Who has sleep apnea?

Obstructive sleep apnea is a common problem that can affect people of any age and body type.  The American Academy of Sleep Medicine reports that at least 26% of adults between the ages of 30 to 70 years old in the United States suffer from sleep apnea.  That's an estimated 25 million individuals.  Although sleep apnea can occur at any age, the risk increases as you get older.  While the sleep disorder is more common in men, it can occur in women as well, especially during and after menopause.  Having excess body weight, a narrow airway, a recessed chin or jaw, all can increase the risk for sleep apnea.  Because of these anatomical risk factors, sleep apnea is known to run in the family.  If your parents or siblings snore heavily or have sleep apnea, chances are you may have it too.   

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How do I know if I have sleep apnea?

Perhaps the most important question to ask yourself is, "Am I getting a good night’s sleep?" If the answer is no, try recording yourself sleeping or ask someone to listen while you sleep. Pay attention to the following warning signs.

 

Listen for:

• Loud, frequent snoring – Loud and frequent snoring is a common symptom of sleep apnea.

• Breathing pauses – By definition, sleep apnea involves repeated breathing pauses throughout the night. Your bed partner may hear you gasp for breath in your sleep or may wait (slightly panicked) to hear you take your next breath.

 

Watch for:

• Excessive daytime sleepiness (You can easily fall asleep during the day if you allowed yourself to do so.)

• Memory problems

• Irritability or moodiness

• Decreased sex drive or impotence

• Morning headaches

• Acid reflux symptoms such as indigestion and heart burn or chest pain

• Unexplained high blood pressure

• More symptoms and risk factors...

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Complete a screening questionnaire:

•  TAKE QUIZ HERE - it will indicate your level of risk for having this condition.

• Calculate your body mass index BMI

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NOTE:  Having the signs and symptoms of sleep apnea is the first step in recognizing the possibility that you may have this condition.  The only way to know if you have sleep apnea for sure is to undergo a sleep study.

 

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I think I might have sleep apnea.  What should I do?

If you think you may have sleep apnea, don't worry, you are not alone.  Speak with a physician about your concerns. If your doctor believes you are at risk for having sleep apnea, you will be advised to undergo a sleep study.  Based on the results of that study, your doctor will determine what, if any, condition(s) you have and which treatment is best for you.  

 

If it is recommended that your sleep apnea be treated with an oral appliance, Dr. Fan can evaluate your teeth and jaw to make sure it is safe for you to have an oral appliance, carefully choose the most effective appliance that best suits your needs, oral anatomy and comfort and guide your through the entire therapy to minimize side effects and ensure comfortable and effective management of your sleep apnea.  

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What are the treatment options for sleep apnea?

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CPAP Therapy

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Continuous Positive Airway Pressure:  The gold standard treatment for sleep apnea.  The CPAP machine blows pressurized air into your nose and/or mouth throughout the night.  This flow of air acts as a pneumatic splint to keep the the airway open.  Although CPAP is highly effective, some people find it makes them feel uncomfortable, claustrophobic and restricted.

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Oral Appliance Therapy

 

Oral Appliance Therapy is recognized by the American Academy of Sleep Medicine (AASM) as a first line therapy for the management of mild to moderate obstructive sleep apnea and is an alternative therapy for those patients with severe obstructive sleep apnea who cannot tolerate CPAP.  This comfortably fitting device holds the lower jaw slightly forward during sleep, thereby, opening the airway space and helping you breathe better. 

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Weight Loss

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Obesity is one of the most common risk factors for sleep apnea.  When an individual is overweight, the excess weight is present throughout the body.  The fat that has accumulated in the neck, throat, uvula and tongue contributes to the narrowing of the airway.  Fat deposition in your abdomen or midsection physiologically affects your lung function and increases your upper airway collapsibility.  Studies have shown that losing even as little as 10% of your weight can ​help reduce the severity of your sleep apnea.  On the other hand, gaining an additional 10% of your weight can result in a 6-fold increased risk of developing moderate-severe sleep apnea.

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Surgery

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There are various surgeries that can help treat sleep apnea including, but not limited to, throat surgery, tongue surgery, jaw surgery, weight loss surgery and implantation of a nerve stimulating device under your skin on the neck and chest wall.  Your physician will determine if surgery is warranted. 

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Can anyone get an oral appliance?

Most people can be treated with oral appliance therapy.  There are a number of devices available that can be used to accommodate each individual's needs.  After a thorough examination and consideration of your specific needs, Dr. Fan will determine which oral appliance is right for you.

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Can't I just buy an oral appliance over the internet?

Studies have shown a generic boil-and-bite type of appliance lacks the effectiveness, comfort and stability of a custom-fabricated appliance.  A qualified dentist is needed to ensure the stability of the teeth, muscles, jaw joints and jaw, all while verifying that the oral appliance is properly treating the sleep apnea.  Without proper training, an individual can cause injury to the jaw and teeth, misalignment of the jaw and can worsen their sleep apnea, a medical condition with serious health consequences.  In addition, as your body changes with time, oral appliances will need to be adjusted periodically to maintain their effectiveness. 

 

Furthermore, if you buy a generic oral appliance to manage snoring without a proper diagnosis, you may be doing more harm than good, by not properly treating an underlying sleep apnea condition.

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How long does it take to feel better?

Although it varies by case and severity of sleep apnea, some individuals will notice a difference almost immediately the next day after wearing the appliance, others may need more time to reach their therapeutic level of advancement and some may not experience any benefit from the oral appliance. On average you will need 4-6 appointments and one to two home sleep studies.

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How long does the oral appliance last?

Your grinding habits and how well you care for and handle the oral appliance will determine its longevity.  Generally speaking, the average life span of an oral appliance is approximately 3 years.

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Is the oral appliance safe to use during the COVID-19 pandemic?  

According to the American Academy of Dental Sleep Medicine, "Oral appliance therapy is an effective treatment for OSA (Obstructive Sleep Apnea) without increased risks for transmitting COVID-19."(3) 

 

This recommendation is made based on the following information:

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• The American Academy of Sleep Medicine (AASM) has indicated that PAP therapy potentially exposes individuals, especially those in proximity to the patient, to increased risk of transmission of COVID-19. (1)

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• A number of studies have found evidence that COVID-19 can remain suspended in the air in aerosol particles. (2) 

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• It is unknown whether it is possible for patients to be re-infected from re-using PAP tubing, filters, and/or masks. (3)

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• There have been reported shortages of distilled water and other supplies necessary for optimal use of PAP machines. (3)

 

• Oral appliances do not generate aerosols and can be easily disinfected by patients to kill the COVID-19 virus. (3)

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(1) COVID-19: FAQs for Sleep Clinicians. https://aasm.org/covid-19- resources/covid-19-faq/. Accessed May 8, 2020.

(2) Liu, Y., Ning, Z., Chen, Y. et al. Aerodynamic analysis of SARSCoV-2 in two Wuhan hospitals. Nature (2020). https://doi.org/10.1038/s41586-020-2271-3

(3) Schwartz, D., Addy, N., Levine, M., Smith, H. Oral Appliance Therapy Should be Prescribed as a First-Line Therapy for OSA during the COVID-19 Pandemic.  Journal of Dental Sleep Medicine.  2020;7(3).  https://www.aadsm.org/docs/COVID_Position_Statement.pdf

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