A Silent Night - A Restful Night - WBOC-TV 16, Delmarvas News Leader, FOX 21 -

A Silent Night - A Restful Night

NO SNORING/APNEA
By Dr. Robert G. Esham

Be sure to take our Sleep Quiz located at the end of this article. Answering these simple questions may be the first step to a restful night's sleep.

SNORING

Have you been told how loudly and often you snore? Can you be heard throughout the house? Does your spouse get a good night's sleep by sleeping in a different room? Then it's about time for you to do something about it!

Snoring is no laughing matter, especially when you become the center of attention during conversation among friends and family. They have no idea of how drawn out and tired you feel without sound sleep and waking up so many times during the night. This may be a warning signal that something is wrong with your breathing during sleep. When your airway is not fully open, the loud snoring noise that you make comes from efforts to force air through narrowed passageways.

One in every ten adults snores and has no serious medical condition. However, habitual snoring is one of the symptoms of the 47% of adult population that have the life threatening disorder known as "Obstructive Sleep Apnea."

Snoring and Sleep Apnea are gaining greater recognition among health professionals and the general public. We can play a role in the recognition and treatment of both snoring and sleep apnea.

SLEEP APNEA - what is it?

The absence of breath for 10 seconds or more is considered an Apnea Episode. One suffers from Sleep Apnea when breathing like this for 30 or more times during a normal seven-hour sleep period. A person can typically have as many as 300 apneic episodes per night, with some of them maybe lasting up to 120 seconds at a time.

The three basic classifications of sleep apnea are CENTRAL , OBSTRUCTIVE and MIXED.

CENTRAL APNEA
In Central Apnea, the trouble seems to lie in the part of the brain that controls breathing during sleep. The breathing muscles don't receive necessary signals or instructions from the brain, keeping the airway open while the chest muscles and diaphragm stop working. The falling levels of oxygen in the brain send a signal, causing the sleeper to awaken and start breathing. Since the airway remains open, snoring may not occur.

OBSTRUCTIVE SLEEP APNEA
When sleeping, the muscles, including those necessary for breathing, are much more relaxed than during waking hours. Normally this would not cause problems in most individuals. Sleep is a time of rest. Some individual's muscles relax excessively; therefore, compromising breathing and making sleep a dangerous time.

Particularly, in obstructive sleep apnea, the throat and tongue muscles relax and sag obstructing the airway, making breathing labored and noisy. Pressure to breathe builds, making the diaphragm and chest muscles work even harder. This would be like trying to sip liquid through a floppy straw. The greater the effort, the more the walls collapse. Breathing is entirely blocked when the airway walls collapse. When breathing is halted, the snoring noise is broken by a pause until the sleeper gasps for air and awakens. This is so brief and incomplete, that the individual doesn¡¯t even remember it come morning.

By these interruptions of breathing, oxygen in the blood drops causing your blood pressure to rise and your heart to work harder. Over a period of time, episodes of apnea can even be connected with hypertension, stroke, initiation of a gastroesophageal reflex, frequent nocturnal voiding, susceptibility to atherosclerosis, and stroke or cardiopulmonary problems that can lead to sudden death.

MIXED APNEA
Mixed Apnea is a combination of Central and Obstructive Apnea, usually beginning with a central episode being immediately followed by an obstructive one. In this case, the obstructive component is treated first. This will usually eliminate the problem. If not, then The patient needs to be re-evaluated for a central component. Those who have Mixed Apnea generally snore.

SNORING
Many have the misconception that snoring and apnea are the same thing. This is not true. What causes snoring? Vibration of the tissues due to air turbulence as the airway narrows. This may be a sign of someone suffering from apnea, but not all snorers are apneics. How can snoring be categorized? There is the benign snorer who snores but experiences no physical problems. The snorer who suffers from Upper Airway Resistance Syndrome, who may not actually experience apnea episodes, but snoring is so loud and breathing is so labored that it can still wake them up numerous times during the night. This leaves them unrefreshed and tired all day long. Then there is the snorer who suffers from apnea.

SOCIAL IMPLICATIONS
Those who suffer from sleep breathing disorders really need to be actively treated due to so many social implications. These can range from husbands and wives who can no longer sleep in the same room, to professional drivers. There is a trend of increasing accidents and moving violations caused by excessive daytime sleepiness. Sleep apnea can also be the cause of on-the-job accidents.

Indirect costs are phenomenal due to sleep disorders from lost productivity, motor vehicle accidents, work-related accidents and in-home and public accidents. This major problem needs to be addressed appropriately.

CONDITIONS LEADING TO SNORING/APNEA
A few of the medical and dental conditions that can lead to Snoring or Sleep Apnea are:
- Overweight
- A small retruded jaw
- Sedatives 
- Allergies
- Alcohol before retiring
- Airway obstruction

TREATMENT OPTIONS
Snoring and Obstructive Sleep Apnea have had many methods of treatment applied throughout the years. The techniques may vary; however, the majority of sufferers benefit by following the simple guidelines of:
- Diet if you are overweight
- Get regular exercise
- Avoid alcohol prior to retiring
- Avoid sleeping pills
- Take only over-the-counter medications that have been approved by your physician
- Sleep on your side

SPECIFIC TREATMENTS Continuous Positive Airway Pressure, known as Nasal CPAP, consists of wearing a mask over the nose. A compressor that gently forces air through the nasal passages holds the airway open.

Surgery can be used to help correct physical abnormalities that sometimes cause snoring and apnea; such as enlarged tonsils, nasal polyps, a deviated nasal septum, and malformations of the jaw or palate.

Dental Appliance Therapy is nothing more than a small device similar to a mouthguard or an orthodontic retainer worn when sleeping. It brings the jaw and tongue forward, keeping the airway open.

DENTAL APPLIANCE THERAPY
Dental Appliances have a reputation of being very successful in treating snoring and diagnosing and treating obstructive apnea. Dental appliances are inexpensive, non-interfering, easily fabricated, reversible and have a high rate of acceptance.

Appliances are very appropriate for those who cannot tolerate CPAP and are used for treatment of primary snoring and mild to moderate obstructive sleep apnea.

DOES INSURANCE FOOT THE BILL?
Dental Insurance will not cover treatment for snoring or Sleep Apnea.
Medical Insurance can help with the costs if diagnosed with a Sleep Apnea problem; however, will not cover a snoring problem by itself.

The necessary steps to be taken in order to have your Medical Insurance consider coverage due to Sleep Apnea are:
- Your referring physician needs to refer you to a sleep specialist, indicating a chief complaint of snoring, fatigue or insomnia.
- Your sleep specialist, after testing in a sleep clinic, will then make a determination if you have a Sleep Apnea problem and also to indicate the severity of the problem i.e. mild, moderate or severe.
- Your sleep specialist and his or her staff will then meet to discuss the options for control and recommended treatment.
- If a Dental Appliance (Mandibular Repositioning Appliance) is prescribed as corrective treatment for the Sleep Apnea, then, we at Delmarva Dental Services, P.A. will provide you with the Dental Appliance and special training as to the application of this appliance, in order to help you feel confident and more comfortable with its use.

For your convenience, we at Delmarva Dental Services, P.A., have our own insurance administrator who will file the necessary paperwork to assist in obtaining Medical Insurance reimbursement.

SLEEP QUIZ
Answering these simple questions may be the first step to a restful night¡¯s sleep for you and your family. You may be unaware of these problems, since they may appear suddenly or gradually over the years. You might find your family members, friends and/or co-workers most helpful in recognizing any of these signs.

I HAVE BEEN TOLD THAT I SNORE
I HAVE BEEN TOLD THAT I SNORE LOUDLY, EVERY NIGHT, IN ALL POSITIONS
I HAVE BEEN TOLD THAT I STOP BREATHING WHILE I SLEEP
I HAVE JOLTED AWAKE GASPING FOR BREATH DURING THE NIGHT
AFTER A FULL NIGHT¡¯S SLEEP, I STILL WAKE UP FEELING TIRED
I FALL ASLEEP AT INAPPROPRIATE TIMES, FOR EXAMPLE, AT WORK OR BEHIND THE WHEEL OF A CAR
I HAVE TROUBLE CONCENTRATING
I HAVE BECOME UNUSUALLY FORGETFUL
PEOPLE SAY, OR I FEEL, I HAVE BECOME UNCHARACTERISTICALLY IRRITABLE, ANXIOUS OR DEPRESSED
I OFTEN WAKE UP WITH A HEADACHE
I HAVE HIGH BLOOD PRESSURE
I AM OVERWEIGHT
I SEEM TO HAVE LOST MY SEX DRIVE

IF YOU ANSWER YES TO ANY OF THE ABOVE STATEMENTS YOU SHOULD ASK US ABOUT SNORING AND SLEEP APNEA.

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