Snoring
SNORING – AS A SLEEP DISORDER
Snoring can indicate a wide range of problems. It can be harmless - much like a cat’s purring - or it can get to an extreme state call Obstructive Sleep Apnea (OSA) where many times every hour, the airway is completely blocked. If breathing stops for 10 or more seconds it is called “Apnea” (literally means “without breathing”).
Some people would benefit enormously from wearing a Sleep Medicine approved mouth appliance. Few dentists in Northern Vermont make these appliances in collaboration with sleep clinics, but We have been working with the Vermont Medical Sleep Disorders Clinic for years.. making one for patients called Silent Night and it has been getting raves.
On our office facebook page one night I gave people a link to this video of a little boy going crazy with joy over the Mickey Mouse Club, so I asked my readers to tell us what makes them dance with Mickey Mouse Club zeal. I got a lot of different answers about food and hobbies, but there was one that was really unexpected: Here's a comment about our snoring device!...
Kathy O. ~ " As of Nov 9, my Silent Nite which lets me sleep without snoring or apnea...love it enough to dance the jig:) "
SO HOW BIG IS THE PROBLEM?
40% of adults over age 40 snore. Half of those snore every night. 30-50% of those have sleep apnea.Snoring worsens with increased age and weight.Here's a simpler test: If you can't fit in the jeans that you wore 10 years ago, or 5 years ago,.. then you are quite likely to be on a path to sleep apnea.
Here's another: OSA appears to be related to neck size as this part of the body usually increases with excess weight. Men with a great than 17 inch neck, and women with a neck size greater than 15.5 inches are likely to have OSA. As little as 5 – 10 pounds can add enough tissue to your airway to increase snoring significantly
Even if you are the picture of health, sometimes soft tissue over-growth (unrelated to weight gain) in the back of the mouth, nose and throat can also be a factor. Tongue size, length of soft palate, size of uvula and excess tonsil tissue can all decrease the size of the airway. These are also things that are considered by a sleep medicine specialist.
Here's some sobering statistics:
The prevalence of OSA (Obstructive Sleep Apnea) is surprisingly high:
10 million Americans have Asthma
16 million Americans have Diabetes
12 million Americans have OSA (most do not know it)
Is there a cure?
In short, a “cure”? – probably not – but there are ways to treat OSA successfully. In some respects, OSA is like a vision problem. Eye glasses do not cure the problem, they are one of a number of possible treatments. (Loosing significant weight may go a long way to help some people, so perhaps we might consider that a possible cure,…. But we can only hang our hat on this if you are better at permanently pushing away the chocolate cake than most folks.)
The first thing to do if we suspect OSA is to do “diagnostic testing” at a professional sleep clinic. It could save your life, to invest just one night in this important kind of study.
If you have only mild sleep apnea we will be able to make you a mouth appliance that will help you keep your airway open during sleep.
What about TV or drugstore remedies?
There are 85 types of Anti-Snoring Devices on the market. Only 2 are designed in congruence with science from the American Academy of Sleep Medicine – an official specialty of medicine since 1996. The one type of Anti-snoring devices that shows real promise is the design that includes an adjustable and custom-made fit.
Apparently, the detail that makes a mouth appliance successful is if it positions your jaw far enough forward to keep your airway open,… while at the same time, being comfortable enough for you to wear gladly every night. That’s a tall order! The only way we can accomplish comfort and effectiveness in the same appliance is to make it highly adjustable.
It must have two separate pieces (upper and lower) that only touch in the front. It must be made of durable hard plastic that can be cleaned daily and will not distort. Our Silent Night appliance meets all those criteria.
How do you know how bad the problem is?
One of the most important findings of the professional sleep study is the “RDI” score. (Respiratory Disturbance Index) Basically, this is how many times your sleep is disturbed by airway blockage per hour throughout the night. (Another important score is “AHI” (Apnea/Hypopnea Index) This is basically, how many times per hour the patient was without oxygen for more than 10 seconds and blood oxygen saturation fell. )
We will look at many things to determine the level of your problem, but how many times per hour your sleep is disturbed is one of the most telling numbers. Here are the classifications of sleep apnea:
Mild = You have 5 – 20 RDI’s per hour
Moderate = You have 20 – 30 RDI’s per hour
Severe = You have more than 30 RDI’s per hour
The findings of this extensive examination are many and varied. This study can determine the role of numerous factors in your apnea: body position, activity of the elevator muscles of the jaw, abnormal nature of your progress through sleep stages as indicated by brain waves,.. etc. etc..The end result is an accurate diagnosis and therefore a more effective treatment plan.
CPAP is the “gold standard” treatment for OSA. It is basically a device that blows air into your airway, keeping the passage open. Again, in many patients, this is a life changing device. They have energy, intellect and a sense of well-being that had gradually faded. (Usually, so gradually that the problem went unnoticed.)
Unfortunately, about 50% of CPAP users, find that they are not using the device. Some cannot get accustomed to the pressure of the mask or straps on their faces. Some have nasal complaints- stuffiness or dryness- that they cannot overcome. Some people have difficulty exhaling against the pressure of the air blowing at them. There are issues with travel using a CPAP. Noise, bloating and partner inconveniences are also limitations for some patients. Just as contact lenses are not an options for some people with vision problems, the CPAP may not be acceptable to every patient.
As a “plan B”, some patients try using a Sleep Medicine approved mouth appliance like Silent Night.
There are also people who can be helped with surgery to remove excess soft tissue. We will expand on that matter here on the website as we learn more from the team of sleep specialists that are available to assist you here in Northern Vermont.