Focus On: Snoring and Obstructive Sleep Apnoea (OSA)

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Do you, or does someone close to you snore? Snoring may be a sign of a serious illness – obstructive sleep apnoea.
Approximately 1 in 3 people have some form of sleep disordered breathing which ranges from snoring to severe obstructive sleep apnoea  (OSA). OSA is quite common and affects approximately 4% of men and 2% of women in the middle aged workforce, as well as children and the elderly. Despite this, most sufferers are undiagnosed.
We now understand that the side effects of obstructive sleep apnoea are not just an elbow to the ribs from our partner, but OSA is a contributing factor in significant health problems like high blood pressure, obesity and an increased risk of heart attack, heart disease or stroke.

What is Obstructive Sleep Apnoea?

Apnoea literally means “without breath”. Obstructive sleep apnoea is characterised by repetitive pauses in breathing at night caused by a blockage of the upper airway. 
As the muscles of body relax during sleep, the position of the jaw, tongue and the muscles and soft tissues in the neck and mouth narrow or block the airway opening. Not only does this narrowing of the airway cause snoring, but it can also then lead to a reduction of airflow or even stop the airflow altogether. Breathing can stop for 20-40 seconds at a time at which stage a signal is sent to the brain to wake up! The person gasps for breath, falls asleep again, starts snoring and the cycle continues. 
A person with severe sleep apnoea may have hundreds of these episodes each evening, resulting in lack of oxygen to the brain and the body’s vital organs, as well as disrupted sleep. 

How is OSA diagnosed?

Usually our partner will be the first to recognise a problem, however many people suffering from OSA are unaware of their condition. Diagnosis is confirmed by a sleep study, which can be undertaken at a sleep clinic or in your own home. A sleep study measures the presence and severity of sleep apnoea by measuring brain activity, eye movement, muscle activity, heart rate and rhythm, breathing and oxygen levels during sleep. 

What are the signs of OSA?

Signs of obstructive sleep apnoea include waking tiredness, poor cognitive function, headaches, constant fatigue and excessive daytime sleepiness. A partner may notice loud snoring followed by periods of silence and then gasps for breath. Occasionally people report waking themselves up snoring because they stop breathing, however this is not experienced in all cases.
The importance of treatment is much more than just addressing the anti-social implications of snoring, as we now understand that OSA is associated with many heath problems.
Common consequences of OSA include :
  • Depression
  • Anxiety
  • Obesity
  • Poor concentration and memory
  • Type 2 diabetes
  • Acid reflux (Gastro-oesophageal reflux disease)
  • High blood pressure
  • Increased risk of heart attack, heart disease or stroke

What treatment is available for OSA?

Treatment is based on the severity of the condition, which is why a sleep study is so important. If obstructive sleep apnoea is diagnosed, treatment would usually involve either a CPAP machine, or a mandibular advancement splint (MAS) in combination with behavioural modifications. 
Behavioural modifications may include losing weight, avoiding alcohol before sleep and avoiding sleeping in the supine (fully horizontally reclined) position. 
For moderate to severe OSA the standard treatment is the use of a CPAP (continuous positive airways pressure) machine. This machine pumps a stream of warm, moistened air through a tube and into a mask that fits over the nose, or the nose or mouth. The pressure of the air pushing into the upper airway, keeps it open. CPAP is the most effective way of treating OSA however, it can take some time to adjust to wearing this mask as it can be a little cumbersome and some people find it difficult to tolerate. Very few cases of OSA require surgery. 
For mild to moderate OSA your sleep physician may recommend an oral appliance called a mandibular advancement splint (MAS) or, less commonly, a tongue retainer. A mandibular advancement splint is worn at night and advances the lower jaw to a more forward position. This forward position of the jaw correspondingly brings the tongue and other soft tissues forward and away from the throat, keeping the airway open.  
If you are concerned that you or a loved one may suffer from obstructive sleep apnoea, please speak with you Medland dentist. We can organise a sleep study to be undertaken from the comfort of your own home, discuss arranging a sleep study with your GP and if required, we can assist in the construction and fitting of a mandibular advancement splint.