Obstructive sleep apnoea (OSA) is one of a range of sleep disorders, and is caused by a temporary pause in breathing, commonly as a result of tissue collapse (airway narrowing) between the back of the tongue and the wall of the throat. When we fall asleep (and become unconscious) the muscles of our upper airway relax, allowing your tongue to fall back (under the force of gravity) onto the throat and palate, especially if you sleep on your back. This point of contact (tongue to throat and palate) narrows or collapses the airway, thus reducing the amount of air travelling through the throat into your lungs. A partial airway collapse may only result snoring (noisy breathing), but a more severe complete airway collapse, will result in causes an apnoea episode where there is a complete absence of breathing for a short time. Untreated severe OSA can be life threatening low oxygen levels (associated with apnoea) can lead to elevated blood (hypertension), heart attack (myocardial infarction) and stroke (cerebrovascular accident).
When your brain and organs become oxygen deprived you will probably wake up momentarily (disturbed sleep), however many of these restless sleep episodes are often not remembered in the morning. These episodes can happen a few times a night or in more severe cases, several hundred times a night. As a result, the brain doesn’t achieve the restorative deep sleep it needs, and long-term consequences damage your overall health.
What are the symptoms of sleep apnoea?
The most common symptom associated with sleep apnoea is snoring, but not everyone who snores has OSA. If snoring is combined with gasping or choking sounds however, it is more likely due to sleep apnoea. Other common symptoms of this sleep disorder are:
• Pauses in breathing
• Morning headaches
• Excessive daytime fatigue
• The frequent need to urinate during the night
• Insomnia due to difficulty staying asleep
• Waking up with sore throat or a dry mouth
• Trouble concentrating
• Memory or learning problems
• Irritability, moodiness or depression
How does CPAP assist with sleep apnoea?
Many people with sleep apnoea actually haven’t been diagnosed and therefore don’t receive treatment. Sleep Specialists can diagnose the condition using home sleep tests or via an in-lab sleep study. One of the most common treatments for sleep apnoea is called Continuous Positive Airway Pressure (CPAP).
CPAP generally involves using an air pump and mask to deliver mild air pressure to the upper airway (throat) of a person via their nose or their nose and mouth while they are sleeping. The air pressure can be variable or constant depending on the type of machine, however CPAP machines usually deliver a constant air pressure. Automatic or Auto-Titrating Positive Airway Pressure (APAP) machines have an in-built algorithm that delivers a variable air pressure according to the person’s needs. In both cases the pressurized air prevents the upper airway from collapsing, and allows an individual to breath normally.
What if I can’t tolerate CPAP treatment methods?
Unfortunately, some people don’t tolerate CPAP and turn to other treatments such as using an oral appliance. These appliances are also called mandibular advancement devices (MAD) or mandibular advancement splints (MAS) and there are many types, but unfortunately not all of them are effective.
A standard oral appliance consists of a type of mouth guard fitted to both the top and bottom teeth which joins them in such a way that the bottom teeth end up in front of the top teeth. Pushing the bottom jaw forward in most people helps open up the airway (space between the back of the tongue and throat) and maintain the airway during sleep. This can help with getting a healthy sleep by either reducing the number or severity of sleep apnoea events. Advancing the jaw by eight to 10mm is normally enough to make a difference in most people, but this amount may need to be adjusted depending on the effectiveness in each individual.
Most experts agree that oral appliances aren’t as effective as CPAP, as CPAP can reduce the number of apnoea events to less than five per hour. However, many patients find the CPAP difficult to use, uncomfortable and often troubling for domestic harmony; the physical size of the CPAP machine can also be a challenge for patients when they are travelling. Treatment for OSA is considered successful if the number of apnoea events is reduced to less than twenty each hour or by at least 50 per cent. If you have severe sleep apnoea symptoms however, even reducing the number of events by this amount may not be enough to reduce symptoms or risk factors, so undergoing CPAP therapy may be the best option.
Do oral appliances work for everyone?
Everybody has different shaped airways, different shaped faces and differing abilities to tolerate lower jaw protrusion, which is why the success rate of oral appliances is variable. The fitting and subsequent assessment of these devices should always be undertaken with the guidance of a Sleep Specialist who understands the role of these appliances to treat sleep apnoea.
Properly fitted oral appliances should not cause lasting discomfort to the face, jaw joints (TMJs), teeth or gums.
Some patients (around 40%) will experience discomfort with forward movement (protrusion) of the lower jaw. The main issues surrounding the use of oral appliances are experienced in the bony structure in front of your ear in the area where the jaw pivots (called the temporomandibular joint; TMJ). Prolonged protrusion of the jaw may cause this to ache but if the appliance is fitted correctly, aching should soon disappear once the device is removed in the morning. Other problems reported by some people are excess saliva formation and tooth and mouth tenderness.
What do I do if I think I have sleep apnoea?
If you think you may be suffering from sleep apnoea and determined to investigate how to get better sleep, the first step is to attend for assessment with one of our Specialists. They will assess your symptoms, face and jaw shape and discuss the various factors that might help your situation. Then, if necessary advise on the appropriate courses of action.
Many Sleep Specialists will recommend that you try CPAP first, but if that’s not the best solution for you, they will refer you to a Specialist with comprehensive knowledge of facial shapes, an understanding airway structure and experience in using oral appliances.
CPAP didn’t work for you, so now it’s time to investigate the best oral appliance for your sleep apnoea. Contact the experts at the Dental Implant & Specialist Centre today on (07) 5503 1744.