Is it dangerous to snore?
The National Sleep Foundation found that about one third of U.S. working adults report snoring at least a few nights each month. Snoring generally worsens with age so the rate increases among the elderly. Contrary to common perceptions, it’s nearly as common in women as men. Menopause and being overweight are important factors. Yet many who regularly snore don’t realize that it could be bad for their health.
According to the scientific literature, snorers experience
- A higher incidence of stroke and cardiovascular disorders;
- A 40 percent greater risk than non-snorers of suffering from high blood pressure;
- A 34 percent greater risk of having a heart attack; and
- A 67 percent greater chance of having a stroke.
What causes snoring?
The research linking hypertension, heart problems and loud snoring is relatively new and awareness of sleep apnea is growing. But it is a condition that remains vastly undertreated.
What is obstructive sleep apnea?
When breathing is interrupted by an obstruction in the airway, the body reacts by waking enough to start breathing again. These arousals may occur hundreds of times each night but do not fully awaken the patient, who remains unaware of the loud snoring, choking and gasping for air that are typically associated with obstructive sleep apnea.
Obstructive sleep apnea sufferers never get “a good night’s sleep” because repeated apneas and arousals deprive patients of REM and deep-stage sleep, leading to chronic daytime exhaustion and long-term cardiovascular stress.
What’s the difference between mild, moderate and severe Sleep Apnea?
Moderate Sleep Apnea = AHI between 15 and 30
Severe Sleep Apnea = AHI > 30
Is it possible that I snore and don’t have apnea?
Is it possible that I have apnea even though I don’t snore?
Who gets sleep apnea?
Can sleep apnea be cured or will it go away?
What happens to my body when I have an apnea?
This can leave you with a weakened immune system and many other serious health complications. It also can cause a hormone imbalance as sleep deprivation causes the release of stress hormones like cortisol, which can harm your body.
What are the health implications of obstructive sleep apnea?
In addition, loud snoring and intermittent breathing interruptions can affect the quality of sleep of the apnea patient’s bed partner. Witnessing an apnea can be a frightening experience because the apnea patient appears to be suffocating. Frequently, it is the sleep-deprived bed partner who convinces the patient to seek medical help.
Who suffers from obstructive sleep apnea?
While obstructive sleep apnea is commonly associated with obesity and male gender, it affects a broad cross-section of the population. Other risk factors result in habitual snoring, which is often a precursor of more serious upper airway disorders such as obstructive sleep apnea. In fact, results from a recent study indicate that 1 in 3 men and nearly 1 in 5 women who snore habitually suffer from some degree of obstructive sleep apnea.
What types of testing is available?
How much does sleep apnea testing cost?
Do I need to have an overnight study in the sleep lab?
What is a polysomnogram?
If you do get a polysomnogram, do not take any sleeping pills, alcohol or caffeinated beverages before the test because they will throw off the accuracy of the polysomnogram. When you start the polysomnogram many sensors will be placed over parts of the body to gather the necessary measurements. Most people are able to sleep with the sensors on because they’re small and unobtrusive. The testing area is typically set up as like a bedroom, so patients can feel comfortable.
What is AHI?
What is OAT, Oral Appliance Therapy?
How long have oral appliances been used to treat OSA?
How does the oral appliance work?
Will this oral device help my snoring?
How do I know that the oral appliance will benefit me?
Why hasn’t my sleep physician and PCP ever mentioned OAT as a treatment choice?
If you did broach the subject of an oral appliance with your physician, did he/she merely pass it off? Was there a consideration that surgical options are laden with risks (and only about 40% effective) or that you’re not sleeping anyway because you can’t use the CPAP? The CPAP is, will be, and always has been the “gold standard” in sleep medicine because it works 100% of the time–but only in 25% or so of the population that needs it–so it is hardly “gold standard-worthy” in the eyes of many. If one can’t use a CPAP and surgical procedures don’t work–what other choice does one have? OAT can be the answer delivered by our experienced oral and maxillofacial surgeon.
What’s the general consensus among physicians regarding the effectiveness of OAT?
The rest of our patients are post-surgical patients (only 40% or so of surgical procedures are effective) that still can’t breathe at night, or those who can’t put up with the hassles, stigma, or claustrophobia that accompanies the use of a CPAP in bed every night.
Are there patients for whom Oral Appliance Therapy does not work?
Do I need to see my PCP first?
How do I start the OAT process?
How will I know if my appliance is working?
Does my insurance cover treatment?
How much does the treatment cost?
Does Medicare cover the treatment?
How long does the treatment take?
Will I be required to return to the same office for follow-up care?
I have full upper and lower dentures, can I still have an oral appliance?
I haven’t had dental care in awhile. Must that be taken care of beforehand?
Is there an extra fee for the provisional appliance?
If I am claustrophobic, can I still have an oral appliance?
I have a latex allergy, can I have an oral appliance?
I am presently taking medication for reflux. Will OAT help or reduce my usage?
I am presently taking medication for hypertension. Will OAT help or reduce my usage?
Are there any long-term problems with the use of an oral appliance?
What are the side effects of use of an oral appliance?
How often will my appliance have to be remade, and will my insurance cover it?
Does my dental insurance cover any of this treatment?
Does Medicare cover OAT?
How many appointments will it take to complete OAT?
What are the side effects of OAT?
Another common side effect is jaw discomfort in the morning. Similar to the stiffness one might experience in the knees/hips when trying to stand up after a long movie, the jaw is not permitted to return to its fully seated position in the socket. Some muscle stiffness is common in the morning. Most patients report that the symptoms dissipate within several hours or so. This is a small price to pay for being able to sleep soundly and silently all night long and to minimize the health risks of apnea. Other minor considerations include dryness of the lips and mouth, irritation of the cheeks/gums, and, though exceedingly rare, allergic reaction to the materials in the appliance.
Will my jaw feel sore?
Will I salivate at night?
Will I be able to make my own adjustments?
Will I have permanent bite changes?
How do I clean the appliance?
What is CPAP?
CPAP treatment consists of three parts: the CPAP compressor, tubing and a special CPAP mask or cannula. The CPAP Machine is essentially a quiet air compressor that continually forces air thorough the tubing to the mask or cannula (cannulas are small tubes that fit within the nose). The continuous air pressure forces the airway to remain open, which allows for normal breathing for the entire night. Difference between Bi-level and Auto CPAP machines: Bi-level CPAP machines have two different settings, one for inhalation and one for exhalation. Auto CPAP machines automatically adjust to the resistance a patient’s breath gives and provides the appropriate amount of pressure. While Bi-level CPAP machines will work without problems, Auto CPAP machines provide maximum comfort.
What is an AutoPAP?
What is a Bi-level/BiPAP Machine?
What type of mask should I use?
Which type of mask you use depends on your individual needs. If you breathe through your mouth, you will most likely want a full-face mask. If the bulkiness of the mask is uncomfortable for you, nasal pillows might be appropriate.
Can you give me some tips about using my CPAP machine?
Probably the second-most common side effect of CPAP treatment is the dry or congested nasal passages. There are several solutions to this problem. One solution is to use a CPAP machine that has a CPAP Heated Humidifier. The heated humidifier, with the help of the CPAP machine, blows wet, warm air through the nasal passages, which helps keep them moist and comfortable. Another solution offered by Metrohealth is to purchase a saline nasal solution, which is essentially a mixture of salt and water. Saline nasal solution can be purchased for a low price at a local drug store. A final option would be to use a nasal decongestant, although you will want to consult with a physician before taking a decongestant for an extended period of time.
The third most common problem with CPAP machines is adjusting to the continuous pressure. The Hopedale Medical Complex recommends using the CPAP’s machine “ramp” setting. The “ramp” setting allows users start out with very little pressure with the machine gradually increasing it until the optimal pressure level is achieved. Consult with your physician about what ramp setting is right for you. The method of adjusting the ramp setting varies between CPAP machines; consult the owner’s manual or manufacturer for more information.
There are a few other things you can do to avoid CPAP problems. The most important thing is to clean the tubing, headgear and mask regularly. Bacteria grows in the tubing over time, especially when used with a heated humidifier, which can cause respiratory problems. Unclean headgear and masks can also accumulate bacteria and cause infections. Another important tip is to stay consistent and committed to the CPAP treatment. If you don’t stay consistent with treatment, it will be more difficult to continue because you have not gotten accustomed to mask and continuous pressure. Finally, if you still have trouble, consult your physician and get help from CPAP support forums, such as Apneasupport.org or CPAP Talk.
Is my CPAP machine covered by my insurance company or Medicare/Medicaid?
I have been told that I need a surgical procedure to correct my problem.
What is UPPP Surgery?
What is the Pillar® Procedure?
Pillar implantation takes about twenty minutes to perform. This procedure is associated with minimal discomfort with most patients returning to work the following day.
Why would a doctor put in up to five implants when most other doctors put in three?
Based on personal experience over the years, better snoring control occurs for more patients with four to five implants. The width of the soft palate will determine whether four or five implants will be placed.
How much pain is expected and what is the recovery time?
When will I start to notice an improvement in snoring?
The natural tissue response to the implants will progressively support the soft palate over the 3-12 months after implantation to further minimize the sound of snoring.
Are the implants permanent?
Is the Pillar Procedure covered by my insurance?
Some insurance companies will cover the consultation visit for evaluation of snoring, since snoring can be a sign of sleep apnea a serious medical condition.
I have sleep apnea. Will the Pillar Procedure be covered by my insurance?
Insurance companies see CPAP as the first-line treatment for sleep apnea. And in place of that, an oral appliance would be the next best option. If you wish to have the Pillar® Procedure as an alternative to an insurance covered benefit like CPAP for the treatment of your sleep apnea, please understand that our practice cannot bill your insurance company for the Pillar procedure, nor can we contact them to request authorization to perform the Pillar® procedure as a covered benefit.
What is Somnoplasty®?
How effective is Somnoplasty in the treatment of obstructive sleep apnea?
Who is a candidate for Somnoplasty for obstructive sleep apnea?
What other conditions can be treated with Somnoplasty?
Is there a glossary of terms? I am not familiar with the medical and dental jargon.
A cessation of breathing/airflow lasting greater than 10 seconds.
Apnea Hypopnea Index (AHI)
A measure of one’s severity of sleep apnea, as determined by the number of apneas plus hypopneas, on average, in an hour of sleep; <5 events /hour = ("normal"); 5-15 events/hour = (mild sleep apnea); 15-30 events/hour = (moderate sleep apnea); >30 events/hour = (severe sleep apnea).
An interruption of sleep of a duration greater than 3 seconds.
Adaptive Servo Ventilation machines: essentially operates as would a bilevel machine, but with the added ability to adjust IPAP (inhalation pressure) upward very rapidly (within one breath) if the sleeper looks like they won’t reach the target volume or flow that the machine has been tracking.
This device regulates airway pressure at prescribed levels, alternating between inhalation (IPAP) and exhalation (EPAP) pressures. Usually, the inspiratory pressure is higher than the expiratory pressure. Bilevel therapy is helpful to those with sleep apnea combined with other respiratory conditions.
Philips Respironics trademark for its bilevel machine
Grinding of the teeth. Often associated with sleep apnea.
Central Sleep Apnea
Sleep Apnea characterized by episodes where there is no airflow and no effort to breathe lasting greater than 10 seconds. Different from an obstructive sleep apnea because the cause of the cessation of breathing is not a physical obstruction.
A form of Central Sleep Apnea where one’s breath becomes progressively shorter and shallower, pauses completely, and then after a period starts the cycle over. Could be a sign of a problem with the heart.
A chinstrap is worn to keep the mouth closed to prevent leak from the mouth.
Complex Sleep Apnea
When central sleep apneas are triggered by the application of positive airway pressure. Contrast with Mixed Sleep Apnea, Obstructive Sleep Apnea and Central Sleep Apnea.
Continuous Positive Airway Pressure. Filtered room air is delivered to a mask that fits over the nose to prevent upper airway tissues from collapsing. The prescribed pressure acts as a splint to maintain the airway. This pressure is continuous during both inhalation and exhalation. CPAP is used to treat Obstructive Sleep Apnea (OSA) as well as Upper Airway Resistance Syndrome (UARS). CPAP is a corrective therapy that should be used on a nightly basis to be beneficial.
Drop in O2 oximetry distribution saturation by 3% below average saturation.
Durable Medical Equipment provider, home health care provider or any other person or entity that sells CPAP supplies and equipment. Equipment is prescribed by a physician, and supplied by the DME. CPAP supplies can be rented on a month-to-month basis or purchased, depending on insurance requirements.
Ear Nose Throat physician
Epworth Sleepiness Scale
<10=(does not indicate EDS (Excessive Daytime Somnolence));10-15=(indicates daytime somnolence-not excessive);>16 (indicates EDS).
Filters attach to pressure devices to improve the quality of air inhaled. There are two types of filters available: reusable and disposable.
Gastroesophageal reflux disease
Humidifier for Breathing Device
Humidification is provided by passing air across a tray of water to prevent nasal dryness. There are two types of humidifiers: heated or non-heated. A humidifier can increase the comfort and tolerance while using a positive pressure device. Some insurance companies do not cover humidification.
>50% decrease in airflow for 10 seconds or greater with a decrease in oxygen saturation of >3%.
There are several interfaces for positive pressure devices, most involving a mask with headgear, worn over the nose. A properly fitted mask creates a good seal around the nose, while maintaining comfort. Air leaking into the eyes should be avoided. The user’s mouth must be closed during therapy while using a nasal mask or pillows or a leak will occur.
Mixed Sleep Apnea
Sleep Apnea characterized by episodes of both central and obstructive apnea events (the centrals not being triggered by the CPAP therapy). Contrast with Central Sleep Apnea, Complex Sleep Apnea and Obstructive Sleep Apnea.
Maxillo-mandibular advancement, a type of surgery
An alternative to the standard mask, small silicone “pillows” fit into the nostrils and deliver air directly to the nasal passages.
Frequent nighttime urination, often associated with untreated sleep apnea.
Sleeping in any position other than on the back.
Normal Sleep Architecture
Stage 1: 5%
Stage 2: 50%
Stage 3: 10%
Stage 4: 10%
Stage REM: 25%
Nocturnal Polysomnogram, or sleep study.
Oral Appliance Therapy – custom oral jaw and tongue positioning devices which have proven to be remarkably effective at reducing and eliminating snoring and obstructive sleep apnea episodes.
A respiratory episode where there is no airflow lasting greater than 10 seconds, and the cause of the airflow limitation is a physical obstruction.
Obstructive Sleep Apnea (OSA)
Obstructive Sleep Apnea is the partial or complete collapse of the upper airway which is caused by the relaxation of excessive tissue during sleep. This may result in frequent arousals associated with decreases in blood oxygen levels. This constant interruption of sleep results in a loss of restful, healthy sleep. This lack of sleep generally causes daytime sleepiness and poses a serious threat to physical health and mental well-being.
Oral & Maxillofacial Surgeon, who is a doctor that specializes in problems with the mouth and face, including airway issues involved in the diagnosis and non-surgical and surgical treatment of sleep apnea.
Process by which plastic component parts of CPAP masks and other CPAP supplies give off a chemical odor after being manufactured until they have been exposed to the air for a sufficiently long period of time.
PLM arousal index
The number of periodic limb movements that cause arousals multiplied by the number of hours of sleep.
Periodic limb movements.
Polysomnogram study (PSGS)
Sleep study consisting of a test of sleep cycles and stages through the use of continuous recordings of brain waves (EEG), electrical activity of muscles, eye movement (electrooculogram), breathing rate, blood pressure, blood oxygen saturation, and heart rhythm and direct observation of the person during sleep
Technician, typically registered, who administers a sleep study.
Term for the condensation that can build up inside a CPAP hose when warm, humidified air flows through a CPAP tube exposed to cold air.
A feature of most units, allows for a gradual increase of pressure as the user falls asleep. The ramp time is usually measured in 5-minute intervals, ranging between 5 and 45 minutes to reach prescribed pressure settings.
Respiratory Disturbance Index. An index used to assess the severity of sleep apnea based on the total number of complete cessations (apnea) and partial obstructions (hypopnea) of breathing occurring per hour of sleep. These pauses in breathing must last for 10 seconds and are associated with a decrease in oxygenation of the blood. In general, the RDI can be used to classify the severity of disease (mild 5-15, moderate 15-30, and severe greater than 30).
Time it takes to achieve REM (dreaming) sleep from sleep onset.
Short for Rapid Eye Movement sleep, which is the dreaming stage of sleep; Normally occurs every 60-90 minutes.
Respiratory effort related arousals. Episodes that are not apneas or hypopneas, often related to loud snoring, that generally do not cause a decrease in oxygen saturation.
Respiratory Arousal Index (RAI)
(AHI + snoring related EEG arousals)/hour of sleep.
Respiratory Effort Related Arousals (RERAs)
Sleep Arousals due to respiratory events characterized by pressure flow limitations in the airflow indicator channel without significant O2 desaturations.
Respiratory related sleep fragmentation
Sleep arousals due to respiratory events or snoring.
Registered respiratory therapist (i.e., a respiratory therapist who has passed a board exam for certification).
Registered polysomnographic technologist (i.e., a polysomnographic technologist who has passed a board exam for certification).
a measure of oxygen desaturation in the body brought about by sleep disordered breathing; >89%=(“normal”); 85-89%=(mild desaturation);80-84%=(moderate desaturation); <80% (severe desaturation).
Normal is >80%
Stage 1 Sleep
The lightest stage of sleep. Transitional stage from wake.
Stage 2 Sleep
The first true stage of sleep.
Stages 3/4 Sleep
The deepest, most restorative sleep; aka “Deep Sleep” — Deep Sleep, along with REM sleep, decrease as we age
Sleeping on back. Without positive airway pressure, often associated with more severe obstructed sleep apnea than sleeping on one’s side.
Temporo-mandibular joint, quite often used to refer to a symptomatic problem with the joint or disease state.
A tracheostomy is a surgical procedure to create an opening through the neck into the trachea (windpipe). A tube is usually placed through this opening to provide an airway into the upper trachea. This tube is called a tracheostomy tube or trach tube. This airway bypasses the entire upper airway and therefore is 100% successful in curing sleep apnea.
Upper Airway Resistance Syndrome. UARS is a narrowing of the upper airway during sleep associated with frequent arousals due to difficulty breathing.
Uvulopalatopharyngoplasty, a type of surgery
Trade name for its bilevel machine.
Generic term to refer to any positive airway pressure machine: CPAP, bilevel, etc.