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Sleep Apnoea and Snoring

Snoring affects both women and men, old and young, little and large. It affects a significant percentage of the population in every country around the world. Research has shown that it only becomes worse as we get older. 30% of men and 20% of women under the age of 60 snore. Increasing to 60% and 40% over the age of 60.

Snoring is essentially a mechanical problem. The airway at the rear of the throat behind the tongue becomes smaller in some people when they sleep. This is due to an increase in fatty tissue, the effect of gravity when lying on your back, the loss of muscle tone, the relaxation of the muscles, the lower jaw and tongue dropping back, or any mixture of all these reasons. The reduced airway means the air travels faster through the airway when we breath, this causes the relaxed soft tissues in the throat to vibrate which results in the snoring noise.

The most well researched technique around the world for stopping snoring is the use of a mandibular advancement appliance (MAA). An MAA looks like a sports mouth guard and is frequently referred to as a snoring guard. An MAA fits over the upper teeth and lower teeth. The 2 parts are connected to hold the lower jaw in a slightly forward position. By holding the lower jaw forward the tongue and hyoid bone are brought forward too. This keeps the airway open and is unequivocally proven to control snoring. Mandibular advancement devices can be purchased online but it is highly recommended to get one from a dentist that will be made to fit your individual mouth and teeth.

Mandibular advancement devices are normally made from various kinds of plastics. This makes them inherently bulky and they all need to be replaced regularly. The plastic material deforms and degrades from regular wear in the mouth. The latest 4th generation mandibular advancement device from Somnowell is made from chrome cobalt alloy. Like gold, chrome cobalt is ideal for long-term use in the mouth as it does not suffer from wear or tear. It has the added advantage of being far smaller and more comfortable.

Good news is the overwhelming majority of people suffering from problematic snoring can be effectively treated using a Mandibular Advancement Appliance (MAA). We use the Somnowell appliance which is designed to gently hold the lower jaw and tongue in the 'recovery position' whilst you sleep and thereby keeping your airway open. This simple and effective treatment option has become the world's most popular solution for snoring. Follow up studies of patients treated with the Somnowell reveal a reported success rate of 96%.

Your snoring might be an indication of a far more dangerous condition called Obstructive Sleep Apnoea (OSA). The causes of snoring and sleep apnoea are very similar and the overwhelming majority of sleep apnoea sufferers are heavy snorers.

Obstructive sleep apnoea is where the airway is briefly and repeatedly fully constricted. Air can no longer enter the lungs and breathing stops. The blood oxygen levels reduce and the brain sends out an emergency signal causing a deep gasping breath. This can happen many times each hour and lead to daytime drowsiness and can severely damage health. The sleep apnoea sufferer normally is ignorant of the pauses in breathing. Sleep apnoea raises blood pressure, increases the heart rate, and robs the body of oxygen. The apnoea lead to sleep deprivation for the sufferer.

Symptoms and risk signals of OSA include loud snoring, being overweight, daytime sleepiness, morning headaches, high blood pressure, depression and irritability. If OSA is not treated it can lead to serious health risks such as cadiovascular disease, raised blood pressure, obesity and diabetes.

Sleep apnoea is classified as either mild, moderate or severe. This is set by the number of pauses in breathing per hour (AHI). The 2 main sleep apnoea treatments are continuous positive airway pressure machine (CPAP), or otherwise a mandibular advancement appliance. Though CPAP would normally be the 1st line of treatment for severe cases. If however the patient can't tolerate CPAP they can use the mandibular advancement appliance as an alternative.

With Obstructive Sleep apnoea (OSA) an increase in weight or a reduction in muscle tone can trigger the change from a partially blocked airway (snoring) to a completely blocked airway (apnoea). Obstructive sleep apnoea ranges from mild to severe. This is established using an Apnoea/Hypopnoea Index (AHI) which measures the number of apnoeas plus the number of hypoapnoeas.

The symptoms and risk signals of obstructive sleep apnoea include loud snoring, being overweight, daytime sleepiness, morning headaches, high blood pressure, depression and irritability. Other indicators of obstructive sleep apnoea include needing to get up and urinate in the night, memory loss, mood changes and lack of interest in sex.

The snoring will be accompanied by regular pauses in breathing whilst the sufferer is asleep. The individual will stop breathing and the snoring will stop, this may last for 10-20 seconds and possibly longer. After a short while the bodies emergency system will get them breathing again. This is normally accompanied by loud gasp or choking sound. This can happen many times each hour and lead to daytime drowsiness and can severely damage health. Sleep apnoea is classified as either mild, moderate or severe. This is set by the number of pauses in breathing per hour (AHI).

The sufferer normally is ignorant of the pauses in breathing. The partner however may notice the snoring noise stop, followed by a pause in breathing, and then a gasp or choking sound when breathing resumes. Sleep apnoea raises blood pressure, increases the heart rate, and robs the body of oxygen. The apnoeas lead to sleep deprivation for the sufferer. People can die of asphyxiation because of sleep apnoea, unfortunately most sufferers take many years before being diagnosed and treated.

Each apnoea will cause some breaths to be missed, leading to a rise of carbon dioxide levels in the blood. Typically the sufferer will become conditioned to the effects such as daytime drowsiness and headaches upon waking. It is common for the sufferer to be completely unaware of the disorder, and remain undiagnosed for several years. Obstructive sleep apnoea has been linked to an increased risk of stroke and cardiovascular disease. The estimated prevalence of this serious sleeping disorder ranges from study to study, but it should be noted that in every confirmed case of obstructive sleep apnoea the person diagnosed is also a snorer.

The two conditions are very closely linked. Often your sleeping partner, or others close to you, will notice the symptoms of sleep apnoea first. The symptoms are likely to include loud snoring interrupted by pauses and gasps, frequent daytime sleepiness, and morning headaches.

Obstructive sleep apnoea is a serious medical condition that has been linked to an increased risk of stroke, high blood pressure, cardiovascular disease, and arrhythmias. If you suffer from obstructive sleep apnoea you are 30% more likely to have a heart attack or die prematurely. The condition has also been linked to memory loss and brain damage. If you frequently feel tired during the day it is possible you suffer from obstructive sleep apnoea. While obstructive sleep apnoea is closely linked to snoring, it is far more damaging and potentially life threatening.

The industry standard for screening patients for obstructive sleep apnoea is the Epworth Sleepiness Scale test.

Sleep Apnoea - Self-Test

If you answered yes to one or more of the questions below you are at risk for sleep apnoea:

  1. Do you experience any of these problems?
    • Unintentionally falling asleep during the day
    • General daytime sleepiness
    • Un-refreshing sleep
    • Fatigue
    • Insomnia
  2. Do you ever wake from sleep with a choking sound or gasping for breath?
  3. Has your bed partner noticed that you snore loudly or stop breathing while you sleep?

Other questions you can ask yourself to determine if you are at higher risk for sleep apnea include:

  1. Have you ever nodded off or fallen asleep while driving?
  2. Do you often wake up with a headache?
  3. Do you have a neck size of 17 inches or more?
  4. Do you have a body mass index (BMI) of 25 or higher?
  5. Do you have high blood pressure?
  6. Do you have a family member who has sleep apnoea?

Click hereto take the Somonwell Sleepiness test.

If you have obstructive sleep apnoea that is classed as either moderate or severe, then depending on what country you live in you would most likely have been prescribed a CPAP (continuous positive airway pressure) machine. CPAP is regarded as the gold standard in sleep apnoea treatments. There is however a significant proportion of people that are prescribed CPAP who simply cannot put up with this method of treatment. Using a CPAP machine while you sleep involves wearing a face mask with an air hose going to an air pump machine that sits near the bed. The face mask requires straps that go around the head to keep it in place.

For others there may be issues related to the mask and the air pressure. Some people find they get a stuffy nose, others a dry mouth. Or perhaps red marks or sores on the face caused by the mask. A poor fitting mask that leaks can lead to sore, red or dry eyes. A too tightly fitting mask can lead to problems with the teeth, making them sore and even leading to unwanted tooth movements.

In 2002 Joanna Battagel et al published the outcome of a randomized cross over trial that compared the effectiveness of CPAP (continuous positive airway pressure) with mandibular advancement devices (MAD) in patients with mild to moderate obstructive sleep apnoea. The study showed that over 80% (17 out of the 21) of patients had a preference for the mandibular advancement device.

Each patient used the CPAP for two months and the MAD for two months. Before and after each treatment the patient had a sleep study. Patients also completed an Epworth Sleepiness Scale during treatment. The Epworth Sleepiness Scale is an industry standard questionnaire used to gauge daytime sleepiness. The before and after sleep studies revealed that with both the CPAP machines and the manibular advancement devices the number of apnoea fell significantly and to acceptable levels. There was no statistically significant difference between the two treatments. The Epworth Sleepiness Scale results showed patients reported an improvement in daytime sleepiness with both treatments, and again with no difference between CPAP and mandibular advancement devices.

A mandibular advancement device is worn inside the mouth and holds the lower jaw and tongue forward during sleep. In doing so the airway is kept open. Mandibular advancement devices can significantly reduce the amount of apnoea experienced.

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