Watch a Sample of Sleep Apnea Episode

Symptoms

Obstructive sleep apnea (OSA) is a condition where tissues in the neck block the airway during sleep. This leads to pauses in breathing (apnea) and decreased oxygen levels in the blood (hypopnea) resulting in multiple awakenings that disrupt the normal sleep pattern. While snoring is the most noticeable symptom and can indicate the presence of OSA, there are many other symptoms, including:

• Gasping or choking during sleep
• Witnessed pauses in breathing
• Teeth grinding
• Sore jaw muscles
• Dry mouth
• Excessive daytime fatigue
• Morning headaches
• Changes in personality or irritability
• Problems with attention and/or memory

Diagnosis

The gold standard to diagnose OSA is through a sleep test. This can be done in a sleep lab or from a patient’s home. During the test, several aspects of sleep are monitored including brain waves, oxygen levels, limb movements, and number of times a patient may stop breathing. The results are then reviewed by a certified sleep physician who makes an official diagnosis. There are several important numbers that will be in a patient’s sleep report.

• Apnea-Hypopnea Index (AHI): Measurement of the number of apneic and hypoxic events that occur in one hour. Apnea is defined as the cessation of breathing for at least 10 second.  Hypopneas are defined as a reduction in airflow by 50% for at least 10 seconds.
• Respiratory Effort-Related Arousals (RERAs): Characterized as a series of breaths where airflow is decreased and respiratory effort is increased. They last at least 10 seconds and lead to awakenings that disturb the normal sleep pattern
• Respiratory Disturbance Index (RDI): All apneas + hypopneas + RERAs per hour of sleep
• Lowest Oxygen Saturation: The lowest oxygen concentration in your blood reached during the sleep study

OSA is divided into different severity levels depending on the number of AHIs.

• < 5 AHI/hour = OSA not present
• 5-15 AHI/hour = Mild OSA
• 15-30 AHI/hour = Moderate OSA
• > 30 AHI/hour = Severe OSA

Though insurance companies only consider the AHI when determining coverage for an oral device, RERAs and RDIs should not be ignored. These numbers indicate a respiratory effort is great enough to disrupt sleep patterns multiple times a night. Interrupted sleep leads to excessive daytime fatigue and other symptoms that impact quality of life. These symptoms may indicate Upper Airway Resistance Syndrome or UARS, considered by many physicians to be the “bridge” between snoring and OSA.  Read more about UARS here.

Treatment

There are several options for the treatment of OSA, including:

• Weight loss
• Avoidance of alcohol, tobacco, and sedatives before bedtime
• Improved sleep hygiene
• Adjustment in sleep position
• Continuous Positive Airway Pressure (CPAP)
• Surgery
• Dental Sleep Therapy

For those with mild to moderate disease or for which lifestyle modifications are not enough, dental sleep therapy (DST) is an option. Dental sleep therapy involves the fabrication of a custom, adjustable oral appliance.  The appliance is worn nightly and works by maintaining the lower jaw in a more forward position.  This removes the tongue and other soft tissues from the airway leading to decreased snoring, increased oxygen levels, and improved sleep.

The goal of Carolina Dental Sleep Center is to create an individualized treatment plan that a patient will use, that is effective, and results in the most optimal health for the patient. To do this we work closely with other medical providers to determine what therapy is best for you. For those with severe disease, continuous positive airway pressure (CPAP) is recommended as first line treatment by the American Academy of Sleep Medicine; however the treatment that works is the one that patients will use! If you are intolerant to CPAP we can help you. Let us create an oral device just for you and get you on the road to a better night’s sleep and improved quality of life!