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December 4, 2014

Winning the Snore War

By TOBI SCHWARTZ-CASSELL In Part I of our two-part series, we dealt with the dangers of untreated sleep apnea. In Part II, we’ll describe the treatments now available.

Your Significant Other snores and you think you have it bad? Guess again. It’s even worse for the snorer. But a non-surgical approach is now available so you’ll both enjoy pleasant dreamzzzzz…..

The lack of a good night’s sleep can create more problems than meet the eye. According to those in the know, sleep apnea, and the more severe version—obstructive sleep apnea (OSA)—can also cause headaches, fatigue, mood swings, depression, weight gain and surprisingly, ADHD. Two studies even show there is a connection between sleep apnea and cancer (see “The Truth About Sleep Apnea: It’s More Than Just Extreme Snoring” on page 13 of the July/August 2012 issue of Girlfriendz).

Though the National Sleep Foundation reports that more than 18 million American adults suffer from sleep apnea, the American Sleep Apnea Association (ASAA) says it is only one of 84 different sleep disorders (SDs) including: circadian rhythm SDs (determined by the body’s internal clock), insomnia (the most prevalent of all SDs), narcolepsy, restless legs syndrome and night terrors.

The original diagnostic tool, according to Kent Smith, DDS, of 21st Century Dental, is the polysomnogram, which is “an attended study at a sleep center. But it’s expensive because the tech overseeing the study has to be paid, and the patient has to be provided with a place to sleep. Some insurance companies are actually moving to ambulatory studies (home studies) and some are even saying they will only pay for a full polysomnogram if the patient is incapable of undergoing an ambulatory study.”

Once diagnosed, a number of treatments are available, ranging from the severity of surgery to the first line of defense—weight loss. Stephen J. Markus, DMD, of the Centre for Dentistry of Haddon says, “For some people, losing weight is going to tone down the snoring. The thinner the neck and the less fat in the body, the easier breathing’s going to be. Also, those who are obese often experience very shallow breathing because the stomach has gotten so large it’s pushing the diaphragm up so they can’t take deep enough breaths.”

“Sleep position training can help,” adds Dr. Smith, “as do nasal decongestants, the use of over-the-counter remedies like Breathe Right® Strips and tilting the head of the bed.”

“The surgical approach, uvulopalatopharyngoplasty or UPPP, entails the use of a laser to cut back the tissue in the soft palate and remove the uvula. This allows more space for the tongue, so it does not obstruct the airway,” says Dr. Markus. “But UPPP can be very painful, kind of like a pizza burn, for at least two weeks. I also understand that in a lot of cases the tissue grows back.” ASAA reports the success rate of UPPP is 50%.

With those odds, many doctors recommend CPAP (continuous positive airway pressure) machines that use mild air pressure to keep patients’ airways open. The National Heart Lung and Blood Institute, a part of the National Institutes of Health, explains on its website that CPAP machines have three main parts:

  • A mask or other device that fits over your nose or your nose and mouth with straps to keep everything in place
  • A tube that connects the mask to the machine’s motor
  • A motor that blows air into the tube

“Most people think CPAP for moderate to advanced sleep apnea is the only solution, but it’s not,” affirms Dr. Markus. “It is, however, the best solution. The mask is very difficult for people to sleep with, which is why most of the referrals I get for nighttime sleep appliances are from doctors whose patients are non-compliant.”

Drs. Markus and Smith agree that oral appliances are a safe, non-invasive way of dealing with sleep apnea. “The appliances we work with are designed to create more space at the back of the throat so the tongue and soft palate don’t touch one another,” says Dr. Markus. “The one we’ve had the best results with are the SomnoMed® appliances. You may have seen ads for appliances selling for $19.99, but there are problems with those because they aren’t made by a professional and they’re not monitored. They are made from soft, pliable material so they can act orthodontically and therefore move teeth and create TMJ problems. So there’s a lot of frustration in the marketplace by people who want to find a way to sleep and not disturb the other person in the room and not jeopardize their own lives. These appliances can be a good solution to those with very mild sleep apnea, but for anyone more advanced than that, consultations with a sleep MD and a dentist well-versed in oral sleep appliances would be indicated.”

Dr. Markus continues, “To get the process started, we need a prescription from their sleep doctor, or the results of a sleep study showing they are mild to moderate, because the last thing we want to do is jeopardize someone’s health because they haven’t tried CPAP.”

Equally important to diagnostic studies and treatment is follow-up, says Dr. Smith. “Follow-up sleep studies to assess the effectiveness of the appliance are the standard of care. An MD would not prescribe a drug for hypertension and then never take the patient’s blood pressure again. He would want to make sure the drug was serving the purpose, and was properly calibrated for the patient’s condition. This is no different with oral appliances used to treat snoring and sleep apnea.”

Dr. Smith stresses the importance of follow-up because, “There is a condition called ‘silent apnea’ characterized by someone who may stop snoring. But assuming the condition has been treated effectively simply because the snoring has ceased is a dangerous proposition.”

The frequency of follow-up sleep studies depends on several things, says Dr. Smith, including “Severity of the disorder, availability of monitors and the curiosity of the patient or dentist. If the stars are aligned properly, and the first ambulatory study says the patient’s sleep apnea is abated, the patient is then sent for a full polysomnogram as a final assessment, which also proves success. However, often several intermediate studies are needed before the appliance has reached maximum clinical effectiveness.”

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Stephen J. Markus, DMD Center for Dentistry, Haddon Heights, NJ

Kent Smith, DDS 21st Century Dental, Irving, Texas www.sleepdallas.com

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