Obstructive Sleep Apnoea

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What is Obstructive Sleep Apnoea?

Obstructive sleep apnoea occurs when the tongue and soft palate collapses (obstructs) onto the back of the throat and partially or completely blocks the upper airway during sleep. This causes the person to stop breathing momentarily (this is called an apnoea) and also restricts the flow of oxygen in your blood.   When the brain’s oxygen levels falls low enough, it will briefly awaken the individual from sleep so the airway can be reopened.   A deep gasping, choking, or snorting usually signifies this as the person struggles to breathe again.  The individual will usually fall back to sleep again and may not be aware this has happened.  They may also toss and turn, have restless sleep and snore very loudly.  It is usually their concerned bed partner who notices these events.  These episodes may occur many times during the night, and disrupting normal sleep and starving the body of vital oxygen.  In severe cases, individuals may have more than 30 obstructions in an hour.

How serious is Obstructive Sleep Apnoea?

Individuals with untreated obstructive sleep apnoea have an increased risk of developing a number of medical conditions:

  • High blood pressure
  • Heart disease
  • Heart attack
  • Irregular heartbeats
  • Stroke
  • Diabetes
  • Depression

Scientific evidence shows that individuals with moderate to severe sleep apnoea are at an increased risk of death due to one of the above medical conditions.

Obstructive sleep apnoea may also contribute to driving and work-related accidents due to excessive daytime sleepiness, which affects concentration, cognition, memory and ability to work effectively.  Individuals with obstructive sleep apnoea are at least 4 times more likely to have a motor vehicle accident.  The drowsiness caused by obstructive sleep apnoea is comparable to the consumption of alcohol and drugs.

Obstructive sleep apnoea can also affect families.  Snoring can keep your bed partner awake.  Some partners try to stay awake to ensure their partner starts breathing again every time they stop breathing.  Lack of sleep can place strain on a relationship.

How common is Obstructive Sleep Apnoea?

Obstructive sleep apnoea affects 9% of males and 5% of females. It is commonly associated with snoring and obesity. Individuals of all ages including children can be affected by obstructive sleep apnoea.  In adults, sleep apnoea is more common in middle age. In children, obstructive sleep apnoea is often the result of enlarged tonsils or adenoids or some orofacial abnormality.

Many individuals with obstructive sleep apnoea are aware they snore and feel tired or fatigued during the day but are unaware of a potentially serious medical problem which may exist.  Therefore, many individuals with obstructive sleep apnoea remain undiagnosed.

Signs and Symptoms of Obstructive Sleep Apnoea

  • Loud snoring
  • Gasping or choking at night
  • Stop breathing (apnoeas)
  • Unrefreshed sleep
  • Excessive daytime sleepiness
  • Tired or fatigued during the day
  • Problems with memory or concentration
  • Morning headaches
  • Awakening with a dry mouth or sore throat
  • Fall asleep sitting, reading, watching TV or driving
  • Increased frequency of urination at night
  • Heartburn
  • Irritability, depression, mood, behavioural and personality changes
  • Impotence or decreased sex drive

Risk Factors of Obstructive Sleep Apnoea

  • Obesity
  • High blood pressure
  • Diabetes
  • Heart condition
  • Male gender
  • Menopausal women
  • Greater than 40 years of age
  • Smoking
  • Alcohol, sedative or tranquiliser use
  • Family history of obstructive sleep apnoea
  • Abnormality of the upper airway or orofacial tissues

How is Obstructive Sleep Apnoea diagnosed?

If you believe you have the symptoms of obstructive sleep apnoea, consult your medical general practitioner (GP). Your GP will typically ask you regarding common signs and symptoms and carry out a physical examination. If your history and examination suggests you have obstructive sleep apnoea, your GP must then refer you for a sleep study under the care of a specialist sleep physician. The sleep study is necessary to confirm the presence and severity of obstructive sleep apnoea in order to establish a diagnosis. This is important, as your diagnosis will determine the best treatment option for you.

A sleep study is performed overnight in either a sleep laboratory or at home using a portable device. Although a home based sleep study may be more convenient, current evidence suggest that a laboratory based sleep study is more accurate. During a sleep study, electrodes and sensors are attached to the scalp, face, chest, legs and finger.   The sleep study will record the following information:

  • Blood oxygen levels
  • Body position
  • Brain waves
  • Breathing rate
  • Electrical activity of muscles
  • Eye movement
  • Leg movement
  • Heart rate
  • Number of times breathing stops
  • Snoring
  • Teeth grinding

A sleep study may also detect other sleep disorders such as narcolepsy, periodic limb movement disorder, central sleep apnoea and sleep bruxism.

PATIENTS MUST HAVE A CURRENT SLEEP STUDY (WITHIN 5 YEARS) PRIOR TO FABRICATION OF AN ORAL APPLIANCE FOR SNORING AND OBSTRCUTIVE SLEEP APNOEA. TREATMENT CANNOT BE COMMENCED WITHOUT THIS INFORMATION.

Treatments for Obstructive Sleep Apnoea

There are several treatments available for Snoring and Obstructive Sleep Apnoea and should be directed by your sleep physician or medical GP based on your diagnosis and clinical presentation. Choosing the best treatment option will increase the likelihood for success. The Perth Oral Medicine and Dental Sleep Centre specialises only in Oral Appliance Therapy and you will require a referral to visit our practice. [CREATE LINK TO “MANDIBULAR ADVANCEMENT APPLIANCE THERAPY FOR SNORING AND OBSTRUCTIVE SLEEP APNOEA”].

  1. Oral Appliance Therapy

Oral appliance therapy is often used when the patient is unable to tolerate CPAP therapy.  It has been proven to be very effective for snoring and those suffering mild to moderate obstructive sleep apnoea. Also oral appliance therapy may be utilised in the patient with severe obstructive sleep apnoea who are unable to tolerate or refuse CPAP therapy.

There are two types of oral appliance therapy:

  • Mandibular Advancement Appliance– is the most common type of oral appliance used. They are also known as Mandibular Advancement Splint or Mandibular Repositioning Device.  This is an area of speciality at the Perth Oral Medicine and Dental Sleep Centre.  Click here for further information regarding the mandibular advancement device.  [CREATE LINK TO “MANDIBULAR ADVANCEMENT APPLIANCE FOR SNORING AND OBSTRUCTIVE SLEEP APNOEA”].
  • Tongue Repositioning Device – engage and hold the tongue in a forward position by means of a suction bulb without affecting the mandible or teeth. When the tongue is in a forward position, it prevents the back of the tongue from collapsing during sleep and obstructing the airway in the throat.  Tongue repositioning devices are non-adjustable.

 

  1. Lifestyle and Behavioural Changes

These factors may also improve your snoring or sleep apnoea over time. Please be guided by your medical practictioner and specialist as to the most appropriate therapy for your individual needs.

  • Exercise
  • Weight loss
  • Good sleep hygiene (e.g. have a regular sleeping pattern, avoid caffeine and eating large meals late at night)
  • Sleep position – sleeping on the side is beneficial
  • Avoid sedatives and tranquilisers such as sleeping pills
  • Avoid alcohol
  • Avoid smoking
  1. CPAP (Continuous Positive Airway Pressure)

CPAP is considered as the “gold standard” treatment for patients diagnosed with obstructive sleep apnoea.  CPAP has been clinically proven to assist symptoms and long-term consequences of obstructive sleep apnoea.

Every night during sleep, patients wear a face mask (worn over nose, mouth or both) connected to a pump which blows a steady flow of air into the nasal passages at pressures high enough to gently force the airway open and stimulate normal breathing

Woman sleeping on her side with CPAP machine in the foreground, sleep apnea treatment.

  1. EPAP (Expiratory Positive Airway Pressure) – Provent Therapy

Provent is a small, disposable nasal device, which covers each nostril and secured by an hypoallergenic adhesive. Provent uses microvalve technology and the pressure of your own breathing to keep your airway open.  The microvalves allow you to inhale normally but let only a small amount of air out when you exhale, increasing the pressure inside your airway and preventing it from collapsing.  This creates an “expiratory positive airway pressure”.

 

  1. Surgery

There are different surgical procedures performed to the nose, tongue, soft palate, walls of the throat and upper and lower jaws.  These procedures aim to enlarge the airway and decrease the collapsibility of the airway. An Ear, Nose, Throat (ENT) Surgeon or Oral and Maxillofacial Surgeon may perform these surgeries. Your sleep physician will be able to advise you whether you are a candidate suitable for surgery.

  • Tonsillectomy and adenoidectomy
  • Nasal surgery
  • Uvulopalatopharyngoplasty (UPPP)
  • Palatal implants (Pillar procedure)
  • Genioglossus advancement
  • Tongue base reduction
  • Maxillo-mandibular (jaw) advancement

Building a healthy environment that supports development for the community. Your personal case manager will ensure that you receive the best possible care.

Jonathan Steve

Healthcare Plan

Dental Implant

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