Q: [All Ages] My husband suffers from incessant, deep, abnormal snoring, and I suffer from serious lack of sleep. He thinks it’s funny, but it’s affecting my mood and daily routine. Are there any remedies or medical advice on what can be causing this and how we can handle it?
A: Snoring can take a toll on a marriage and health, and can be a sign of obstructive sleep apnea (OSA). OSA can take more years off of a life than diabetes and smoking. It increases the risks of stroke by three times and heart disease by four times. It occurs when the body loses its ability to maintain an airway that is large enough for air travel as the muscles relax during sleep. This produces an audible noise as air passes the soft palate causing it to vibrate.
If there is a complete blockage, an obstructive apnea occurs. An apnea is generally followed by a gasp. A hypopnea is a significant drop in pulse oxygen levels of greater than 4 percent. The combination of apneas and hypopneas per hour create the apnea hypopnea index (AHI). This is the metric used by the medical community to measure the presence and severity of this disease. Associated with OSA is a list of detrimental health and lifestyle effects.
There is another disorder called Upper Airway Resistance Syndrome (UARS) that also has serious detrimental effects on health, but is only detectable by measuring the number of arousals. This is the precursor to sleep apnea and is easier to treat before it becomes full blown apnea.
One of the biggest factors leading to OSA is obesity. Men with a neck size greater that 17 inches and women with a neck size greater than 16 inches are at a much greater risk of OSA. By losing weight, OSA can be reduced or even eliminated. Weight loss can be a challenge for many OSA patients because one of the main symptoms is fatigue and many of the hormones that allow for weight loss are released in the later stages of sleep. The later stages of sleep aren’t often reached due to constant sleep disturbances associated with the disorder.
The key to your husband’s health and your rest is treating or eliminating OSA. The best method is weight loss. However, weight loss alone often is not enough to eliminate OSA. The two main forms of treatment are Continuous Positive Airway Pressure (CPAP) and mandibular repositioning devices. CPAP is very effective and most often recommended by sleep physicians, especially for severe cases. Unfortunately, due to lack of comfort, size and many other factors, some believe compliance to be as low as 10 percent. On the other hand, mandibular repositioning devices are very effective and less encumbering than CPAP. For mild to moderate levels of OSA, oral sleep appliances work great and are very comfortable when properly fabricated and titrated (adjusted for efficacy using pulse oximetry). You will see many commercials for cheaper devices. However, these fit very poorly and are generally only worn for a few nights before they find their way in the trash. Custom-made oral sleep appliances—when accompanied by a sleep physician’s diagnosis of OSA following a sleep study—are often covered by health insurance (not dental insurance). Your dentist’s office can bill this to the insurance company.
In the past, all sleep studies were done at a sleep center. Today, we have the ability to measure sleep disorder breathing with very easy-to-use home sleep studies. The results are sent to a sleep physician and a diagnosis of severity is made in just a few days. With this, diagnosis treatment recommendations can be made. Other options for treatment of OSA include surgery and utilization of orthotropic orthodontics. Orthotropic orthodontics are removable, growth-stimulating oral appliances. Both options can also be covered by health insurance.
When searching for a dentist to treat OSA and UARS, be sure that the dentist is educated in the area of sleep medicine.
Andrew Spath, DDS, FAGD practices Preventative, Implant, Cosmetic and Sleep Dentistry in Newport Beach. He graduated from the Kois Center and achieved his Fellowship in the Academy of General Dentistry.