Sleep apnea is a potentially life-threatening sleep disorder characterized by repeated pauses in breathing during sleep. The term sleep apnea is derived from the Greek etymology meaning “without breath”. Breathing pauses can last anywhere from several seconds to minutes, and happen as often as 30 times or more per hour. Ongoing disrupted breathing causes an imbalance between the carbon dioxide and oxygen levels in the bloodstream, as not enough carbon dioxide is exiting and not enough oxygen is entering the body.
Sensing this imbalance, the brain sends a message to the body, telling it to wake up to restart breathing the process. People with sleep apnea will partially awake as they struggle to breathe, and this is often accompanied by loud snoring or choking sensations. Because people with sleep apnea don’t always completely awake during the episodes, they are often unaware they have a sleeping disorder and it can remain undiagnosed.
There are two main types of this disorder; central sleep apnea which occurs when the brain fails to send important signals to the breathing muscles, and obstructive sleep apnea which occurs when air cannot flow through the nose or mouth even though the body is still trying to breathe. Obstructive sleep apnea is far more prevalent and easily treatable by the dental Surgeon.
Common signs of obstructive sleep apnea can include severe early morning headaches, sleepiness in the daytime, and insomnia. Fortunately, the maxillofacial surgeonis equipped with the necessary technology and expertise to treat sleep apnea in several different ways.
In severe cases of OSA breathing stops completely for periods of time ranging from a few seconds to nearly one minute or longer. This may occur as many as 500 times during a 7 hour sleeping period. OSA is also associated with heavy snoring and significant disruption of normal sleep pattern. The disruption of normal breathing also causes frequent awakening that results in sleep deprivation which can lead to fatigue, daytime drowsiness, and depression. OSA is often associated with other health issues including high blood pressure and obesity. Most patients severely affected by sleep apnea are over the age of forty, but sleep apnea may occur at any age.
The cause of sleep apnea is from obstruction of airflow from the mouth or nose to the lungs. There are three potential levels of obstruction. Level one is within the nose or nasal cavity, level two is the soft palate or base of tongue and level three is hypopharynx or the portion of the throat just above the vocal cords. The location of the area of obstruction determines the treatment that is most likely to eliminate or improve OSA. Many times these deformities can be compounded by neurologic disorders or obesity.
If one suspects OSA then an appointment should be made with your primary care physician for consultation and a complete physical examination. A consult with an oral and maxillofacial surgeon will include an examination of the mouth nose and throat and an x-ray of the skull and jaws. The final evaluation includes polysomnography or a “sleep study” which is completed at a sleep laboratory. Multiple monitors are placed while you sleep and numbers are assigned to determine one's severity of obstructive sleep apnea. After these evaluations an exact diagnosis can be confirmed and the appropriate treatment recommended.
It is very important to seek medical attention if sleep apnea is suspected. A sufferer can completely stop breathing numerous times per hour, and this can quickly turn into a deadly situation. Obstructive sleep apnea occurs when the soft tissue lying at the back of the patient’s throat collapses into the airway. The tongue then falls towards the back of the throat which tightens the blockage and prevents oxygen from entering the lungs.
The problem worsens when the chest region, diaphragm, and abdomen fight for air. The efforts they make to obtain vital oxygen only cause a further tightening of the blockage. The patient must arouse from deep sleep to tense the tongue and remove the soft tissue from the airway.
Because sleep apnea causes carbon dioxide levels to skyrocket in the blood and oxygen levels to decrease, the heart has to pump harder and faster to compensate for the lack of oxygen. Sleep apnea has been linked to a series of serious heart-related conditions, and should be investigated by a physician specializing in sleep medicine at the earliest opportunity.
Moderate or severe sleep apnea usually requires some form of treatment and different modalities are available. Initially, the sleep medicine physician will want to conduct tests in order to investigate, diagnose, and pinpoint a suitable treatment. Maxillofacial Surgeon can offer many different treatment options which depend largely on the exact diagnosis and the health of the patient.
Conservative treatments can include medical management, weight loss, oral appliances, and or positive pressure masks or CPAP machines. CPAP involves wearing a mask connected to a machine that pushes air under pressure into the collapsed airway to improve breathing. This requires wearing this apparatus during sleep. Many patients can not tolerate use of the mask and results are inconsistent.
There are some dental devices that gently tease the lower jaw forward and are very effective in preventing the tongue from blocking the main air passage. These dental devices are gentle, easy to wear, and often help patients avoid unwanted surgeries.
A more permanent solution is to have surgery that sections the lower jaw and helps pull the bone holding the tongue forward slightly. This surgery has an impressive success rate and is simple for the oral surgeon to perform. The maxillofacial surgeon needs to formally make a diagnosis of each individual case before recommending the best course of action.
Surgical treatment may be indicated and may involve surgery of the soft palate and throat. In many cases surgery to improve the position of the jaw bones results in improved support of the soft tissue and a significant opening of the airway. Upper and lower jaw advancement combined with intranasal surgery can often relieve the obstruction at all levels and may greatly improve moderate to severe obstructive sleep apnea.