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Sleep apnea is a common disorder in which you have one or more pauses in breathing or shallow breath while you sleep. These breathing pauses can last from a few seconds to minutes. When breathing is paused, carbon dioxide builds up in the bloodstream. Chemoreceptors in the blood stream note the high levels of carbon dioxide. The brain is signaled to wake the person sleeping and breathe in air. Breathing normally will restore oxygen levels and the person will fall asleep again. Sleep apnea is often diagnosed with an overnight sleep test called a polysomnogram or more commonly known as a “sleep study”. Diagnosis is made when the person stops breathing for 10 seconds or longer 5 times per hour.

The most common type of sleep apnea is obstructive sleep apnea (OSA). This happens when the tongue, tonsils or other tissues in the back of the throat block the airway. When the person is trying to breathe in, air can’t get through. Central sleep apnea (CSA) is less common. In CSA, the brain doesn’t always signal the body to breathe when it should. With sleep apnea, one may stop breathing up to 400 times throughout the night. These last 10-30 seconds and often are followed by a snort when breathing resumes. This breaks the sleep cycle and can leave you tired during the day.

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Doctors estimate that more than 18 million Americans have sleep apnea. It is more common after age 40, but can affect all ages. There are more cases still because people don’t either report it or they don’t know they have it. Sleep apnea is recognized as a problem by others witnessing the person during episodes or is suspected because of its effects on the body.

SIGNS AND SYMPTOMS

  • Episodes of no breathing, abnormal breathing pattern, shallow breathing, mouth breathing, or loud breathing
  • Insomnia
  • Nightmares
  • Excessive daytime sleepiness
  • Snoring
  • Sleep deprivation
  • Restless sleep

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EFFECTS OF SLEEP APNEA

  • Abnormal heart rhythms; heart failure
  • Stroke
  • High blood pressure
  • Hormone Disruption
  • Nocturia
  • GERD
  • Increased Insulin Resistance (even in non-diabetic patients)
  • Headaches (in the morning)
  • Dry throat; dry mouth
  • Depression
  • Weight gain
  • Teeth grinding
  • Sexual dysfunction/Impotence
  • Mood swings/Irritability
  • Fatigue
  • Poor sleep quality
  • Memory problems and inability to think correctly; decreased attention and concentration
  • Increased traffic and workplace accidents
  • Death

Sleep apnea can affect people regardless of gender, race or age, even children. Obstructive sleep apnea is common in children, affecting 1 in 10. In most cases the symptoms are mild. The child will eventually outgrow the condition. Some kids may develop behavioral issues or serious medical problems as a result of obstructive sleep apnea. Risk factors for OSA include being a male, overweight, obese or over the age of 40. Also, having a large neck size (greater than 16-17 inches), enlarged tonsils, enlarged tongue, a small jaw bone, a deviated septum causing nasal obstruction, gastroesophageal reflux, allergies, or having sinus problems. Family history of sleep apnea is also a risk factor. Alcohol, sleeping pills, sedatives and tranquilizers relax the muscles in the back of the throat making it easier for the airway to become blocked. People who smoke have sleep apnea at 3x the rate of people who have never smoked. Central sleep apnea is more influenced by being a male, being older than 65 yrs old, having heart disorders like atrial fibrillation and stroke or a brain tumor. Brain tumors may hinder the brain’s ability to regulate normal breathing.

STATS (Source: National Sleep Foundation)

  • 75 million Americans (1 in 4) have Sleep Breathing Disorders (SBD)
  • 38 million Americans have Obstructive Sleep Apnea (Mild-60%, Moderate-25%, Severe-15%)
  • 37 million Americans have chronic snoring
  • The People with OSA are more likely to die from Sudden Cardiac Death (occurring between 10pm-6am; for the general public, Sudden Cardiac Death occurs between 6am-12pm).
  • Men are 2x as likely to have sleep apnea.
  • Twenty-eight percent of men and 24% of women over age 65 have sleep apnea
  • Men with severe OSA are 3x more likely to have a stroke than men without OSA.
  • 1 in 5 adults has mild OSA and 1 in 5 has moderate or severe OSA.
  • 80-90% of sleep breathing disorders remain undiagnosed.
  • Patients with OSA are 4-6x more likely to be involved in a motor vehicle accident than the general population.
  • Women who snore regularly are at twice the risk of heart attack and stroke compared to women who never snore.
  • 1-4% of children suffer from Sleep Breathing Disorders and 3-12% are habitual snorers (American Academy of Pediatrics).
  • IQ score, attention span and memory skills in children with SBD are lower compared to children without SBD.

In the dental office, we are able to identify various disease conditions and disorders by what we see or smell in the oral cavity. Your dentist may be the first to know about an issue or problem with your overall health that you or even your primary care physician may not have recognized yet. Research shows that 90% of all systemic diseases have oral manifestations. Symptoms of these conditions can manifest in the mouth, making dentists key in diagnosing the diseases. Some of these diseases/conditions include diabetes, leukemia, oral cancer, pancreatic cancer, heart disease, kidney disease, acid reflux, sleep apnea, eating disorders and more. In many cases, a dentist may be the first health care provider to diagnose a health problem in its early stages since many people have regular oral examinations and see their dentist more often than their physician. Seeing a dentist regularly (at least 2x year) helps to keep your mouth healthy and allows your dentist to watch for developments that may point to other health issues.

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It has been well documented that sleep apnea patients have both a reduced antioxidant capacity and higher levels of oxidative stress than controls, according to Spectra Cell Laboratories, Inc. This correlation with nutrients is a non-exhaustive list and there are additional nutrients that affect sleep apnea.

Vitamin A: Sleep apnea patients have low retinol. Retinol suppresses the growth of vascular smooth muscle, a process that causes blood vessels to clog, linking low Vitamin A levels to cardiovascular complications seen in sleep apnea.

Vitamin D: High prevalence of Vitamin D deficiency. The worse the apnea, the more severe the deficiency. Evidence suggests low Vitamin D worsens sleep apnea’s negative affect on heart disease risk.

Vitamin C: Improves endothelial function (blood vessel health) in sleep apnea patients to levels seen in people without sleep apnea.

Vitamin E: Mitigates the oxidative stress seen in sleep apnea patients. Works synergistically with Vitamin C.

Minerals: The trace minerals zinc, copper, magnesium, manganese and selenium are critical cofactors for the major antioxidant enzymes, which are important in repairing cellular damage caused by hypoxia (lack of oxygen) in sleep apnea.

Selenium: In one case report, selenium supplementation completely stopped snoring caused by non-obesity sleep apnea. Selenium’s role as a potent antioxidant may reduce the oxidative stress seen in sleep apnea patients.

Copper: Considered a strong predictor of oxidative stress in sleep apnea patients. Copper’s role as a key cofactor on the powerful antioxidant superoxide dismutase (SOD) explains this. SOD is very low in sleep apnea patients.

Sleep apnea is treatable. One way to treat it is by making lifestyle changes to decrease the risk factors by losing weight, quitting smoking and exercising. Changing your sleeping position can also help. Sleeping on your back causes gravity to pull the tissues in the throat down where they will more likely block the airway. By sleeping on your side, this helps to open the throat. You can find special pillows to help keep you on your side. A mouthpiece or appliance can be made by your dentist to ease mild sleep apnea. It is custom-made for the individual and works by adjusting the position of the lower jaw and tongue. You put it in at bedtime to help keep the airway open while you sleep.

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The most common treatment for OSA is the CPAP (Continuous Positive Airway Pressure) machine. It works by blowing a steady stream of air into the airway. The flow of air is adjusted until it’s strong enough to keep the airway open while you sleep. The CPAP is most commonly used for the treatment of moderate to severe OSA.

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Surgery can also be an option. This can be good for some to treat OSA. For instance, children with large tonsils that block their airway will have them removed. In adults, surgery may improve symptoms by shrinking or stiffening floppy tissues. A fairly new device that is approved by the FDA and is now available to treat sleep apnea is called Inspire. Because some people just cannot get used to wearing the CPAP, this device may be a great alternative to those people. Inspire is an upper airway stimulation device. “It works inside your body and with your natural breathing process to treat sleep apnea. Based on your unique breathing patterns, the system delivers mild stimulation to key airway muscles, which keeps the airway open”. Patients have reported that this device has changed their lives! The procedure to implant this device is being performed all over the United States, including locally here in Philadelphia. Check out the website for doctors in your area, news stories and more information on Inspire.

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Although surgery can be a good option for some, it is not always an option for everyone. Patients should consider the pros and cons and their doctor’s opinion before going forward with any surgical procedure.

**The information presented in this post is for informational purposes only and should not be used as a substitute for talking with your doctor. Always talk to your own personal healthcare professional about any diagnosis and treatment information.

Image Credits: WebMd; Inspire