Obstructive sleep apnea is a common and serious sleep disorder that causes you to stop breathing during sleep. The airway repeatedly becomes blocked, limiting the amount of air that reaches your lungs. When this happens, you may snore loudly or making choking noises as you try to breathe. Your brain and body becomes oxygen deprived and you may wake up. This may happen a few times a night, or in more severe cases, several hundred times a night.
In many cases, an apnea, or temporary pause in breathing, is caused by the tissue in the back of the throat collapsing. The muscles of the upper airway relax when you fall asleep. If you sleep on your back, gravity can cause the tongue to fall back. This narrows the airway, which reduces the amount of air that can reach your lungs. The narrowed airway causes snoring by making the tissue in back of the throat vibrate as you breathe.
Sleep apnea can make you wake up in the morning feeling tired or unrefreshed even though you have had a full night of sleep. During the day, you may feel fatigued, have difficulty concentrating or you may even unintentionally fall asleep. This is because your body is waking up numerous times throughout the night, even though you might not be conscious of each awakening.
The lack of oxygen your body receives can have negative long-term consequences for your health. This includes:
- High Blood Pressure - Heart Disease - Stroke - Pre-Diabetes and Diabetes - Depression
A sleep medicine physician can diagnose obstructive sleep apnea using an in-lab sleep study or a home sleep apnea test. Sleep apnea is manageable using continuous positive airway pressure (CPAP) therapy, the front-line treatment for sleep apnea, oral appliance therapy or surgery.
The most common symptom of sleep apnea is snoring. However, not everyone who snores has sleep apnea. Snoring is likely to be a sign of sleep apnea when it is followed by silent breathing pauses and choking or gasping sounds.
People with sleep apnea often have daytime sleepiness or fatigue.
Common symptoms of sleep apnea include:
- Loud or frequent snoring - Silent pauses in breathing - Choking or gasping sounds - Daytime sleepiness or fatigue - Unrefreshing sleep - Morning headaches - Nocturia (waking during the night to go to the bathroom) - Difficulty concentrating - Memory loss - Irritability
The major risk factor for sleep apnea is excess body weight. You are much more likely to have sleep apnea if you are overweight or obese. However, sleep apnea can occur in slim people too. Common risk factors for sleep apnea include:
- Excess weight – Your risk for sleep apnea is higher if you are overweight with a body mass index (BMI) of 25 or more or obese with a BMI of 30 or higher.
- Large neck size - Your risk for sleep apnea is higher if you have a neck size of 17 inches or more for men, or 16 inches or more for women. A large neck has more soft tissue that can block your airway during sleep.
- Middle age – Sleep apnea can occur at any age. However, it is more common between young adulthood and middle age.
- Male gender – Sleep apnea is more common in men than in women. For women the risk of sleep apnea increases with menopause.
- Hypertension – High blood pressure is extremely common in people who have sleep apnea.
- Family History – Sleep apnea is a heritable condition. This means that you have a higher risk of sleep apnea if a family member also has it. Inherited traits that increase the risk for sleep apnea include obesity and physical features such as a recessed jaw. Other common family factors - such as physical activity and eating habits - also may play a role.
Snoring - Overview and Facts
Snoring is the often loud or harsh sound that can occur as you sleep. You snore when the flow of air as you breathe makes the tissues in the back of your throat vibrate. The sound most often occurs as you breathe in air, and can come through the nose, mouth or a combination of the two. It can occur during any stage of sleep.
About half of people snore at some point in their lives. Snoring is more common in men, though many women snore. It appears to run in families and becomes more common as you get older. About 40 percent of adult men and 24 percent of adult women are habitual snorers. Men become less likely to snore after the age of 70.
Sleeping on your back may make you more likely to snore. It may also occur as your throat muscles relax from use of alcohol or other depressants. Congestion from a cold or allergies can also cause you to snore.
Snoring can be a nuisance to your partner and anyone else nearby. You may even snore loudly enough to wake yourself up. Though, in many cases people do not realize that they snore. Snoring can also cause you to have a dry mouth or sore or irritated throat when you wake up.
Oral Appliance Therapy
An oral appliance is a device that fits in your mouth over your teeth while you sleep. It may resemble a sports mouth guard or an orthodontic retainer. The device prevents the airway from collapsing by holding the tongue in position or by sliding your jaw forward so that you can breathe when you are asleep. Some patients prefer sleeping with an oral appliance to a CPAP machine. A dentist trained in dental sleep medicine can fit you with an oral appliance after you are diagnosed with sleep apnea. Oral appliance therapy is recommended for patients with mild to moderate apnea who cannot tolerate CPAP.
There are several types of oral appliances, below are the main appliances Dr.Ross treats most with.
Elevate (Created and patented by Dr. Ross himself! In 2021 also was FDA approved)
Each appliance combination results in moving your lower jaw forward. Each upper and lower appliance has notches for elastics to help train your teeth to stay together through the night. When using elastics, make sure both sides of your appliances have matching elastics.
The EMA® (Elastic Mandibular Advancement)
The appliance is designed to both advance the lower jaw (mandible) and open the bite to allow for less restricted airflow during sleep. The EMA has many options for mandibular patient advancement with five strap lengths and four different elastic tension options. Non restricted side-to-side (lateral) or front-to-back (protrusive) movements of the jaw are possible while wearing the appliance due to varying elastic bands.
The Herbst sleep appliance
This is a hard plastic appliance which has the adjustment hardware set on the cheek side of the molar teeth. It prevents side-to-side motion, but since the bottom jaw is held closed with small orthodontic rubber bands, opening the jaws is fairly easy.
While many use a CPAP mask to treat sleep apnea, Ross said some can't tolerate it. The main alternatives are mouth pieces that go along the top and bottom teeth separately. These hold the lower jaw forward and keep the tongue from falling back during sleep and creating an obstruction.
Ross himself has sleep apnea, and said he wanted to create a better alternative.
"I've tried all of them myself so I kind of came up with this idea to do my own," Ross said.
Ross said his version is one of the most comfortable appliances. They are custom-made from a scan of the individual's teeth, so they fit comfortably.
An orthodontist since 1995, Ross said he is now focused on further issues like airway control.
"I'm caring more for your health than just your straight teeth," he said.