Frequently Asked Questions: Sleep Apnea

Are you drowsy during the day with no explanation? Do you snore loudly or wake up breathless in the middle of the night? If you’re experiencing any of these symptoms, you may be one of more than 12 million Americans who are affected by sleep apnea. People who are overweight (body mass index over 30) or have thick necks (men over 17.5″, a woman over 16.5″)are at a higher risk (in the 90th percentile of having Obstructive Sleep Apnea. We are a trained provider of Oral Appliances to manage sleep apnea. These appliances are considered medical in nature and therefore are covered by medical insurance.

We are also a Medicare Provider of Oral Appliances for Sleep Apnea. For Qualified Medicare part B patients, there is little or NO OUT OF POCKET COST!

What is sleep apnea?

Sleep apnea is a condition in which your breathing stops periodically during sleep, as many as 20-30 times per hour. Each time you stop breathing in your sleep, the resulting lack of oxygen alerts your brain, which temporarily wakes you up to restart proper breathing. Since the time spent awake is so brief, most people with sleep apnea don’t remember it, and many feel like they are getting a good night’s sleep, when in fact, they are not. The constant wake-sleep, wake-sleep cycle prevents those with sleep apnea from achieving deep sleep, resulting in a constant drowsy feeling during the day.

Depending upon what causes the cessation of breathing there are different classifications or types of Sleep Apnea. The three types of Sleep Apnea are: Obstructive Sleep Apnea (OSA), Central Sleep Apnea (CSA) and Mixed Sleep Apnea. Most patients with Obstructive Sleep Apnea also experience Hypopnia. An Hypopneic Event occurs when a person’s  airway is not totally blocked, but due to an Obstruction, they are unable to maintain good airflow. It is like trying to breathe through a straw. You are passing air, but not enough. Your body is still starving for oxygen. When the oxygenation level drops in a short period of time, it is considered an hypopneic event. By definition there is a 30% (or greater) reduction in flow lasting for 10 seconds or longer and an associated 4% (or greater) desaturation in the person’s oxygenation levels.

What are the signs of sleep apnea?

The following symptoms can indicate the presence of sleep apnea. If you notice one or more of these, contact our practice.

  • Insomnia or difficulty sleeping
  • Loud snoring at night
  • Waking up at night short of breath
  • Snorting or choking sounds during the night (indicating a restart of breathing)
  • Headaches upon waking in the morning
  • Falling asleep unintentionally during the day
  • Extreme drowsiness throughout the day

Are there different types of sleep apnea?

There are three categories of sleep apnea.

  • Central Sleep Apneas (CSA) are controlled by your brain. It is a more rare condition. Your brain actually tells your body to stop breathing. Your body, through certain mechanisms, fights your brain and causes you to breath again. This occurs many times during the night.
  • Obstructive Sleep Apnea (OSA) is a more common disease. It occurs when the base of your tongue causes an obstruction in your airway while sleeping.
  • Mixed Sleep Apnea occurs when a patient has a combination of both Obstructive Sleep Apnea and Central Sleep Apnea.

Sleep apnea is quantified by the average amount of times a person either stops breathing (Apneic Event) or has a reduction in oxygenation level (Hypopneic Event) on an hourly basis. There are three grades of Obstructive Sleep Apnea. Although this is an oversimplification, it is a good guide.

  1. Mild–  when a person’s AHI is between 5 – 15 events per hour
  2. Moderate – when a person’s AHI is between 16 – 30 events per hour
  3. Severe – when a person’s AHI is greater than 30 events per hour

What are risk factors for sleep apnea?

Obstructive sleep apnea is more common in males than females, and more common in older adults (40+) than younger adults and children. However, anyone — regardless of gender or age — can suffer from sleep apnea. Other risk factors include obesity, smoking, drinking, use of sedatives or tranquilizers, and family history. Central sleep apnea strikes most often in people with heart disorders, neuromuscular disorders, strokes, or brain tumors. It is also more common in males.

Is sleep apnea dangerous?

Sleep apnea is considered a serious medical problem and if left untreated can lead to high blood pressure, increasing the risk of heart failure and stroke. The ongoing state of fatigue caused by sleep apnea can lead to problems at work or school, as well as danger when driving or operating heavy machinery. Sleep apnea can also cause complications with medication or surgery; sedation by anesthesia can be risky, as can lying flat in bed after an operation. If you know or suspect you suffer from sleep apnea, let your family doctor know before taking prescribed medication or having surgery.

How do you test for sleep apnea?

In most cases sleep apnea can only be diagnosed by a sleep physician in a sleep lab. The test is called a polysomnogram (PSG). The patient generally checks into a sleep lab for an overnight test. The patient sleeps at the lab and is studied during that nights rest. A PSG measures your breathing, pulse, and oxygenation levels. It also measures your brainwave patterns to see what stages of sleep you are in when you have apneic events.

Since Polysomnograms are costly tests, some insurance companies are beginning to do studies with ambulatory (Take Home) studies. The data from an ambulatory study is not as complete as that from a study done in the sleep lab. Your Physician will decide the best type of test for you.

How is sleep apnea treated?

Treatments for sleep apnea depend on the classification of each individual case, and the type of apnea. Basic treatment can be behavioral — for instance, patients are instructed to lose weight, stop smoking, or sleep on their sides instead of on their backs. Beyond that, There are 3 methods of treating Obstructive Sleep Apnea.

CPAP:  is an anachronism  for Constant Positive Air Pressure. The patient wears a mask which covers the mouth and or nose. That mask is connected to an air pump which blows air down your throat and opens up the obstruction. Although this is a highly effective treatment, many people find the mask and pump intrusive to their sleep. The resulting noncompliance means the disease is left untreated.

Surgical Intervention: If the cause of the obstruction can be identified, surgery can be performed to eliminate the obstruction. Even if surgery is done many times the apnea can return after a patient fully heals depending on the type of surgery performed.

Oral Appliance Therapy(OAT): Also called a Mandibular Advancement Splint (MAS). A device which is used during sleep to move your lower jaw forward. Your lower is attached to the base of your tongue which is usually the source of the obstruction. By moving your lower jaw forward it helps open the obstruction.

What is the connection between snoring and sleep apnea?

Snoring occurs when the airway is partially blocked or collapsed while sleeping. This narrowing of the airway can cause the tissues of the throat to flutter and cause noise. The more restricted the airflow the louder the noise. Not everyone who snores has sleep apnea and not everyone that has sleep apnea snores. If a patient has loud restrictive snoring without apneic or hypopneic events, it is usually considered Upper Airway Resistance Syndrome (UARS). This can be a precursor to Obstructive Sleep Apnea.

What should I do if I suspect that someone in my family suffers from sleep apnea?

Contact our practice, and we can refer you to a sleep apnea specialist. The specialist may recommend a “sleep study” to diagnose the precise extent of the problem, and can prescribe appropriate treatment. Depending on the patient’s situation, treatment may involve an oral device that we can custom-create for you.

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Eric Shantzer, DDS
130 Almshouse Road
Suite 406
Richboro, PA 18954