Sleep Apnea Questions | Snoring | OSA

Who gets Sleep Apnea?

Sleep apnea happens in all age groups and both sexes. However, is more common in men. At least 4% of middle-aged men and 2% of middle-aged women have sleep apnea with excessive daytime sleepiness. People who are most likely to have sleep apnea include:

Those who snore loudly (although you can snore and NOT have sleep apnea)
Have high blood pressure
Are overweight
Have a physical abnormality/obstruction in the nose, throat/or other parts of the upper airway

What’s the difference between Obstructive Sleep Apnea and snoring?

Snoring arises when the soft tissues in your throat and upper airway constrict and vibrate. The sound created is called snoring. When the soft tissues completely closes or obstructs the airway and prevents air from reaching your lungs, it is called Obstructive Sleep Apnea (OSA).

What are some signs that I may not be sleeping well or getting the rejuvenating aspects of sleep?

Continuous nights of improper sleep and breathing takes its toll on our quality of life and can include the following:

Always being tired, no energy
Easily irritated
Feeling of depression
Falling asleep at inappropriate times
Forgetfulness
Difficulty concentrating
Wake up with headache
Others are frustrated
Decreased sex drive

Regrettably, snoring and obstructive sleep apnea does not only affect the person with the problem. Anyone who has slept with a person who snores knows it can disrupt their sleep partner as well. This second-hand snoring can cause the bed partner to suffer the same daytime sleepiness problems that their snoring partner experiences which may lead to relationship disharmony and adverse health consequences.

What is Obstructive Sleep Apnea?

Obstructive Sleep Apnea is a sleep disorder with serious medical problems. Obstructive Sleep Apnea (OSA) occurs when the soft palate and tongue collapse onto the back of the throat. This blocks the air flow into the lungs. Lacking oxygen, the brain rouses the body from sleep with emergency signals. The sleeping person can stop breathing up to 300 times a night. This constant arousal to open the airway deprives the person of essential REM sleep and causing a list of problems associated with the chronic lack of sleep.

Symptoms of Obstructive Sleep Apnea are:

Loss of energy
Forgetfulness
Morning headaches
Trouble concentrating
Anxiety and depression

Untreated, chronic sleep apnea can cause:

High blood pressure
Cardiovascular disease
Memory problems
Weight gain
Impotency
Headaches
Impaired job performance
Motor Vehicle accidents

How severe is my OSA?

The degree of OSA is based on your AHI (Apnea Hyponea Index). The AHI is determined during your over night sleep study. An apnea event is defined as lack of breathing for at least 10 seconds. Hyponea is “shallow breathing” that leads to a reduction in airflow of greater than 50% for at least 10 seconds. The total number of apnea and hyponea events that occurred during your PSG are added together and divided by the total amount of time slept to provide an “index” number.

AHI of: 5 to 14 is mild
AHI of: 15 to 30 is moderate
AHI of: greater than 30 is severe

Why is it vital that Sleep Apnea be treated?

There are two reasons to treat snoring and apnea. The first is to improve your quality of life. Apnea and snoring can result in altered sleep patterns. Sleep is very important to the healing process and our ability to perform normally throughout the day. Snoring, of course, can be a nuisance to a bed partner as well.

The second reason is the relationship of apnea to serious medical conditions. Untreated sleep apnea can cause or worsen the following:

High blood pressure and other cardiovascular disease
Risk for heart attack
Risk for stroke
Pulmonary hypertension
Weight gain
Migraine headaches
Bruxism (teeth grinding)
Brain and cognitive changes
Morning headaches
Hyperactivity in children
Diabetes
Impotency and sexual dysfunction
Depression and anxiety
Acid reflux
Mood swings
Job impairment
Marital and other personal relations
The likelihood of motor vehicle accidents
Accidents at the workplace

Is Snoring Dangerous?

Snoring, a sign of Obstructive Sleep Apnea (OSA) can kill you. The struggle for breath and lack of breathing can result in high blood pressure. This can damage the walls of the carotid arteries and increase your risk of stroke.

How do oral appliances help me to stop snoring?

The oral appliance moves the lower jaw downward and forward. This moves the tongue and soft tissue forward. This action keeps the airway open when your muscles in the throat relax while sleeping.

Why would I need to consult a medical doctor?

About 40% of snorers also have sleep apnea. A sleep study will determine if you only snore or also have the serious medical condition of OSA. Next, without a medical diagnosis of OSA, insurance will not cover any portion of treatment.

What is the role of my physician in this treatment?

Obstructive sleep apnea is a serious medical disease. It can only be diagnosed by a board-certified sleep physician. Dr. Nugent works with sleep physicians to treat your OSA.

What if I do not want consult a medical doctor for a diagnosis?

Then you will not be fully informed of your own health condition. Obstructive Sleep Apnea does not always have visible symptoms. You must have all the information available to you so that you can make the best decisions regarding your treatment. OSA is a life-threatening condition as Oxygen in absolutely necessary.

What should I do if I think I have sleep apnea?

Discuss your symptoms with your physician or Dr. Nugent and Dr. West. If they think that you have OSA, they will facilitate you getting screened. A company will send you a home sleep monitoring device. This device will record your critical sleep data and allow a Board-Certified Sleep Physician to diagnosis you sleep. After the results of the test are reviewed and a diagnosis is made, different treatment options are discussed.

Why worry about snoring? It is normal, just annoying sleep habit?

No. Since it is so common, most people assume it is only an irritation to the bed partner. Besides being disruptive to close relationships, snoring is a sleep-breathing disorder and can lead to serious health problems like sleep apnea.

Can I just wear one of those nasal strips to cure my snoring?

Nasal strips have been shown to improve flow of air just through the nose. However, snoring is not always nasal only. Usually it is a combination of nasal and oral constriction.

What is an Oral Appliance?

Oral appliances (OA) that help stop snoring and Obstructive Sleep Apnea are devices worn in the mouth similar to orthodontic retainers or sports mouth guards. There is no one particular appliance that will work for every patient. The devices are called Mandibular Advancement Device (MAD). Dr. Nugent will recommend the most appropriate MAD for you.

Advantages of using an Oral Appliance:

Treatment with oral appliances is reversible and non-invasive
Oral Appliances are small and convenient, making them easy to carry when traveling
Quiet
Easily adjustable
Easy to wear and more comfortable than CPAP, resulting in increased compliance
Sleep without being attached to a hose and machine

What is the difference between Oral Appliance, Mandibular Advancement Device and Oral Advancement Device?

Nothing. They are all the same thing with different names. They are all Dentist fabricated devices that pull the lower jar forward to prevent the collapse of the airway.

How does an Oral Appliance / Mandibular Advancement Devices work?

The device works by pulling your lower jaw forward. This does two things. 1) it prevents the soft tissue in the back of the throat and the tongue from collapsing over the airway 2) opens up the airway

Do oral appliances really work?

Yes! According to the studies, Oral Appliance Therapy (OAT) is 84.0% effective in treatment of non-severe Obstructive Sleep Apnea cases and 69.2% effective for severe cases. —Hoekema A. Oral-Appliance Therapy In Obstructive Sleep Apnea-Hypopnea Syndrome. A clinical study on therapeutic outcomes. 2008

The American Academy of Sleep Medicine published the “Practice Parameters for the Treatment of Snoring and Obstructive Sleep Apnea with Oral Appliances” in 2006. “Oral appliances (OA) are indicated for use in patients with mild to moderate Obstructive Sleep Apnea (OSA) who prefer them to continuous positive airway pressure (CPAP) therapy, or who do not respond to, are not appropriate candidates for, or who fail treatment attempts with CPAP. Until there is higher quality evidence to suggest efficacy, CPAP is indicated whenever possible for patients with severe OSA before considering OA’s.”

Will an oral appliance will work for me?

No medical treatment including CPAP, surgery, or oral appliance therapy can guarantee that your apnea will be eliminated. The only way to treat apnea is to try one of these treatments. True success of any of these treatments can only be measured with a follow up Sleep Study. In the case of oral appliance therapy, the follow up sleep study is done while wearing the oral appliance.

What does Oral Appliance Therapy consist of?

Fabricating an oral appliance is comfortable and non-invasive. We will make several measurements of your jaws including making molds of both the upper and lower jaw.

Am I a candidate for an oral appliance?

The Board-Certified Sleep Physician will read your at home sleep study. If the Mandibular Advancement Device is appropriate care it will be stated on the sleep study signed by the Physician.

What oral appliance is right for me?

Dr. Nugent considers many factors before choosing which appliance will be best suited for you. Dr. Nugent begins with a comprehensive examination of your oral cavity. He will then discuss lifestyle factors and sleeping habits such as:

Manual dexterity
Travel destinations
Preferred sleep positions
Oral cavity restrictions (anatomical structures)

How does the Oral Advancement prevent snoring and Obstructive Sleep Apnea?

By stabilizing the lower jaw and tongue
By repositioning the lower jaw, tongue, soft palate and uvula
By increasing the muscle tone of the tongue

With the above actions, the tissues and tongue are prevented from collapsing and occluding the airway. Therefore, air flows freely into the lungs and there is no vibrations of the soft tissue (known as snoring).

How successful is Mandibular Advancement Therapy?

For mild Obstructive Sleep Apnea, Mandibular Advancement has been found to be about 76% effective. For the treatment of snoring control, Oral Appliances are over 90% effective.

Is it hard to sleep with an appliance in your mouth?

Most patients have never slept with something in their mouths. The first couple of nights will be awkward. However, most patients find the appliances very comfortable. Because the appliances are custom made using molds of your teeth, they fit precisely and are easy to get used to. A very small percentage of patients need a couple of weeks or more to get used to the appliances. Patients who cannot sleep using CPAP adjust easily to a dental appliance.

Does insurance cover the cost of Mandibular Advancement Therapy?

Most medical insurance policies will cover the Oral Device when Obstructive Sleep Apnea is diagnosed. For snoring with no OSA component, most policies do not currently pay for the oral device. Nevertheless, there is no question that for a snorer, mandibular advancement therapy is the best investment he/she can make in his/her health and domestic peacefulness.

Are Oral Appliances Covered by Insurance?

Oral Appliances are often covered in full or in part by MEDICAL insurance. Depending on many factors such as the severity of your apnea and specific policy limitations, coverage may vary. Our Pasadena, Texas Sleep Office will help you to maximize your medical benefits.

Are there any long-term health consequences Obstructive Sleep Apnea (OSA)?

Absolutely! In patients with untreated sleep apnea, the lowering of blood oxygen levels can contribute to the development of heart irregularities. Also, blood pressure will almost always be elevated due to the stress on the heart. Sleep apnea is known to be a cause of sudden death during sleep, although this is an uncommon occurrence. More heart consequences can be read in the Health Consequence section.

What will Dr. Nugent do if I need an oral appliance?

On your first visit after Obstructive Sleep Apnea is confirmed and the OSA can be treated with an oral appliance, Dr. Nugent will examine your teeth and mouth systematically. If it is determined that Mandibular Advancement treatment is the best treatment option for you, dental impressions will be taken. These impressions are used by a dental lab to fabricate your custom made oral appliance. Once you have been wearing your appliance regularly and symptoms such as snoring or daytime sleepiness has been reduced, Dr. Nugent will again initiate a Home Sleep Study to determine how effective the appliance is for you. Regular recall visits to our office is vital to maintain your oral appliance over time.

What are the side effects associated with Mandibular Advancement Therapy?

Excessive salivation or dryness
Morning soreness in the teeth or jaw muscles
Minor tooth movements

Most of these side effects improve within a few weeks of regular use and some adjustments of the appliance by Dr. Nugent. Normal recall maintenance by Dr. Nugent is important to track any potential side effects such as tooth movements as well as to maintain and adjust the appliance.

Are there patients that are not good candidates for Mandibular Advancement?

It is always best to evaluate if you are a good candidate for OAT during your initial consultation with Dr. Nugent. There are several conditions that may be contraindicated for oral appliance therapy:

Central Sleep Apnea as opposed to Obstructive Sleep Apnea
Poor dental health
Very obese individuals
Fibromyalgia and severe arthritis
Chronic untreated TMJ symptoms
Limited jaw movements

What does the Oral Advancement Device (OAD) feel like in your mouth?

OADs are comprised of two units that fit over your upper and lower teeth. Most people adapt quickly to the OAD At first it can feel “strange”, simply because it is something new and different. This feeling quickly goes away as the mouth and tongue becomes accustomed to the device.

Does it hurt to wear an Oral Appliance?

There is sometimes some initial discomfort, it is usually quickly resolved as the device is adjusted and the mouth adapts.

How long does it take to get a Mandibular Advancement Device?

After the initial exam and consultation, you will be scheduled for an appointment for impressions and bite registration. Approximately three weeks later you Dr. Nugent will fit your appliance and begin the process of titrating the device to the ideal position.

How do I keep my sleep apnea oral appliance clean and safe?

After removing your device each morning, brush your device with a soft toothbrush without toothpaste. You can also place in water with a denture cleansing tablet to break up the proteins. When finished, dump out the used cleanser, refill the container with clean water and put in the OAD. When traveling, keep the device in its protective container.

Is a Mandibular Advancement Device more effective than CPAP?

A CPAP (Continuous Positive Air Pressure) is an air pump that delivers controlled air pressure through a hose and into a face mask. It is very effective for the 60-70% of people who can tolerate it. The 30-40% of people simply cannot tolerate the CPAP for many reasons. In many cases the Mandibular Advancement Device has been as effective as CPAP without discomfort or inconvenience.

I can’t use my CPAP. Can I use an oral appliance instead?

CPAP is the gold standard for treating sleep apnea but unfortunately many people find that they can’t tolerate wearing it. For persons with severe apnea, though CPAP is the treatment of choice, oral appliance therapy if recommended if the patient can’t tolerate their CPAP. For persons with mild to moderate apnea an appliance will in most cases eliminate the need to use their CPAP machine