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Do you
snore?
Is your
snoring bothering your sleeping partner or other household members?
If so, it can be stopped. Very often a custom made dental appliance
can be a simple and effective way to stop snoring.
However,
a dental appliance is not an appropriate solution for all people
who snore.
Also,
people who snore heavily/loudly are also more likely to have a
life-threatening condition called sleep
apnea,
that may require another device to stop their
snoring.
In order to
effectively treat your snoring problem it is important for you read
the following information.
(i) What
causes snoring?
When some
people fall asleep their tongue relaxes and falls to the back of
their throat, closing off their airway either partially or fully.
Snoring is simply the sound of air passing through the narrowed
airway.
(ii)
What is Sleep Apnea?
While we
sleep, if our airway is partially closed (as commonly occurs with
snorers) our lungs receive a reduced amount of oxygen. However if
our airway is completely closed off (by our relaxed tongue)(common
in loud snorers) our lungs will not be getting any oxygen. When our
brains detect the lower levels of oxygen in our blood it
immediately awakens us just enough to take a quick breath or two.
This is why snorers sometimes wake up with a sudden gasp for
air.
Sleep
Apnea is the complete
stoppage of air entering our lungs
during sleep for at least ten seconds in adults (less time in
children). So a patient with sleep apnea will stop breathing for a
full ten seconds or more at a time.
Hypopnea is defined as
an inadequate
amountof air entering our lungs
during sleep caused by partial airway blockage.
People
who suffer from sleep apneas or hypopneas can “wake-up” briefly
anywhere from several times an hour in mild cases to several
hundreds of times a night in patients who have severe sleep
apnea.
During
these brief awakenings the patient may gasp for air, however they
are only partially awake and do not have any awareness or memory of
the awakenings in the morning. As you can imagine, if you are
waking up several hundred times a night to breathe this is a
serious disturbance of your regular sleep cycle. This can have
potentially serious effects on our daytime functioning and
health.
Signs
and Symptoms of Sleep Apnea:
•
sleepiness during the day
• decreased ability to concentrate
• depression, irritability, sexual dysfunction
• learning and memory difficulties
• falling asleep while at work, on the phone or while driving
• higher risk of high blood pressure, heart attack and stroke
(sleep apnea is a strain on the heart and the circulatory
system)
When
should Sleep Apnea be Suspected?
• if you
snore heavily and struggle to breath during sleep
• if you fall asleep during the day at inappropriate times i.e.
while driving a car, working or talking
• very often the spouse or co-workers of sleep apnea sufferers
notice there is a problem and the person with sleep apnea won’t
believe it when told
Do
you have sleep apnea or do you simply snore?
In order to
stop snoring you should first see your family doctor who may refer
you to a physician who specializes in sleep disorders. The sleep
specialist will determine if you have sleep apnea, and if so,
whether it’s mild, moderate or severe (depending on the number of
times you stop breathing each hour during sleep, or for what period
of time each night your blood oxygen levels are below
normal).
How
is Sleep Apnea Treated?
(A) If
you snore and do not have sleep apnea, or if you have been
diagnosed with mild sleep apnea
Changes in certain behaviors or habits may be all that is required
:
Alcohol,
tobacco or sleeping pills all make the airway more
likely to collapse during sleep, and also increase the length of
time that people with sleep apnea stop breathing. Eliminating the
use of alcohol, tobacco and sleeping pills can eliminate snoring or
mild apnea.
Overweight people are more
likely to have sleep apnea. This is because they will often have
fat deposited in their airway causing it to narrow. So when an
overweight person falls asleep they are more likely to have a
greater amount of airway closure when their tongue relaxes and
falls back. If a patient is able to reduce their weight by ten
percent this can reduce the severity of sleep apnea in most
cases.
Some
patients only experience sleep apnea when they sleep on their
backs. These patients may simply choose to use pillows or other
devices to help keep them on their sides.
In my own
personal experience, sleeping on my side stopped me from snoring,
however I am more comfortable sleeping on my back, and despite my
best efforts to sleep on my side I would usually wind up on my back
during the night and resume my snoring. Or, I even tried sewing a
tennis ball into the back of my pajamas to prevent me from sleeping
on my back, but I would wake up during the night whenever I rolled
unto my back, which would result in interrupted sleep.
(B) If
you snore or have Mild to Moderate Sleep Apnea:
There are
many different dental appliances on the market that can effectively
eliminate snoring and mild sleep apnea. The appliance that I have
used for our patients with good success is called the SUAD dental
appliance (see attached brochure and additional information
below).
These
patients may also elect to use a CPAP
machine instead of a dental
appliance (see below).
(C) If
you snore or have been diagnosed with Moderate to Severe Sleep
Apnea:
The best
way to treat severe sleep apnea is through the use of a CPAP
Machine. This machine will also eliminate snoring.
The CPAP
unit consists of an air blower, hose and nose piece. The patient
will sleep with a mask over their nose. The machine blows air
through their nose and creates the correct amount of air pressure
to prevent their airway from collapsing during sleep. (See attached
sample for one of many CPAP units on the market).
Advantages
of a CPAP Machine
• is very
effective
• is the only available treatment for moderate to severe sleep
apnea
• the most effective alternative when a patient is not a good
candidate for a dental snoring/apnea appliance
Disadvantages
of a CPAP Machine
• units can
be somewhat noisy for partners sleeping in the same room
• is not as portable as the dental appliance for traveling and does
require a power supply
• some patients find it uncomfortable/cumbersome to wear
Advantages
of wearing a Dental Appliance (SUAD Appliance) to treat Snoring
and/or Mild Sleep Apnea:
• Suad appliance is very portable / can fit in a pocket or purse
when traveling
• does not require an external power supply
• is effective
• silent / no motor as is the case with the CPAP machine
Disadvantages
of a Dental Appliance for Snoring / Mild Apnea:
•
may not be suitable for patients with chronic pain in their jaw
(TMJ) joint
• not suitable for patients with severe gum disease and/or loose
teeth (these dental problems must be corrected before the dental
appliance can be made)
• may not be suitable for large, heavy set people who also
powerfully grind their teeth at night (this type of patient may be
better served by using the CPAP machine...this is the one type of
patient who may continually break their dental snoring
appliance...they’re tough but they do have their breaking
point
A
Personal Testimonial Regarding the wearing of a Dental (SUAD
Appliance) to Eliminate Snoring and Mild Sleep
Apnea:
I have
personally worn the SUAD Appliance every night for the past two
years. It has completely eliminated my snoring, according to my
wife. I have had the same success with any other patient that we
have mad the SUAD Appliance for . The appliance is comfortable but
does require a brief period of getting use to.
The
appliance is well built, very durable and is repairable if it
should break. But please, if you do have me make you one, keep it
away from your family dog (they seem to enjoy chewing on these
appliances...as my dog did)... and out of the reach of small
children who may enjoy taking the appliance apart.
My
appliance has been problem free after two years of nightly use and
I was even able to reshape and continue to use it after our dog
gnawed on it. Yes, I was incredibly lucky to be able to salvage it
and yes, I sterilized it before reusing it (the appliance, not the
dog).
Are
there any other effective ways to eliminate snoring or sleep apnea
besides using dental appliances or the CPAP unit?
Surgery is an option for
some patients who snore and/or have sleep apnea. These surgeries
have the goal of increasing the size of the airway. None of these
surgeries are completely successful or without risk.
(i) young
patients may benefit from the removal of adenoids, tonsils, nasal
polyps and the correction of deformities of the airway.
(ii) A surgical procedure known as Uvulopalatopharyngoplasty (UPPP)
is the surgical removal of excess tissue at the back of the throat
(tonsils, uvula, and part of the soft palate) This technique only
has a 30-50% success rate and is not necessary as less invasive
methods are available.
What
is your next step?
If you
snore, please consult your physician first to discuss if you may
have sleep apnea and if a sleep study is required.
If a sleep
study is required your doctor will refer you top a sleep
clinic.
REGARDLESS
OF WHICH SLEEP CLINIC YOU GO TO, IF YOU ARE ADVISED BY
THE SLEEP SPECIALIST THAT A DENTAL APPLIANCE IS RECOMMENDED THERE
IS ONE IMPORTANT PIECE OF INFORMATION YOU SHOULD KEEP IN
MIND:
I am
trained in they delivery of dental appliances for patients with
sleep apnea and snoring and have successfully treated patients with
these conditions for several years
To properly
make a dental appliance to treat these conditions the dentist
should conduct a thorough examination/assessment of you teeth,
gums, bone that supports the teeth and jaw joint (TMJ).
You should
have an appliance made that is durable, is professionally made and
has a good record of success for the treatment of snoring and sleep
apnea such as the SUAD appliance used in our office
The
appliance fee should be cost effective and reasonable.
Our
appliance carries a two year manufacturers warranty.
Our SUAD
snoring/apnea appliance fee is: $875.00 (this includes the lab fee
of $550 and our professional fee of $325)
If you are
not a patient of our office we will need to examine your
teeth/gums/jaw and take at least one xray film, which will add an
additional $170.
Unfortunately, I have
heard stories from some patients over the years that they were told
by a sleep specialist that they were best to see a dentist that the
sleep specialist “knew” and they wound up paying substantially more
an appliance.
If
you have a snoring/sleep appliance made in our
office:
Please ask
your MD or sleep specialist for a letter stating a dental appliance
is a suitable option to treat your snoring and/or apnea (they can
give you the letter or mail/fax/email it to me with your
permission)
Please
contact our office for a sleep appliance consultation.
The
procedure to make your appliance is simple: models will be made of
your upper and lower teeth and as well and a few brief measurements
will be made of your particular bite
The lab
then requires between 1 to 3 weeks to construct your
appliance
You will
return for a brief appointment where we will give you your
appliance and instructions on its proper use and
maintenance.
Patients
with sleep apnea may be asked by their sleep specialist to return
for a sleep study to ensure that the appliance has been effective
in treating the apnea.
Usually
patients will provide us feedback that their snoring has stopped;
in case where it hasn’t the appliance can be briefly adjusted while
you sit in my chair and this should do the trick.
Snoring and
Sleep Apnea are easily treatable conditions. You owe it to
yourself, your partner and other family members to get properly
diagnosed and treated.
If you
should have any questions or concerns please feel free to contact
me by phone or e-mail.
Best
regards,
Dr. Jeff
Shnall BSc., DDS
tel: 416-691-2886
email: Dr.Shnall@bellnet.ca | 