Sleep is an essential physical need that our bodies require to survive. When we are deprived of quality sleep, our bodies and our lives are negatively affected. Man or woman, child or adult, we all need sleep to refresh our bodies each day. The consequences of sleep deprivation are serious and can be life threatening when left untreated. Your body could be running a marathon every night in fight or flight mode because of a very common and frequently undiagnosed disease called obstructive sleep apnea.
Obstructive sleep apnea (OSA) is reported to have a prevalence in our population of 55% and affects both adults and children. Additionally, 80% of people who have OSA go undiagnosed (National Sleep Foundation). OSA is a life-threatening health problem and is the most common sleep-related breathing disorder. It is also the leading cause of death over all forms of cancer combined. (1) Studies show that undiagnosed and untreated OSA shortens a person’s lifespan by 12-15 years (National Sleep Foundation). Many people have this disease and are completely unaware. It is very treatable and this article will tell you what OSA is, what symptoms are indicators for OSA, and how you can treat this condition.
What is obstructive sleep apnea (OSA) and why is it so serious?
OSA is a disease of the collapsibility of the upper airway. When the upper airway collapses during sleep, then either a partial or full obstruction can occur. This causes a decrease in blood oxygen saturation because the person has stopped breathing, much like holding your breath under water. Depending on the severity of the disease, a person may have multiple apneic events that each last seconds to over a minute. When this continues repeatedly throughout the night, the body is in a constant fight or flight mode trying to survive on the reduced oxygen it is receiving. The most concerning effect of this disease is that the repetitive interruptions in breathing cause sleep fragmentation that is associated with hypoxia. This hypoxia (lack of adequate oxygen) provokes overnight hypertension and can lead to irregular heartbeat, heart attack, stroke, and sudden death. (1) A person may think they are getting a good night’s sleep, when in fact their body is fighting for its life. This constant nighttime fight contributes to daytime factors as well.
Again, sleep is an essential physical need that our bodies require to survive. Studies show that chronic restriction of sleep characterized by a duration less than 7 hours per night leads to significant cognitive disfunction and can also have negative effects on hormone and metabolic function and inflammatory responses. (2) Many people point to stress, work, family, etc. as reasons they do not get enough sleep, however it could be undiagnosed OSA that is contributing to the lack of quality snooze time. Often times, it is a loved one who complains of snoring, or who notices that their child or significant other stops breathing while they are sleeping. The one who is sleeping has no idea what is happening. However, we can evaluate other factors that the person who is affected will likely notice.
OSA affects many systems of the body. It puts the body into fight or flight mode and is therefore chronically inflamed and on high alert. People with untreated OSA have trouble with being alert during the day. They can be foggy, have difficulty remembering things, fall asleep reading or watching tv, and can even fall asleep at the wheel which has been the cause of many car accidents. This sleep deprivation leads to irritability, unstable behavior, and being fidgety or disruptive (especially in children). In fact, many children are misdiagnosed with ADD or ADHD and are put on medication, when in fact, they have undiagnosed OSA and now the medication is only covering up the underlying cause of poor behavior. (3) This can also be seen in adults and is often covered up with sleeping pills or anti-anxiety/depression medications. Again, OSA can be the underlying cause and when the OSA is treated, these other conditions are lessened, or go away completely. Furthermore, the constant fight or flight mode of the body causes an unbalance in hormones which leads to an abundance of cortisol and a decrease in glucose tolerance. This leads to inflammation, water retention, and fat storage because the body is keeping everything it can to survive. People may notice weight gain despite good diet and exercise and difficulty losing weight. Finally, the antibody activity in the body decreases because the body is putting all of its energy in keeping the tissues oxygenated and alive. This can lead to someone getting sick easier and more often and having difficulty recovering. This chronic fight or flight and related conditions greatly reduce a person’s quality of life. This situation can be dispiriting because they never seem to feel better because these conditions are often covered up with caffeine, medications, and other band-aids that are not treating the underlying condition. Without a proper diagnosis, the body stays stressed out which greatly affects the condition of the heart and can lead to death. It is important to recognize these factors and even though you or your loved one feel that you/they sleep just fine, if these other signs and symptoms are present, get screened for OSA. It must be diagnosed to be treated and is very treatable. You can feel better and add years back to your life!
What is the OSA screening process?
Many factors are considered when screening for OSA. As a dentist, I am looking in my patients’ mouths all of the time. I look for a high palatal vault, narrow arches, crowded teeth, a large tongue that sits above the lower teeth, permanent teeth extractions for orthodontics, and how the back of their throat looks. For example, can I see past the tongue into where the tonsils are located? Are the tonsils large and inflamed? In kids, I also focus on developmental factors on how their jaws relate and if they have any trouble with speech. Furthermore, if they are under weight for their age and they appear to be underdeveloped. All of these physiological factors suggest that the space for air to flow is constricted, and if a patient has a collapsible airway as well, then more often than not OSA is diagnosed.
Once I see the aforementioned physical signs of possible sleep disordered breathing, then I ask questions related to daytime sleepiness, headaches, night sweats, having to use the restroom at night, if a child wets the bed, and questions related to overall mood and feeling throughout the day. I also ask adults if they sleep in the same room as their spouse, or if snoring is too disruptive that it affects their relationship. Snoring is not always present in OSA, but is one of the leading symptoms when present. When I get responses consistent with the conditions discussed earlier, then we move forward with a sleep wellness exam for adults 18 and older and I will refer children to a sleep physician who specializes in pediatric care.
A Sleep Wellness Exam consists of using a special device called a rhinometer and pharyngometer to test the airflow through both nostrils and the collapsibility of the airway. This is a simple test that only requires you to breathe. We collect the data and compare the results to the parameters set forth by the American Academy of Sleep Medicine. If you meet those parameters, then a sleep study is recommended in order to diagnose possible OSA. I have sleep study devices that I can send home with my patients, or you can go to a sleep center. Once the sleep study is completed, it is read and diagnosed by a board-certified sleep physician. If OSA is present, that physician will write a prescription for the appropriate treatment.
How is OSA treated?
OSA is characterized as mild, moderate, or severe based upon how many apnea or hypopnea events you have per hour which is called the AHI. Mild OSA is an AHI of 5-14, moderate OSA is 15-29, severe OSA is an AHI equal to 30 or more (Division of Sleep Medicine; Harvard Medical School). Once the diagnosis is made, the board-certified sleep physician will prescribe the best treatment for each patient. For patients with mild to moderate OSA, oral appliance is very effective and is proven to be more comfortable for patients which allows them to be more compliant.1Patients who have severe OSA are most often prescribed CPAP, PAP, or auto-PAP machines. These machines are forced air that comes either through a mask, nasal pillows, or a cannula. Some are continuous and some adjust throughout the night based off of the calibration for the patient. Although CPAP is the gold standard for OSA treatment, only 6% of those who have them are compliant because they report that they are uncomfortable, cause other side effects, and they cannot travel with them easily.1In these cases where a patient cannot tolerate a CPAP, this is another opportunity for oral appliance. The oral appliance is worn at night to stabilize the collapsibility of the upper airway. It is proven that patients are more compliant with oral appliance versus CPAP which results in comparable effectiveness.1There are also devices on the market that can be implanted into a patient to stimulate their nervous system when apneic events occur. These are new and clinical trials reveal that the patient candidates for the devices can be limited.
In children, treatment can be a little different. Children are still growing so we can often times affect the airway positively by removing adenoids, expanding the arches through orthodontics, and occasional steroids if they have trouble breathing through their nose. Sometimes a nasal cannula or CPAP is recommended for children as well depending on the severity and root cause of the obstructive apnea. (3)
Regardless of the treatment chosen, anyone diagnosed with OSA MUST TREAT their OSA EVERYDAY! Someone with OSA has apneic events every night and not wearing an oral appliance, CPAP, or surgically implanted device puts you at greater risk for STROKE, HEART ATTACK, AND SUDDEN DEATH. OSA is very treatable, but you must be consistent and compliant.
Everyone deserves a good night’s sleep. It is also important to know that even though you or your loved ones may think they sleep well, if they have any of the aforementioned signs and symptoms, then obstructive sleep apnea could be the underlying cause. We know that OSA is very prevalent in our population and is an 80% undiagnosed condition. We also know that it is the leading cause of death over all forms of cancer COMBINED. (1)
Treating the underlying cause of conditions helps people to feel better and reduce or potentially remove certain medications from their body. Overall, the goal of screening for and treating patients with OSA is to help our community to live longer and to be happier and healthier overall! Call Falcon Park Dental Group today at 303-683-5091 and mention this article for a FREE Sleep Wellness Exam! We look forward to meeting you and to helping you and your loved ones have peaceful, restful, and healthy sleep.
References:
Cardiovascular Benefits of Oral Appliance Therapy. Van Haesendonck et al. J. Dental Sleep Medicine, 2015 – Vol 2. No 1.
Behavioral and Physiological Consequences of Sleep Restriction. Banks, S; Dinges, DF. J. Clin Sleep Med. 2007; 3(5): 519-528.
Obstructive Sleep Apnea in Children: A Critical Update. Tan, H; Gozal, D; Kheirandish-Gozal, L. Nat Sci Sleep. 2013; 5: 109-123.