Obstructive Sleep Apnea

Snoring and Obstructive
Sleep Apnea

Snoring

While snoring itself may be harmless, it can also develop into, or be a symptom of, a more serious medical condition known as obstructive sleep apnea (OSA).

What Causes Snoring?

Snoring is caused by a narrow airway. That's because air travels faster through a slender tube than through a broad one. This rapidly moving air causes the soft tissues of the throat (the tonsils, soft palate, and uvula) to vibrate. It is this vibration which is the sound of snoring. It's like putting a flag in front of a fan: the faster the fan, the greater the flutter. Why is the airway narrow in snorers? Many things can take up space in the airway reducing its diameter. These can include large tonsils, a long soft palate or uvula, and, in people who are overweight, excessively flabby tissue. The most common cause of a narrowed airway is a tongue that relaxes too much during sleep and gets sucked back into the airway with each breath taken.

Help for Snoring and Obstructive Sleep Apnea

Mild or occasional snoring and symptoms of OSA may be alleviated by lifestyle changes:

  • losing excess weight
  • getting regular exercise
  • within three hours of bedtime, avoiding alcohol, heavy meals, and medications that make you drowsy

When symptoms are more severe, and these measures don't resolve the problem, other treatment options may include:

  • surgery to the nose, throat, tongue, or jaw
  • nasal CPAP (Continuous Positive Airway Pressure), a therapy in which an air compression device and a nose mask are used to force the airway open and aid breathing during sleep
  • Dental Appliance Therapy, which is an effective way of treating snoring and OSA for many patients. It may be employed on its own, or in combination with other methods of treatment

What is Obstructive Sleep Apnea?

When the tongue is sucked completely against the back of the throat, the airway is blocked and breathing stops. Once that happens, the harder the sleeper tries to breathe, the tighter the airway seal becomes. It's like trying to drink through a straw that's stuck in a lump of ice cream. The harder you suck, the flatter the straw becomes. The airway obstruction won't clear until the brain's oxygen level falls low enough to partially awaken the sleeper. The tongue then returns to a more normal position, and the airway seal is broken—usually with a loud gasp.

Did you know?

  • Regular snorers have a 33% increased risk of cardiovascular disease.
  • Patients with OSA are four times more likely to have a heart attack.
  • 40-80% of stroke sufferers also suffer from OSA.

OSA is a serious medical condition that can have a significant impact on quality of life, placing unnecessary strain on relationships between bed partners, family and the work place. If you have been heard to gasp for breath at night, are excessively sleepy during the day, or display symptoms of OSA you should consult your general practitioner, sleep specialist or ENT surgeon. Some of these symptoms are:

  • Loud snoring
  • Excessive daytime sleepiness
  • Depression
  • Fatigue
  • Reduced resistance to infection



Treatment Options

Continuous Positive Airway Pressure (CPAP)

CPAP is a machine that blows air at a prescribed pressure via a hose to a nasal pillow, a nose mask, or a full-face mask keeping the airway open by air pressure in order to reduce airway resistance.



Oral Appliance Therapy

A device worn on the teeth to position the tongue and lower jaw forward while sleeping in order to reduce airway resistance.

Uvulopalatopharyngoplasty (UPPP)

A surgical procedure to widen the space in the back of the throat to reduce the callapsibility of the airway.

Oral Appliance Therapy for Obstructive Sleep Apnea

What is a Dental Appliance?

A dental appliance is a small plastic device, similar to an orthodontic retainer or an athletic mouthguard. It is worn in the mouth during sleep to prevent the soft throat tissues from collapsing and obstructing the airway. Dentists and dental specialitsts with training in dental appliance therapy can design, construct, and fit these special appliances to meet their patients' individual situations and conditions. Clinical studies have found a majority of patients, a well-made, well-fitted dental appliance will effectively reduce or eliminate snoring, and significantly relieve symptoms of mild and moderate obstructive sleep apnea.

Dental appliances work in three ways:

  • Brings the lower jaw forward
  • Holds the tongue forward
  • Lifts a drooping soft palate

A combination appliance may perform two or more of these functions at the same time. Dental appliances have been in use as far back as the early 1900's. Finally, in the 1980’s, physicians and dentists began to work together to study and develop this alternative form of treatment, enabling more patients to benefit from it.

Advantages of Dental Appliance Therapy

Dental appliance therapy offers many advantages:

  • Small, and easy to wear
  • The appliance is easy to use when travelling
  • Comfortable when wearing the appliance
  • Dental appliances are relatively inexpensive
  • Treatment is reversible and non-invasive (does not involve surgery).

What the Dentist Can Do

On the first visit, the dentist will thoroughly examine the teeth and mouth, using X-rays and dental impressions. The patient will be fitted with an appliance, which will be worn for a week prior to a second evaluation. Over succeeding weeks, if necessary, other types of dental appliances can be used to see which fits best. Finally, the specialist will design and fit a custom-made appliance. The dental specialist will show you how to place the dental appliance into the mouth and how to care for it when not in use.

Once the dental appliance has been worn regularly, during sleeping hours, for two or three months, the dental specialist will refer you back to the physician or sleep specialist to determine how effectively the appliance is controlling the snoring and OSA. The patient will continue to visit their dental specialist at regular intervals. At times it may be necessary to modify and maintain your dental appliance so that it remains effective.

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