The Importance of Restful Sleep 4. Normal Breathing During Sleep 5. The Impact of Snoring on Sleep 6. Causes of Snoring 7

Transcription

1

2 Contributing Authors THEODORE M. BERMAN, M.D. is a board certified medical specialist in sleep disorders medicine and pulmcnary medicine. Dr. Berman is a partner of the Minn sota Sleep Institute and practices in Edina, Plymouth, Fridley, and Minneapolis, Minnesota. JOAN FOX, M.D. is a sleep disorders and pulmonary medicine specialist board certified by the American Board of Sleep Medicine and American Board of Internal Medicine. Dr. Fox practices at the Minnesota Sleep Institute, Abbott Northwestern Sleep Center, and the Minnesota Lung Center. JONATHAN A. PARKER, D.D.S. is the director of the Snoring and Sleep Apnea Dental Treatment Center in Minneapolis, Minnesota. He is an Assistant Clinical Professor of Dentistry at the University of Minnesota. Dr. Parker is on the consulting staff of six sleep disorders centers in the Minneapolis- St. Paul area. He has lectured throughout the U.S. on evaluation and treatment of snoring and sleep apnea.

3 The Importance of Restful Sleep 4 Normal Breathing During Sleep 5 The Impact of Snoring on Sleep 6 Causes of Snoring 7 Factors That Affect Snoring 8 Obstructive Sleep Apnea 10 Five Negative Effects of Snoring and Obstructive Sleep Apnea 11 Evaluation by a Doctor 12 Testing for Sleep Problems 13 Four Strategies to Minimize Snoring 14 Medical and Dental Treatments for Snoring and Sleep Apnea 15 A Summary of Treatment Options 19 OTE: This booklet is intended to help individuals manage their snoring and/or sleep apnea. It is not to be used as a guide for self-diagnosis or to recommend a particular treatment. Innovative Sleep Products, Inc. recommends consulting a physician for appropriate diagnosis and treatment.

4 Most adults need 7-8 hours of sleep for peak alertness and energy. 23 % of adults reported that they fell asleep at the wheel of their car during the past year. 67% of adults said that sleep deprivation affected their work, which translates into a $70 billion loss jn productivity. The Importance of Restful Sleep A good night of sleep is very important to our overall health and ability to function effectively throughout the day. However, when our lives become busy, sleep becomes less of a priority for many of us. William C. Dement, MD, PhD, the Dean of Sleep Disorders Research and Professor of Medicine at Stanford University, states: "Americans have gotten the message that good nutrition and plenty of exercise are important for health, but we have not paid enough attention to the third pillar of good health, which is adequate sleep." You can improve the quality of your sleep by following these recommendations: Establish relaxing pre-sleep routines. It is important to incorporate time to "wind down" from your daily activities. Minimize light, noise, and temperature extremes in the bedroom. Avoid large meals just before bedtime. Small snacks are not a problem, but large meals keep the digestive system active and can disrupt leep. Avoid strenuous exercise within two to three hours of bedtime. Strenuous exercise can elevate body temperature and cause difficulty falling asleep at bedtime. Avoid caffeine, nicotine, or other stimulants within four hours of bedtime. 4

5 Normal Breathing During Sleep Keeping the air passages open during sleep is critical to normal breathing. As you breathe, air passes through the nose and mouth and inward into your lungs, moving past the following structures in the nose, mouth, and throat: o Soft palate: Soft curtain of tissue which is an extension of the palate at the back of the throat. This palatal tissue blocks the opening between the mouth and nose during swallowing. fl Uvula: Floppy finger-like projection of tissue that hangs from the middle of the soft palate. 8 Tonsils: Sack-like structures along the side walls at the back of the throat. These tissues are part of the body's immune system. D Tongue: Large muscle at the floor of the mouth that is important for taste, speech, chewing, and swallowing. While you are awake, throat muscles actively maintain an open air passage so you can breathe easily. During sleep, these structures relax. For non-snorers, the airway stays clear so air can move easily into the lungs. But for snorers, this is not the case, and it can have a significant impact on their sleep. 5

6 The Impact of Snoring on Sleep A calm, quiet setting is important to restful sleep. Snoring interrupts that restful quiet. Usually people do not hear themselves snore, but snoring can cause disrupted sleep for both the snorer and the snorer's sleeping partner. It can lead to daytime sleepiness and fatigue, which can affect the ability to function. effectively at home and at work, and could lead to health problems. It is important to eliminate snoring so everyone can get a re tful night's sleep and maintain good health. If you snore, you are not alone in your struggle to find a solution to this problem. Statistics indicate that approximately 67% of adults snore and that number will continue to grow, because the factors that cause snoring continue to be prevalent in our population. Normal, smooth, unobstructed breathing is a key to getting a restful night's sleep. The information in this booklet will help you learn about snoring and related complications so you can find a solution to your sleep problems. Normal Airflow ~ Airflow ['l Soft palate D Base of the tongue rn Uvula 6

7 Causes of Snoring Snoring is the harsh sound you hear when a snorer inhales during sleep. The noise occurs when the soft palate and uvula vibrate against the back of the throat or the base of the tongue. As you fall asleep, the soft tissues at the back of the throat, the muscles that line the airway, and the tongue muscle all relax. As this occurs, the tongue drops back into the airway which cau es it to narrow. As air passes through this narrower airway, it moves faster and causes the tissues to vibrate against each other, which creates a rattling or snoring sound. As the air passage continues to narrow, pressure increases in the airway and snoring becomes louder. The three primary causes of narrowing of the air passage are: Larger soft tissue size, Increased relaxation of the soft tissues, and Increased resistance in the airway. How loud is snoring compared to other noises? Jackhammer lawn mower Airplane loudest recorded snoring 85 decibels 95 decibels 118 decibels 87 decibels Airflow During Snoring Narrowing of the air passage leads to increased pressure in the airway and labored breathing, which causes loud snoring. 7

8 Alcohol and certain medications (valium, antihistamines, and others) can cause or worsen snoring. Factors That Affect Snoring The most common factors that cause increased snoring are: Sleeping on your back. In this position gravity pulls the jaw and tongue down and back. This causes the mouth to open and the tongue to drop back into the airway, and leads to narrowing of the air passage. Sixty percent of all snorers will snore only or most often while sleeping on their back. Difficulty with nasal breathing. Breathing through the nose is a more efficient way to bring air into the lungs than mouth breathing. A deviated septum, allergies, pregnancy, or a cold can cause the blood vessels in the nasal area to swell, which can lead to congestion or stuffiness in the nose. This can cause mouth breathing and increased resistance in the air passage. Obesity. In overweight individuals, excess fat deposits in the area of the neck and throat cause an increase in the size of the tissues or increased pressure on the tissues that surround the air passage. This leads to narrowing of the airway. Obesity is a major predisposing factor to snoring. 8

9 Enlarged soft tissues in the throat area. Snoring is much more prevalent in people who have a large tongue, long soft palate, large uvula, or large tonsils. \"V'henthose tissues are enlarged, there can be a decrease in airway space. Enlarged tonsils and adenoids are the primary cause of snoring in children. A small lower jaw. People who have a receding chin related to a small lower jaw are more likely to snore because there is less room in the back of the throat for the soft tissues and tongue. This reduction in space decreases the size of the au' passage and causes increased snoring. Certain medications and alcohol consumption. Some drugs (particularly certain tranquilizers and antihistamines) and alcohol can cause greater relaxation in the soft tissues and muscles in the throat. This can lead to narrowing of the air passage during sleep, which increases the chance of snoring. Cigarette smoke and other irritants. These irritants can cause increased nasal congestion and mucous in the throat area, which can lead to increased snoring. 9

10 The most common symptoms of obstructive sleep apnea are: loud snoring Periodic stoppages in breathing Significant daytime sleepiness Restless sleep Difficulty concentrating and poor memory Irritability Dr personality change Obstructive Sleep Apnea (OSA) Obstructive sleep apnea is an illness in which the soft tissues at the back of the throat completely close off the airway so that air cannot flow into the lungs. This airway blockage can reduce the amount of oxygen reaching the brain and body. When that happens, the brain alerts the muscles in the airway to tighten up and, unblock the air pas age. As this occurs, a loud gasp or snort is heard, and then breathing (and many times snoring) begins again. This process of blocking and unblocking the airway causes significant disruption of sleep. People who suffer from obstructive sleep apnea frequently complain of daytime sleepiness, which can cause difficulty staying awake during meeting, conversation, while reading, watching television, or driving. Daytime sleepiness can also impair the ability to concentrate, both at work and at home. OSA is a health problem that can be associated with high blood pressure, heart problems, and stroke. It is important to see your physician or a sleep disorders specialist if you are experiencing snoring and daytime sleepiness. Obstructive Sleep Apnea Air flow is completely blocked. 10

11 Five Negative Effects of Snoring and Obstmctive Sleep Apnea Snoring and obstructive sleep apnea can lead to increased risk of: 1. Relationship and marital discord. Loud snoring noises can disrupt the sleep of not only the snorer but also the snorer's bed partner and others in the household. This can be a source of great frustration and anger in their relationship. 2. Heart attack, atrial fibrillation, stroke, or even death. Research confirms that people with sleep apnea have a higher incidence of high blood pressure, atrial fibrillation, heart attack, and stroke. It is estimated that 38,000 people in the United States die each year from the effects of obstructive sleep apnea. 4% of men and 2% of women between the ages of 30 and 60 have obstructive sleep apnea that is severe enough to require treatment. 3. Industrial and traffic accidents caused by daytime sleepiness and fatigue. People with obstructive sleep apnea have a three times greater risk of having an automobile accident than the general population and a seven times greater risk of multiple accidents. The snorer's bed partner also has an increased risk of traffic accidents because of fatigue from disrupted sleep. 4. Lost productivity at home and work from daytime sleepiness due to lack of restful sleep. 5. Depression as a result of lost productivity, relationship discord, accidents, and health problems. 11

12 Typical questions asked: How often do you snore? Is your snoring loud enough to disturb the sleep of others? Are there periods of time when the snoring and your breathing stop? Do you ever gasp or snort during sleep? How many hours do you usually sleep? When you wake up, do you feel refreshed? Do you etten feel sleepy during the day? Evaluation by a Doctor All snorers should be evaluated by a physician or sleep disorders specialist before pursuing treatment, especially if they: Wake unrefreshed in the morning, Fall asleep easily during the daytime at inappropriate times (while watching. TV, reading, driving, or in meetings.) Have periodic stoppages of snoring or breathing during sleep, as observed by their bed partner. Your doctor's evaluation will probably include: A history of your snoring and related symptoms. It is helpful if your bed partner is present at this evaluation to help answer the doctor's questions. A tape recording of the sounds you make while sleeping may also be helpful to the doctor. A complete medical history and physical examination to identify other health problems (high blood pressure, heart disease, stroke, diabetes, GI reflux, headache, chronic pain) that may be caused or aggravated by an OSA condition. In addition, the physician will identify other medical conditions (allergies, rhinitis, sinusitis, obesity, smoking) that may be a factor that contributes to OSA. Additional testing of your sleep may be necessary if the doctor suspects that obstructive sleep apnea is present. 12

13 Testing lor Sleep Problems The testing for sleep problems, including snoring and OSA, is completed at a sleep disorders center that may be located in a hospital or independent center. This overnight sleep study Cpolysomnogram) measures 16 different factors throughout the night and is considered the most accurate testing method. The patient arrives at the center a few hours before their normal bedtime and they are connected to special monitors that will assess their sleep and confirm their diagnosis before the treatment is finalized. In some cases, the doctor may use a testing system that can be used to evaluate your sleep while you are at home in your own bed. Some of these home testing devices have been found to be very accurate in assessing OSA. 13

14 Four Strategies to Minimize Snoring The strategies described below may reduce or eliminate your snoring. 0 matter what treatment you pursue for snoring or obstructive sleep apnea, the e recommendations will have a positive effect on its outcome. 1. Sleep on your side. leeping in this position counteract the effects of gravity and can reduce or eliminate snoring. 2. Normalize your weight. People who are overweight can reduce snoring and apnea symptoms by 10 ing weight. Proper diet and exercise are the keys to losing and maintaining an appropriate weight. 3. Relieve nasal congestion. Reducing nasal congestion can help decrease snoring. Nasal sprays can be prescribed by your physician. ( Tote: Some of the over-the-counter nasal prays should not be used longer than a few days.) Nasal strips which increase nasal air flow may also be beneficial. 4. Avoid alcohol or sleeping pills within four hours of bedtime. Consumption of alcohol or sleeping pills will cause relaxation of the soft tissues and muscles in the airway and will make sleep apnea or snoring worse. It should also be noted that alcohol consumption, even during the day, can increase your risk of an OSA problem.

15 Medical and Dental Treatments for Snoring and Sleep Apnea If the strategies previously described do not improve your snoring or OSA, your physician or sleep disorders specialist may recommend one of the following treatments: 1. Positional device. Most bed partners know that snoring is worse on the back. In fact, research studies show that a high percentage of snorers and about 49% of people with mild sleep apnea have symptoms only when they sleep on their back. Therefore, treatments to keep them on their side or stomach during the night can be very effective in resolving the problem. The device pictured is one of a few that have been designed to keep sleepers off their back. The cushion is inflatable and is worn like a soft, lightweight backpack that is positioned along the middle of the back. It rests comfortably in place when you are sleeping on your side or stomach and it will prevent you from rolling onto your back during sleep. The cushion can be successful when used alone or in conjunction with other treatments for snoring or obstructive sleep apnea. 15

16 2. Continuous Positive Airway Pressure (CPAP) Treatment. CPAPis generally the primary treatment for people with moderate or severe obstructive sleep apnea. The device has an air blower connected to a cushioned plastic mask that cover the nose and sometimes the mouth. The blower blows room air through the hose and mask into the nose and throat to keep the air passage open during sleep. The air pressure from this device prevents the collapse of the airway and the pressure can be adjusted to maintain the airway for people with all severity levels of apnea. Research studies show this treatment to be highly effective in treating moderate or severe sleep apnea; thereby significantly improving quality of sleep and, as a result, quality of life. Some patients may initially experience difficulty adapting to the device. Often these problems go away as the patient continues to use the CPAP unit. The sleep disorders center staff can be very helpful in guiding patients to u e the CPAPsuccessfully. 16

17 3. Oral appliance therapy. An oral appliance is a small acrylic device that fits over the upper and lower teeth or tongue (similar to an orthodontic retainer or mouth guard). This device slightly advances the lower jaw or tongue, which moves the base of the tongue forward, opens the airway, improves breathing and effectively treats snoring and OSA. The appliance is fabricated and customized for each patient by a dentist experienced in the treatment of snoring and obstructive sleep apnea. Oral appliances are usually well-tolerated by patients. This treatment is effective for treating people with snoring and mild to moderate obstructive sleep apnea. It can also be effective for treating certain cases of severe obstructive sleep apnea. Many different appliance designs are available, so the appropriate device can be customized to each patient's situation. Consult your primary physician or sleep medicine physician for proper diagnosis prior to making a treatment decision. 17

18 4. Surgery in the throat area or jaw. urgery is usually targeted at the ite of the airway obstruction. There are several surgical approaches that range from treatments to the soft palate or uvula to advancement of the upper and lower jaw. The most common surgical procedure for treating snoring is the Uvulopalatopharyngoplasty ( PPP). This technique is done in the hospital and removes all of the uvula and about one-third of the soft palate. It requires about two weeks of healing time, and it can be effective in treating people with snoring and mild sleep apnea. It is less effective in treating moderate or severe sleep apnea. A variation of this technique uses a laser and is done in the office with local anesthesia. Somnoplasty (radio frequency surgery) is a minor surgical procedure completed in the surgeon's office using local anesthesia and a customized electrode that delivers radio frequency energy to stiffen the soft palate and/or tongue. The Pillar Procedure uses three polyester strips that are inserted into the palatal tissue that stiffens the palate to reduce the vibration of snoring. Telegnathic surgery is jaw surgery that advances the upper and lower jaw to open the airway and manage significant sleep apnea conditions that have not been effectively managed by non-surgical treatments. This treatment can be effective for moderate or severe sleep apnea. 18

19 A Summary of the Treatment Options 1. A thorough evaluation and accurate diagnosis is the key to successful treatment of snoring and sleep apnea. See a sleep medicine physician for a complete assessment 2. Treatments for snoring: Positional therapy Oral appliance therapy Palatal surgery 3. Treatments for mild OSA: Oral appliance therapy CPAP Palatal surgery 4. Treatments for moderate to severe OSA: CPAP Oral appliance therapy (if CPAP can not be tolerated) Oral appliance therapy combined with CPAP Oral appliance therapy and CPAP combined with palatal surgery CPAP and palatal surgery Telegnathic (jaw) surgery (if non-surgical treatment not successful) 19

20 For further information regarding diagnosis and treatment of snoring and obstructive sleep apnea visit these web sites: American Academy of Dental Sleep Medicine American Academy of Sleep Medicine American Sleep Apnea Association National Sleep Foundation For comments or que tions regarding the information in this booklet, you may contact: Innovative Sleep Products Phon : (888) (roll free) Phone: (952) Fax: (952) jp@endsnoringnow.com S[EEVP PRODUCTS Copyright 2008 by Innovative Sleep Products, Inc. All rights reserved. 10 pan of this book may be used or reproduced in any form without prior written permission from Innovative Sleep Products, Inc.