Getting a good night’s sleep is essential for health. When that sleep is disrupted multiple times during the night, a person can feel so sleepy the following day that it interferes with normal activities. One reason for not getting a restful sleep is because of snoring. Snoring is caused by air passing the relaxed tissues at the back of the throat, palate, tongue and pharynx, causing them to vibrate. Being overweight, consuming alcohol close to bedtime, lying on one’s back, nasal congestion from a cold or allergies can aggravate snoring.
Snoring can also be a symptom of Obstructive Sleep Apnea (OSA) but not everyone who snores has OSA and not everyone who has OSA snores. In this condition the airway is completely closed. There are no breath sounds although you might see the chest or abdomen moving. As the oxygen level in the blood drops, the brain signals the body to wake up. This may happen with a loud snort, gasping for air. These episodes may occur many times within an hour during the night.
People with sleep apnea have been shown to be at increased risk of developing high blood pressure, irregular heartbeats (atrial fibrillation), or a heart attack or stroke. Episodes of fibrillation may lead to sudden death. OSA has also been associated with an increased chance of developing type 2 diabetes, metabolic syndrome (hypertension, high cholesterol, high blood sugar, increased waist circumference), and scarring of the liver. Sleepiness caused by the lack of a restful sleep can increase the risk of being involved in a car accident or a work place accident.
Risk factors for developing OSA include: being overweight, having a thick or long narrow neck, or chronic nasal congestion. Although OSA can occur in anyone, it is more prevalent in men, people with existing hypertension or diabetes, and people who consume alcohol, use sedatives, or are smokers.
If you have excessive daytime drowsiness where you are falling asleep at work, while watching TV, or driving, it would be wise to consult your doctor. Also, if you wake yourself with your snoring or have pauses in breathing, you might have sleep apnea. Your doctor will likely refer you for a sleep study. Overnight your lungs, brain, breathing and body movements are monitored. The information gathered during your sleep will inform the doctor of the presence and severity of the sleep apnea. Treatment may include a recommendation to lose weight, reduce alcohol consumption, treatment of allergies, or devices or surgery to correct the airway obstruction. Forcing a side sleeping posture by sewing a tennis ball in the back of the pyjama top has been used effectively for sleep disturbances that are related to sleeping on one’s back.
The most common and effective treatment of airway obstruction is Continuous Positive Airway Pressure (CPAP). This is delivered via a mask or nasal cannula secured around the head with straps. The air pressure is slightly higher than the surrounding air, just enough to keep air passages open. Dental devices have been used as alternatives to the CPAP machine. Although not as effective in opening the airway, they can be used if someone is unable to accommodate to the CPAP. There are two types of devices: one that holds the tongue forward, the other positions the whole lower jaw forward during sleep. The latter appliances require careful adjustment so as not to put excessive strain on the temporo-mandibular joint. Even so, prolonged use is likely to cause disturbances in the bite. A daytime appliance may be used to correct this. Correct adjustment and regular monitoring of the appliance is key to making sure that the treatment is effective and to minimizing harm to the oral cavity and TMJ. Appliances available over the internet are not effective and could cause harm.
Correct diagnosis of sleep apnea is essential prior to initiating treatment. An oral appliance is only one method of treatment, and not the most effective one. Treatment should be rendered by someone trained in sleep therapy, customized to the individual and rendered only if a diagnosis is made after a sleep study.