Sleep Apnea
May 1999

Dear Dr. Mady: For the past six months, my wife keeps waking me up during the night because she says that my snoring is intolerable. She also said that it sounds like I stop breathing all the time and as if I am choking. My dentist wants to make me some sort of anti-snoring device to wear at night and he said that if it does not work, he will refer me to a sleep clinic to be assessed for Sleep Apnea. What do you think of all this and are there any other alternatives?-David in Sandwich South

Dear David: Snoring can often be very harmless, however it may be a sign of or develop into a serious medical problem known as OSA or Obstructive Sleep Apnea. In this case the snoring is caused by a loss of airway space at the back of the throat. This obstruction is caused by soft tissues including the soft palate, uvula, tongue and even the tonsils. During sleep these tissues may become relaxed causing labored breathing or even halted breathing as in the case of apnea. At this time the oxygen levels can decrease considerably and when the brain receives a signal that this is occurring, it partially awakens the individual. It is this gasp for air that mimics choking and this is probably what your wife is talking about. If you possess any of the following, you may have sleep apnea and should consult with your physician or dentist for treatment options.

a) told that you snore by others
b) told or find that your breathing stops during sleep c) grasping for air while you sleep
d) tired in the morning even after a full night of rest e) dizziness and headaches in the morning
1) weight problems
g) lack of sex drive

In mild cases of snoring or even mild variants of sleep apnea, treatment can be self done and very simple. If you are overweight, losing some of it can help. Regular exercise may also be beneficial along with avoiding certain things before bed such as alcohol, food, and medications that may make you drowsy.

If the symptoms are more severe other treatment options include Nasal CPAP Therapy (Continuous Positive Airway Pressure). This method of treatment involves an air compression device hooked to a face mask to provide a constant pressure of air to keep the airway open. Although very successful at helping individuals with OSA, compliance tends to be low due to the nature of this bulky and noisy apparatus.

If CPAP therapy is out of the question, the most effective other option is surgery .The most common surgical procedure today is the Uvulectomy/Pharyngoplasty where the uvula that hangs at the back of the soft palate is removed along with some of the muscle and tissue of the throat. This allows the airway to be opened more without the need for mechanical intervention. There are some side effects associated with this procedure and it often has to be done once or twice again to "touch up" the throat. The uvulectomy is usually done under a local anesthetic using a laser and an extremely sore throat for up to two weeks post-operatively is not abnormal
Dental Appliance Therapy is an alternative for individuals who snore without sleep apnea or ones with mild to moderate apnea. There are several types that exist depending on the particular situation. Most are fabricated from a hard acrylic or plastic and may look like a special sports mouthguard or a double orthodontic retainer. The goal of these devices is to stop the tongue and other tissues from collapsing back into the throat during sleep. This is usually accomplished by helping to protrude (push forward) the mandible or lower jaw and everything else that is attached usually goes with it. Dentists who are trained in this appliance therapy may provide you with a much less drastic form of treatment than you otherwise would be facing. This type of treatment is reversible by removing the appliance whereas the surgery is not.

Don't take chances if you feel you may have any of the above conditions. It can develop into a potentially life threatening situation if left untreated. If there is any question or chance that your snoring is a more serious problem than you may think you will need to see your dentist to see if you qualify for a removable appliance. You will also need to consult with an ear, nose and throat specialist for an upper airway exam and then complete a sleep study in a sleep clinic to determine whether the obstructive sleep apnea is mild, moderate or severe. From this point you will know exactly which route to take.

This column is reprinted with the permission of the author and The Windsor Star. "Ask the Dentist" is written by Windsor dentist (and ECDS member), Dr. David Mady Jr.. The column appears the first Thursday of each month in the Windsor Star. Readers with questions can write to "Ask The Dentist", c/o The Windsor Star, 167 Ferry St., Windsor Ontario, N9A 4M5



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