Sleep Apnea

Dr. Chenet is an In Network Provider for Highmark, UPMC & Medicare for Oral Sleep Apnea Appliance

Diagnosis of Obstructive Sleep Apnea (OSA)

A consultation, including a thorough sleep history and physical exam, is often the first step to diagnosing any sleep disorder including Obstructive Sleep Apnea. If it is determined you need a more detailed assessment, your primary care physician may refer you for an overnight sleep study (polysomnogram). This test records the patient's brainwaves, heartbeat, respiratory effort, airflow, eye movement, blood oxygen levels and breathing during an entire night. Other sleep tests, such as a Multiple Sleep Latency Test (MSLT), may be performed to measure and assess the severity of daytime sleepiness, and to exclude other sleep disorders. In addition to your PCP, pulmonologists, neurologists, or other physicians with specialty training in sleep disorders may be involved in making a definitive diagnosis. Sleep apnea is easily diagnosed and must not be ignored.

Terminology upon Testing:

An apnea event
Defined as a cessation of ventilation (breathing) for I 0 seconds or longer.
Apnea Diagnosis
Occurs when a person experiences 30 or more apnea episodes during a seven hour sleep period.
Hypopnea
Occurs when there is a partial obstruction somewhere in the airflow. It involves a decrease in oxygen levels in the blood (oxygen
desaturation-uptake of greater than 4%).
RDI (Respiratory Disturbance Index) I AHI (Apnea-Hypopnea Index)
Average number of apneas plus hypopneas combined per hour of sleep.
UARS- Upper Airway Resistance Syndrome
This condition lies midway between benign snoring and true Obstructive Sleep Apnea. People with UARS suffer many of the symptoms of Obstructive Sleep Apnea but sleep testing results lack evidence demonstrating true apneas or oxygen desaturation.

Severity of Apnea Defined By:

  • Percentage of oxygen desaturation.
  • Complete or partial stoppage of breathing.

- 5-20 events per hour = Mild OSA.
- 20-40 events per hour=Moderate OSA.
- 40 events per hour=Severe OSA.

NOTE: Many different factors contribute to the diagnosis of Obstructive Sleep Apnea . The above range is only a general breakdown. Oth e r parameters such as lowest oxygen level obtained and length of apnea episodes during the sleep testing procedure effect the final diagnosis of this disorder.

Who is More Likely to Have Obstructive Sleep Apnea (OSA)

  • Being overweight- obesity is a major risk factor, although thin people can develop severe sleep apnea also. Nasal congestion or obstruction- sinus trouble or allergies.
  • Large tonsils and/or adenoids, having a "crowded throat", a large tongue or small jaw.
  • Family history.
  • Drinking alcohol
  • TMJ and jaw pain.
  • Bruxism (teeth grinding).
  • Lung disease, atrial fibrillation and heart failure.
  • Scoliosis or muscle weakness.
  • Sedating medicines and alcohol.
  • Hypothyroidism and certain other endocrine (hormonal) disorders.
  • Increasing age.
  • Malformation of the orofacial area (misaligned teeth, jaw, palate).
  • Polycystic Ovarian Syndrome (PCOS).
  • Menopause.
  • Progesterone/Estrogen deficiency.
  • Anatomy and physiology of the airway.
  • Male gender.
  • Neck size> 17 inches in men, and> 15 inches in women.
  • A decrease in tone of muscles holding airway open.
  • Smoking.

Warning Signs for Sleep Apnea:

  • Do you snore heavily?
  • Does your snoring disturb your partner?
  • Has your partner observed you not breathing while you sleep?
  • Do you have high blood pressure?
  • Do you fall sleep at inappropriate times?
  • Are you irritable?
  • Do you wake up with a headache or sore throat?
  • Do you have acid reflux disease?
  • Do you notice a decrease in your sex drive?

If you answered yes to two or more of these questions you may be at risk for Sleep Apnea.

Normal Breathing

During sleep you should mainly breathe through your nose. This allows the air to be of better quality and you will actually get more oxygen, which can lead to a better and more restful night’s sleep.

 

What is Snoring?

Snoring is the sign of a breathing problem. It occurs when the jaw opens and the tongue falls into the back or the throat causing the airway to narrow and forcing air through the smaller opening. This creates sound vibrations in the throat known as snoring. Snoring can seriously affect your quality of life. It can be embarrassing and inconvenient, and can cause problems in relationships. In some cases, snoring is a red flag for a more serious medical problem called obstructive sleep apnea (OSA).

 

What is Sleep Apnea?

Sleep Apnea is when the airway is completely blocked and air is unable to flow through the airway. This is also known as Obstructive Sleep Apnea. The obstruction may occur from the area of the soft palate to below the base of the tongue, causing one to awaken during the night with coughing or a gasping sound, attempting to restore breathing.

 

Symptoms of Sleep Apnea:

  • Snoring
  • Fatigue or tiredness
  • High Blood Pressure
  • Falling asleep while reading, watching TV or driving
  • Poor Sleep
  • Morning Headaches
  • Cardiovascular disease
  • Wake from sleep coughing, choking or gasping

Disorders associated with Snoring/Sleep Apnea:

  • Diabetes
  • Mood Swings
  • Grinding of the teeth
  • Depression or anxiety
  • Gastric Reflux
  • Heart Attack/Stroke

How Do Oral Appliances Help?

Oral appliances are the devices worn in the mouth while sleeping that reposition the lower jaw and tongue to help open the airway. This is accomplished by tensing the muscles that support the airway, which in turn opens or dilates the airway so air can freely move in and out without resistance or obstruction.

 

Advantages of these appliances:

  • Posterior support to protect the TMJs
  • Ability to manage teeth grinding
  • Freedom of jaw movement with use
  • Easily modified to accommodate dental work
  • Does not lock or hold the jaw in a set position
  • Helps keep the airway open by preventing the jaw and tongue from falling back during sleep
  • Improves nasal breathing