What is Osbrtuctive Sleep Apnea?
Sleep apnea is an anatomical condition where a person’s airway becomes so narrowed or even blocked that they can no longer breathe. This stoppage of breath causes the oxygen levels in a persons blood to drop to unsafe levels effectively starving every organ of oxygen. If this occurs between 5-14 times per hour it is considered Mild OSA, 15-29 times per hour is considered Moderate OSA and 30 or more times per hour is Severe OSA.
What causes Obstructive Sleep Apnea?
OSA is an anatomic issue. When a person’s jaws don’t fully develop or grow to their full genetic potential they end up with smaller, set back jaws. This is often visible and will show up in a couple of different ways. Crooked teeth, highly vaulted narrow palate and a facial profile that looks like a small set back chin are the most common. When the jaw is narrow and set back it forces a persons tongue to set low and back into the airway space. Often times this arrangement will lead to mouth breathing in addition to snoring and apnea. Once a person falls asleep, especially on their back, their muscles relax and can allow that pushed back tongue and soft palate to fall further back into the airway causing a blockage.
What happens to your body when you have sleep apnea?
When your brain senses that it is losing oxygen it kicks your body into fight or flight mode. Within seconds your brain tells your body increase your heart rate in hopes of sending more oxygenated blood to the brain so that brain cells don’t start to die. When that doesn’t work it tells your head, neck and facial muscles to contract. This is an effort to brace and pull open the blocked airway but it also causes clenching and grinding of the teeth. The lungs and diaphragm continue to try to breath in but when there is a blockage that effort causes a vacuum to form in your esophagus which may reflux stomach contents into your airway. If that still doesn’t work you will begin to wake up until you are able to gasp or move enough to free the blockage.
These frequent bouts of a racing heart are hard on your circulatory system that should be busy repairing itself from the days damage. When more damage is occuring and not enough repair you become at risk for serious health issues such as heart attack and stroke. When you have frequent awakenings your body doesn’t get enough deep sleep or REM sleep. Lack of deep sleep causes things like weight gain, memory loss, fatigue, insulin resistance and skin wrinkles. This can occur in children as well but their overtired state can be mistaken for hyperactivity and their memory loss can be labeled as poor school performance. There isn’t an organ or tissue in the body that does well with a lack of oxygen or a lack of sleep.
What can I do about it?
For patients with severe OSA the best treatment is either jaw advancement surgery performed by an oral surgeon or a CPAP machine worn over the face to blow air into the airway keeping it “blown” open. If you can not tolerate the CPAP or you have a milder form of sleep apnea then a mandibular advancement device may be a better option. An oral device that slips on over your teeth and retains your lower jaw in a more forward poistion works by holding the tongue out of the airway. There are many styles and designs on the market each with their own advantages.
We really like the Narval CC by Resmed due to how thin and durable it is. This designs maximizes tongue space which is the main goal, keeping the tongue in the mouth and out of the airway. If the soft palate is also creating blockages then the NightLase procedure may be right for you.
Correcting the underlying anatomical malformation can also be a good strategy for improving someone’s airway. Orthodontic treatment to correct crooked teeth, widening the palate if it is too high and narrow can be helpful too. Often times these improper growth issue are a result of an undiagnosed tongue tie or other improper muscles patterns like a reverse swallow. A frenectomy can be performed to correct the tied tongue and myofunctional therapy can retain bad muscle habits and improve nasal breathing. The cause of OSA can be multifaceted and the treatment needs to be too. The goal is to improve or maximize the airway space as much as medically possible with the least amount of invasiveness possible.
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