Obstructive Sleep Apnea Treatments are available but first let's talk about the throat (pharynx)...
There are really three parts to the pharynx, and each one has a different name.
The part of the pharynx behind the nose is called the nasopharynx or velopharynx; the part that extends from the uvula to the epiglottis, commonly know as the throat, is the oropharynx and the part that extends from the epiglottis to larynx is the laryngopharynx or hypopharynx.
An important point to note is that the tongue extends all the way back into the throat (oropharynx) and that the back of the tongue (along with the soft palate and uvula) are the most common areas that collapse during sleep.
You didn't know that the tongue went all the way back did you?
As humans evolved from lower animals the snout flattened and the forehead rotated over the face. Want to impress your mother-in-law? The process in evolution that made her look different from a horse or an ape is called klinorynchy. (Who knows maybe that will turn up on Jeopardy someday and we'll all look like geniuses.) As the face flattened, the tongue did not get any shorter so it folded back into the throat and now, in modern man, makes up the front wall of the throat.
This makes the throat a multi-functioning area - because of the design we now use the throat and its muscles to help us speak, swallow and breathe. But this does come with a couple of problems.
- Because it is a multi-function organ, we can occasionally choke on a piece of food
- Since the throat is partially made up of the back of the tongue is what allows the throat to collapse during sleep.
When you are awake, the muscles of the throat keep the airway open to allow air flow to the lungs. But when you fall asleep, these muscles relax and in some people, collapse closing the airway.The nasopharynx and the oropharynx are the most common places for collapse to occur during sleep apnea.
What is sleep apnea?
In the condition known as obstructive sleep apnea (OSA), the throat can close leading to cessation of breathing. Apnea is defined as "a cessation of airflow for at least 10 seconds." This can occur dozens and sometimes even hundreds of times an hour.
Typically, someone with obstructive sleep apnea will snore heavily, then stop breathing. The bed partner will observe that the person struggles to breathe but there is no snoring sound. These periods of lack of breathing are followed by sudden attempts to breathe often accopnied by a gasping or choking sound. The person with OSA will partially awaken leading to fragmented, non-repfreshing sleep which can be the cause of excessive daytime sleepiness.
The lack of breathing also causes the oxygen level in the blood stream to fall leading to multiple medical problems.
Who's at risk for sleep apnea...
Doctors estimate that 9.1% of men and 4% of women have sleep apnea. That translates to 18 - 25 million Americans. Possibly as few as 5% have been diagnosed. Sleep apnea can affect anyone regardless of age or weight, however, it is more prevalent in men than women but a recent study pointed out that the number of women affected may be way underestimated.
If you have a neck size of 16 inches or more as a woman, and 17 inches as a man you have a high risk of having sleep apnea. Risk also increases with increasing alcohol consumption, smoking and age.
And the problem is growing worse with the increasing obesity in the United States.
Most are treated with CPAP but sleep apnea dentists can also treat the problem with a dental device.
Symptoms of sleep apnea...
Often the person with sleep apnea is totally unaware of the problem and will often deny the fact that he/she snores but the bed partner will observe
- Loud snoring followed by cessation of breathing
- Gasping and choking during sleep
Other symptoms include
- Excessive daytime sleepiness
- Drowsy driving
- Awakening not rested in the morning
- A sour taste in the mouth in the morning
- Morning headaches
- Weight gain
- Limited attention
- Memory loss
- Poor judgement
- Personality changes
Drowsy driving
A Canadian study reported that people with sleep apnea are twice as likely to be in a car crash. They reported that even people with fiarly mild sleep apnea had an increased risk of serious crashes.The truckers's associations are informing truck drivers of sleep apnea's seriousness.
Sleepiness related to sleep apnea has also been linked to the Exxon Valdese oil spill, the Chernobyl disaster and Three Mile Island.
Medical consequences of untreated sleep apnea
Sleep apnea is associated with
- Hypertension
- Heart Failure
- Coronary occlusion
- High blood pressure
- High beat irregularity
- Stroke (and an increased risk f death in patients who have had a stroke)
- Diabetes
- Erectile dysfunction
- Mental impairment
- Increased risk of sudden cardiac death during sleep hours
Impact of sleep apnea on the economy
A few assumptions:
- *25 million American suffer from sleep apnea
- *200,000 each year are involved in MVA (Motor Vehicle Accidents) because of sleep problems
- Of these at least 50,000 are estimated to be directly related to sleep apnea
- Insurance cost per accidents is estimated to be over $80,000
- Total estimated insurance cost for MVA related to sleep apnea only $ 4 Billion
- *38,000 die each year from complications of sleep apnea (i.e. heart attack, stroke etc.)
- Cost of healthcare in the ER or ICU is in excess of $ 50,000 per patient
- The total estimated cost is $ 1.9 Billion
- Productivity ratio is at least 10% less in people who suffer from sleep apnea
- That is estimated to costs the US economy $ 75 Billion each year
Treatments
- CPAP
- Surgery - surgical approaches to the treatment of obstructive sleep apnea are beyond he scope of this web site but include moving the upper and lower jaw forward, removing all or a portion of the soft palate and loose tissues in the throat, implantation of stiffeners in the soft palate, suspension of the tongue muscle, movement of the tongue to a more forward position, and surgical suspension of a small bone in the throat called the hyoid bone.
- Oral appliance therapy
