, the snorer may still deny it.  This is actually typical of problem snorers.  It should be understood that because it is done uncontrollably, snorers are not at fault for their snoring.  It should also be understood by snorers, that they may indeed be creating problems for others, whether they care to admit it or not.

Q. My spouse literally STOPS BREATHING.  It SCARES me to death! Is this normal?

A.  NO THIS IS NOT NORMAL.  It is a symptom of a far more serious problem called Obstructive Sleep Apnea.

Q. What is Obstructive Sleep Apnea?

A.  Obstructive Sleep Apnea (OSA) is a condition where the airway becomes covered, usually by the tongue, due to abnormal muscle relaxation of the tongue and surrounding muscles in the throat area.  With the airway covered, a person does not breathe.  Since no breathing is taking place, one's oxygen level in their body drops and their heart rate increases.  This lowered oxygen level is dangerous because it can cause a stroke or heart attack.  The higher heart rate is dangerous because it can aggravate high blood pressure.  In an attempt to breathe, a person either awakens or partially awakens gasping for breath.  Since an individual is always awakening to catch their breath, they never get the deep, restful sleep needed by the body.  This often leads to excessive daytime sleepiness (EDS).

Q. Is OSA dangerous?

A.  YES!  Sleep apnea has been linked to heart disease, strokes, high blood pressure, personality changes, impotence, depression, etc.  The main symptom is excessive daytime sleepiness (EDS).  Statistics show that many traffic accidents are due to driver fatigue.  So, not only can we hurt ourselves, we can also inadvertently injure others.

Q. Do dental devices really work in treating snoring and apnea?

A.  YES!  Research has shown that oral appliance therapy is very effective for snoring, mild and moderate sleep apnea, and sometimes severe sleep apnea.  This therapy is also very effective for people that have had surgery and the surgery was not successful.

Q. What is positional therapy?

A.  Positional therapy is having an individual sleep on their side instead of their back so as to reduce their snoring or apnea.  The most crude yet effective form of this therapy is the elbow from your sleeping companion.  In reality, approximately 70% of the population has a positional component to their sleep.  Actually, sleeping slightly elevated and on your side is the best for people with a positional component to snoring or apnea.

Q. Are there many dentists trained in this form of treatment?

A.  NO.  Before selecting a dentist to treat you with an oral appliance, be sure that the dentist has the experience, knowledge, and education necessary to treat your problem.  Always feel free to question your doctor about his/her credentials and all treatment options.  Ask if your dentist is a member of the Academy of Dental Sleep Medicine.  Is the dentist credentialled by this organization?  The Academy of Dental Sleep Medicine is an international organization of dentists, physicians, and researchers that has the sole purpose to educate and train doctors in the use of oral appliances to treat sleep disordered breathing.  This organization also supports research in the field of oral appliance therapy.  All dentists serious about the use of oral appliances to treat snoring or sleep apnea should be a member and credentialled by the Academy of Dental Sleep Medicine.  Be careful of the dentist who has done a few cases and does not have the full commitment to treat this dangerous medical condition on a full-time basis.

Q. If I wear an oral appliance to treat my snoring or apnea, how will this affect my jaw joint?

A.  Research and clinical data show that there is rarely adverse effects on the jaw joint.  This is not to say that, in rare cases, jaw problems can not occur.  A certain percentage of patients will have tooth or jaw movement.  This is a small inconvenience in comparison to the dangers of sleep apnea.

Q. How does the cost of Oral Appliance therapy compare to other forms of treatment for snoring or sleep apnea?

A.  The costs for this treatment utilizing sophisticated appliances is comparable to surgery or nCPAP therapy.  Most insurance companies are now reimbursing patients for some or all of the cost of oral appliance therapy.  The patient must have a diagnosis of obstructive sleep apnea.  Each insurance company and each medical policy has different benefits and rules though.  It is unfortunately true that new technology is often times harder to be reimbursed for than older types of treatment.  Our office is presently a contracted provider for Mayo Clinic insurances for the treatment of sleep apnea with oral appliances. 

Snoring and Obstructive Sleep Apnea

Snoring affects approximately 44% of men and 30% of women.

Unfortunately, snoring is a problem many bed partners wish they never had to contend with.  The snoring sound is a result of increased upper airway resistance that is caused by the narrowing of the airway passage between the free edge of the soft palate and the back of the tongue.  The free edge of the soft palate will vibrate as the air passes over it causing the snoring sound.  Snoring can be an early warning sign for the dangerous medical condition known as Obstructive Sleep Apnea.

A person with Obstructive Sleep Apnea actually stops breathing while asleep.

This can occur with various frequencies ranging from just a few times to over 100 times per hour.  What usually happens is that the tongue falls onto the airway creating a physical obstruction.  Of course, when you don't breathe, the oxygen level in your blood is reduced.  This is one of the many dangerous aspects of sleep apnea.  Once the airway is closed off, the harder a person tries to breathe, the tighter the airway becomes sealed.  When the oxygen level gets too low, the classic gasping sound and deep breath occurs as the person violently throws the tongue off of the airway in order to breathe.  Of course, reduced oxygen levels can cause serious medical problems.  What are normal body oxygen levels?  How far can they drop for a person with sleep apnea?  During normal breathing, one's oxygen levels can range in the 97-100% range.  Few people can intentionally hold their breath until they get down to a 93% blood oxygen level.  Yet, while asleep, some individuals blood oxygen levels can drop to as low as 40%.  Many people with apnea routinely have a low blood oxygen level in the 60-80% range.  Oxygen levels in this range can precipitate heart attacks, strokes, and other serious medical problems.

There are two types of sleep apnea:

One is Obstructive Sleep Apnea, the most common form.  This type of apnea is characterized by having a physical obstruction of the iarway, but the individual is still trying to breathe.  Once the airway is open, one's breathing continues.  The other type of sleep apnea is Central Sleep Apnea.  In this condition the brain fails to send the signal to breathe.  Once the oxygen level drops far enough, ther person's body stimulates the breathing process.  Some individuals can also have what are called mixed apneas.  Mixed apneas have both obstructive and central sleep apnea events.

If an individual is consistently gasping for breath and having a reduced oxygen level in thier body, it is easy to see why a restful night of sleep is out of the question.  Also, when you stop breathing, your pulse rate increases.  A higher pulse rate means that your heart is beating faster and working harder.  This is fine if you are exercising, but not when you are trying to sleep.  Frequent choking and an elevated heart rate are not the most conducive elements for a restful nights sleep.

Some of the most common signs of sleep apnea are heavy snoring, excessive daytime sleepiness, nighttime choking or gasping, morning headaches and nighttime acid reflux.  Studies have shown that approximately 30% of individuals with high blood pressure have sleep apnea, and 50% of individuals with sleep apnea have high blood pressure.  Other studies have shown that approximately 25% of individuals that have had heart attacks have obstructive sleep apnea and there is strong evidence that heavy snoring and apnea can cause persistent hypertension, memory deficits, decreased sexual functioning, difficulty concentrating and personality changes.