Tuesday, October 23, 2012

Sleep Apnea – NOT for Men Only!

Below is another guest blog post.  One clarification I would like to make to the guest articleby Alex Smith is that the increased frequency of night-time urination seen with OSA is often due to increased urine production (for an explanation, see http://www.thoracicandsleep.com.au/latest-news/115-obstructive-sleep-apnoea-osa-and-urinating-at-night )

Michael Rack, MD
Doctors and patients alike are beginning to realize that sleep apnea in women is more common than previously thought. Men remain statistically more likely to develop obstructive sleep apnea (OSA), but instead of a ten-to-one ratio of men to women, it’s now thought to be three- or four-to-one. At the same time, women also remain more likely to have sleep apnea misdiagnosed as something else, such as chronic fatigue syndrome, depression or simple insomnia. 

OSA occurs when the soft tissues of the throat and at the back of the mouth become overly relaxed at night, to the point where one’s airflow is blocked upon breathing in. This results in a few seconds of not breathing, which may be evidenced by snoring or gasping for breath during one’s sleep, followed by daytime sleepiness. Though women with OSA may have these signs, they seem to appear more often in men. Women with sleep apnea may notice their mouths being very dry in the morning. They may also begin to wake up more often during the night with the need to urinate. This is not due to any real increase in urine production, but because the partial waking that often occurs in OSA allows a person to notice the state of their bladder more than when they are sleeping soundly.

The risk for OSA increases as a woman ages and it is sometimes said that menopause increases the risk for it. However, here again, appearances may be deceiving, with menopause getting the blame for simple changes in soft tissue tone that come with aging. Another risk factor for OSA in women, just as in men, is being overweight or obese. This is simply due to the increased thickness of throat tissues that begin to accumulate fat cells. In some studies, as many as 80% of obese women screened for sleep apnea were found to have the condition. It can also flare up due to the weight gain of pregnancy. Drinking alcohol before bed time also increases the likelihood of OSA, as does smoking.

Though women are still a bit less likely than men to have OSA, it unfortunately appears that their risk of mortality from it is greater than in men. The reason for this is not clear, but it seems to be especially true in regards to heart and circulation problems, i.e., decreased cardiovascular health. It was recently reported that OSA increases the risk of developing so-called ‘soft’ plaques in atherosclerosis (hardening of the arteries), which are more likely to come loose from blood vessel walls and form an embolus, blockage of an artery or vein.

If a woman has sleep apnea, especially if she is overweight or obese, she has a greater risk during pregnancy of developing the life-threatening condition called pre-eclampsia, or of needing to deliver her baby by caesarian section. Since pregnancy itself somewhat raises the risk of OSA, this seems a real life case of double jeopardy! A pregnant woman may also be more apt to attribute daytime sleepiness or fatigue to simply carrying a baby, rather than to other possible causes.  

For all these reasons, it is especially important for women to know that they, too, are at risk for sleep apnea. If there are signs of dry mouth, excessive daytime sleepiness, or any reports from her partner that she is snoring, a woman should not hesitate to ask her doctor if she might have sleep apnea. It is diagnosed definitively by performing an overnight sleep study at the hospital. Because OSA can have serious health repercussions if left untreated, insurance companies typically cover both the sleep study and the therapy the condition requires if found. Women and men alike thus have nothing to lose with a sleep study, and may also gain a much better night’s sleep for their efforts.

Guest article by Alex Smith of SleepDisorders.com.

Tuesday, October 02, 2012

Oral Appliances or CPAP, Which is Better?

The following is a guest blog post, see below this article for my thought on the issue:

Devices that provide CPAP, or continuous positive airway pressure, are often considered the “gold standard” of treatment for obstructive sleep apnea. After a sleep study is conducted and sleep apnea is diagnosed, a sleep specialist will typically prescribe CPAP machines and masks as the first line of treatment. Though the sleep disorder solution may be a blessing to many, others may find the device loud, restrictive and ineffective in getting them a better night’s rest. For patients who do not tolerate CPAP therapy, the American Academy of Sleep Medicine (AASM) has offered its recommendation for alternatives in the form of oral appliances.

In an issue of Sleep, researchers at the AASM released updated instructions for the treatment of obstructive sleep apnea with CPAP alternatives in an article entitled, “Practice Parameters for the Treatment of Snoring and Obstructive Sleep Apnea with Oral Appliances.” Since the publication of these guidelines in 2006, patients diagnosed with mild to moderate sleep apnea have been able to take advantage of alternative devices. Physicians will prescribe the oral appliances to those who have already responded poorly to CPAP or to those who simply prefer another method. However, the AASM still advocates CPAP as the best form of treatment for patients with severe sleep apnea.

According to the AASM’s guidelines, the first step to treating sleep apnea of any severity is to have the sleep disorder diagnosed by a physician with ample experience in Sleep Medicine, particularly with sleep-disordered breathing. You can find certified sleep professionals in your area by searching local or online listings for sleep centers. To find a sleep dentist trained in oral appliances, experts such as Ira Shapira, DDS recommend that you find a sleep specialist that is a Diplomate of the Academy of Dental Sleep Medicine (ADSM).

If you have ever had to wear a mouth guard or an orthodontic retainer at night, you won’t have too much trouble adapting to an oral appliance for sleep apnea. The devices are designed to prevent the airway from collapsing while you sleep. This is most often achieved by moving your lower jaw, jaw muscles, uvula, soft palate, tongue or a combination of several of these parts.

The most common type of oral appliance is a mandibular repositioning device, which uses the upper jaw as an anchor to bring the lower jaw forward. In this position the walls of the pharynx and the tongue are also corrected. There are other oral appliances for sleep apnea available too, such as the tongue retaining device, which uses a suction mechanism to keep the tongue from falling backward and blocking the throat while you lie down.

In general, oral appliances have a higher compliance rate than CPAP in treating obstructive sleep apnea. Less than half of patients that are put on a CPAP treatment plan are actually able to continue the use of their machines and masks as recommended. And even these patients sometimes prefer oral appliances over CPAP because the oral devices are supposedly easier to use during travel and feel less distracting in shared bedrooms. Some oral devices, such as the Thornton Adjustable Positioner (TAP), have volume knobs that allow the patient to be more in control of sleep apnea treatment. Others, such as the Somnomed appliance, feature a straw through which you can drink water at night. In the end, the specific brand of oral appliance you use is not as important as keeping the upper airway unobstructed.

This is a guest blog post:

Sleepdisorders.com is designed to link sleep disorder sufferers to local sleep doctors and sleep centers. In addition to our directory of sleep doctors, you can find informational articles related to your unique sleep disorder.


My thoughts:  Oral appliances are a reasonable treatment option for mild to moderate OSA.  CPAP remains the gold standard, especially  for more severe forms of OSA.   Oral appliances can be difficult to tolerate for some patients.  In order to have success with an oral appliance, the involvement of a well-trained dental sleep specialist, working with a board-certified sleep doctor, is necessary.  I do NOT recommend mail-order dental appliances.