What is Sleep Apnea

Sleep Apnea

People with obstructive sleep apnea (OSA) have disrupted sleep and low blood oxygen levels. When obstructive sleep apnea occurs, the tongue can be sucked against the back of the throat. This blocks the upper airway and airflow stops or is greatly diminished. When the oxygen level in the brain becomes low enough, the sleeper partially awakens, the obstruction in the throat clears, and the flow of air starts again, usually with a loud gasp.

Repeated cycles of decreased oxygenation lead to very serious cardiovascular problems. Additionally, these individuals suffer from excessive daytime sleepiness, depression, and loss of concentration as well as other serious health problems.

Some patients have obstructions that are less severe called Upper Airway Resistance Syndrome (UARS). In either case, the individuals suffer many of the same symptoms. By far the majority of the people do not have UARS, but only a trained specialist can eliminate this from the other more normal forms of obstructive sleep apnea.

The first step in treatment resides in recognition of the symptoms, diagnosis, consultation and ultimately the correct treatment. In addition to a detailed history, the Doctors will assess the anatomic relationships in the nose as well as the oral pharynx. With different kinds of analysis, the doctors can ascertain the level of obstruction. In all cases it becomes necessary to find out the condition of the nasal airway as well as the oral and throat. A variety of different kinds of equipment are utilized to check for cardiovascular compromise and decreased oxygenation levels. This is usually confirmed by an "at home" (ambulatory) or a overnight sleep study called a polysomnograph (PSG) to monitor an individual overnight.

There are several treatment options available depending on the severity of the condition. Depending on the overnight study results, people are put into categories of mild, moderate or severe OSA. Treatment of severe sleep apnea usually consists of using a nasal CPAP machine that delivers pressurized oxygen through a nasal mask to limit obstruction at night. This "solution" is considered the gold standard of treatment because it usually works and reduces the sleep apnea to a very low level. If the condition is either mild or moderate sleep apnea, then the treatment is usually a oral device made by a Dentist with advanced training in sleep apnea. Unfortunately, the "over the counter" and internet based appliances can cause severe problems including joint pain, tooth movement and altered bite and are usally uncomfortable to wear because they are not comfortable to wear. Also, they do not quantify or diagnose the problems of OSA nor do they allow for the retest to see how well it is working. In the past there has been other surgical options including an uvulo-palato-pharyngo-plasty (UPPP), which is performed in the back of the soft palate and throat. The theory behind this treatment is that the soft palate is responsible for airway resistance including the sounds associated with snoring. The treatment involves surgically removing part of the soft palate. The results show a fairly low success rate relative to other more conservative treatments. A similar procedure is sometimes done with the assistance of a laser and is called a laser assisted uvulo-palato-plasty (LAUPP). In other cases, a radio-frequency probe is utilized to tighten the soft palate. These procedures usually performed under light IV sedation in the office. Again, all these surgical proceedures are generally painful, irreversable and have limited success.

OSA is a very serious condition that needs careful attention and treatment. Most major medical plans offer coverage for diagnosis and treatment. It is important that this serious problem be treated witht he combined input from the medical and dental communities with advanced training to appropriately give the correct diagnosis and treatment.