Snoring is the loud, rasping noise made by the vibration of the soft palate, uvula, and other structures of the airway during sleep. Obstructive sleep apnea is the momentary cessation of breathing during sleep leading to awakening of the person gasping for air or choking in a repeated manner.

Snoring is bothersome and may disturb your bedroom partner.  It may strain your relationships but may be the first sign of obstructive sleep apnea, a more serious health problem.

Signs of Sleep Apnea

• Gasping, choking or snorting during sleep
• Feeling sleepy, drowsy, sluggish or tired, despite a full night's sleep
• Waking up tired, exhausted or with a headache
• Unintentional falling asleep in unsuitable situations including watching T.V., lecture hall, or sitting quietly.
• Having memory and concentration problems.
• Behaving with irritability, annoyance and ill-temper

Obstructive sleep apnea has recently been associated with risk factors for serious medical conditions including stroke, diabetes, cardiovascular diseases including hypertension, cardiac arrhythmia, heart attack, and even erectile dysfunction. In addition, many motor vehicle accidents are attributed to daytime sleepiness as a result of sleep apnea.

Obstructive sleep apnea is very common and is estimated to affect a large number of individuals where the breathing is interrupted due to a mechanical obstruction of the airway as in mandible or tongue posterior positioning, large tonsils or adenoids, or large neck size. This is different from central sleep apnea which is due to a problem in the central nervous system. Some patients may suffer from a mixed condition where both central and obstructive sleep apnea exist.

Evaluation 

The evaluation process starts with taking a detailed history inquiring about how long you have snored, your sleep habits, lifestyle and work issues, medical conditions, medications used, daytime sleepiness, and the impact snoring has on you and those who live with you. Then, the dentist examines the inside of your mouth, teeth, jaw joint and facial muscles. An examination may show a decreased space at the back of your mouth, where your throat begins. The dentist may order some testing such as radiographs of the mouth and jaw, computer tomography (CT) scan, or magnetic resonance imaging (MRI) to study the quality and the size of your airway. A referral to an ear nose and throat physician to examine the nose and throat may be recommended. Oftentimes, the dentist requests a sleep study that is called polysomnography (PSG) that is usually performed in a sleep center and provides the most information about how you breathe when you are asleep.  The sleep center may measure your breathing, heart rate, oxygen saturation, muscle activity, and other functions.  Lately, at-home instruments have become available that measure some of these functions in a more normal and comfortable atmosphere in your own bedroom.

Contributing Factors to Obstructive Sleep Apnea:

• Sleeping on the back increases the occurrence of obstructive sleep apnea due to backward positioning of the mandible and tongue.
• Abdominal sleeping places pressure on the side of the jaw causing narrowing of the airway.
• Overweight individuals often have large and excess fat tissues in their throat which cause narrowing of the throat leading to snoring and apnea.
• Euphoric conditions such as after heavy exercise, alcohol or sedative medications intake relax the muscles of your throat which may worsen snoring and apnea.
• Allergic conditions of the nasal sinuses may cause clogging of the nose obstructing breathing.
• Heavy meals prior to sleep time may cause narrowing of the chest volume for the lung to expand decreasing the breathing efficiency.

Management

Several treatment options are available for snoring and obstructive sleep apnea.  The recommended therapy for sleep apnea depends on its severity, which is usually determined by the physical examination and in some cases sleep study.

• CPAP-Continuous Positive Air Pressure (CPAP) consists of a device that pumps air into a mask that is held over the nose by a strap. The air pressure holds the airway open, permitting you to breathe better. It is the first type of treatment recommended unless there is a reason not to use it such as the patient's compliance. It takes some time for the patient to get used to the CPAP. Usually, the problems are resolved by changing the type of machine, modifying the mask, or other aspects of this treatment. But, some patients are unable to tolerate using CPAP.
• Oral Appliance Therapy. This type of therapy provides an alternative to CPAP and is primarily used for snoring or mild to moderate obstructive sleep apnea. Custom-made oral appliances by a dentist hold the lower jaw and tongue forward to allow more space in the back of the mouth and throat increasing the airway  space and prevent the obstruction. These appliances generally work well but, similar to CPAP, are not for everyone. A specially trained dentist may help you determine your suitability for an oral appliance. Oral appliances require time to get used to and they need to be adjusted to determine the optimum position for each patient. These appliances require maintenance and follow up visits to ensure they continue to fit correctly and help you breathe better. These oral appliances may cause sore jaw muscles or jaw joints, difficulty putting teeth together and in some cases develop changes in the way the teeth fit together. Therefore, follow up appointments are very important to prevent any unforeseen problems.
• Surgery-there are several surgical options but all are aimed at opening the airway by removing tissue at the back of the mouth, soft palate, top of the tongue, and in the throat. some mandibular advancement procedure may be recommended. There are potential risks and complications associated with these procedures.

                  -UPPP - Uvulopalatopharyngoplasty is the most common surgery for sleep apnea. It removes the uvula using a laser device.

                   -LAUP - Laser-assisted uvulopalatopharyngoplasty is a method of removing a portion of the soft palate and the uvula using a laser device.

                   -RFA - Radiofrequency ablation uses radio waves to shrink the nasal turbinates or uvula, surrounding tissues and sometimes the back of the tongue.

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