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Learn about the wide range of breathing abnormalities that occur during sleep such as snoring, upper airway resistance syndrome (UARS), Obstructive Sleep Apnea (OSA), and how they affect the quality of your sleep and the quality of your life. Sleep-Disordered Breathing is a continuum that encompasses the well-known obstructive sleep apnea, as well as the little known but highly prevalent UARS (upper airway resistance syndrome). This is similar to OSA , but without the cessation of breathing. Sleep Disordered Breathing interrupts your sleep, affecting our overall health. When we sleep, we heal, and allow our bodies, complex systems, and chemical mediators to repair our bodies, and stay healthy.
Loud snoring, insomnia and sleep apnea are the main issues people have today when it comes to sleep disorders. Sleep is critical to our health and it is restorative sleep specifically that allows our bodies to heal.
As many as 30% of couples are sleeping in separate rooms due to their bed-partner’s snoring!
All though snoring is considered more of an annoyance than a medical problem, it can actually be indicative of a much more serious health condition that causes many chronic diseases. It is crucial to find out if your snoring is part of a bigger problem. 40% of adults over 40 snore. Susceptibility to snoring increases with age. 70% of the time loud snoring is indicative of sleep apnea.
As we fall asleep and get into deeper stages of sleep such as REM, progressively profound muscle relaxation occurs. As the tongue relaxes it presses on the tissues at the back of the throat causing narrowing of the airway. Air passing through a narrow airway creates turbulence which in turn causes the uvula and soft palate to vibrate and create the all too familiar snoring sound.
Mild or benign snoring does not usually require treatment unless it bothers those around you. It has been shown that after one’s snoring was improved with oral appliance therapy (a device that fits in your mouth), marital relations improved as well.
Loud snoring however has been shown to have a positive correlation with an increased risk for heart attack and stroke. 70% of the time loud snoring is indicative of obstructive sleep apnea.
Snoring increases with weight gain and age. As we get older we lose muscle tone everywhere including our palate. This makes it more flabby and more susceptible to vibration. Weight gain causes further narrowing of the airways due to the increased fat deposition in the pharyngeal (around our airway, and throats) structures.
Oral appliance therapy has been found extremely effective in treating simple or benign snoring. Modern American Dentistry provides overnight home sleep testing prior to treatment of benign snoring in order to rule out sleep apnea. With the passage of time, benign snoring can often led to the more serious and dangerous sleep apnea. For this reason it is important to evaluate and treat snoring to prevent more severe complications in the future.
Often know as severe snoring. Occurs due to a significant narrowing of the airway causing the body to have to work harder to draw in air. This increased effort to breathe can prevent the body from getting the restful sleep that it needs because the body is fighting to keep the airway open. It is important to note that not all UARS patients snore or even realize that they sleep poorly.
With UARS, the airway narrows to the point that it results in an increased effort to breathe.
Can be thought of as severe snoring. With UARS, the airway narrows to the point that it results in an increased effort to breathe. It is important to note however, that not all UARS patients snore or even realize that they sleep poorly.
Imagine having to breathe through a small straw the whole night. This restriction in the airway makes the body have to work really hard to draw air into the lungs. As snoring gets worse, it results in UARS, and as UARS gets worse it results in obstructive sleep apnea. Sleep disordered breathing is a progressive disease.
The obstruction/narrowing of the airway results in repetitive arousals (signals from the body and brain that disrupts you out of sleep) because the body is fighting to keep the airway open eventually causing a chronic state of low-grade stress. This can result in:
It is common for UARS patients to state that they are “light sleepers” and that they don’t sleep on their back. Due to the repetitive arousals the body cannot remain in the deeper restorative phases of sleep that are need for the brain to feel refreshed and rested. It is possible to sleep through the night but remain in light sleep the entire time because the body is fighting to breathe. These arousals don’t necessarily wake you up from sleep, but they do pull you out of whatever sleep stage you are in.
Young petite women, both during and after pregnancy are at risk for this, and preeclampsia and postpartum depression are often a result. UARS goes unnoticed by almost everyone, and can be difficult to notice until the symptoms are more severe. Post-partum depression is thought to be linked to UARS, because after a baby is born, the mother still has extra weight due to the pregnancy, without the same pregnancy hormones to keep the airways open, making the new mother’s sleep deprivation even worse, not to mention a crying baby is now a new sleep disruptor.
UARS is often overlooked and misdiagnosed as other diseases. The following symptoms are frequently found in patients suffering from UARS:
People don’t make the connection that if they are not breathing well they are not sleeping well. Doctors do not ask often enough how a patient’s quality of sleep is. Too often a sleeping pill such as Ambien, Lunesta or even Valium and other anti-anxiety medications are prescribed and the root cause of the problem remains undiscovered. If these patients get a referral to a sleep lab to check for sleep apnea, they often times do not stop breathing enough to receive the diagnosis of sleep apnea. Insomnia is a frequent misdiagnosis of these patients who are sent home with medication to help them sleep. Unfortunately medications prescribed for sleep can cause more relaxation of muscle tone and actually make the problem worse.
In most cases of UARS the anatomic reason for the collapse of the airway is the tongue. Oral appliance therapy has been proven extremely successful in the treatment of UARS by repositioning the jaw and the tongue forward resulting in opening of the airway.
Sleep Apnea in essence is your body choking on itself at night. The airway narrows to the point that oxygen levels are negatively affected. Sleep suffocation puts a very serious strain on the body and is directly linked to chronic conditions such as high blood pressure, diabetes, chronic migraines, dementia, Alzheimer’s and frequent night-time urination.
Obstructive Sleep Apnea (OSA) is an actual physiologic obstruction that stops airflow. In essence your body is choking on itself, which results in periodic bouts of suffocation. This is due to the tongue blocking the airway or the throat relaxing to the point that there is a collapse of the tissues. With OSA, oxygen saturation (the amount of Oxygen carried in your blood by percent) is negatively affected.
Once the tissues closes, breathing cannot be resumed until the muscles activate to open the throat or move the tongue. The problem is that these muscles are paralyzed in REM sleep so you must wake out of REM in order for this to happen. Most of the time you are not conscious of this awakening because you don’t fully awaken but revert to a lighter stage of sleep where you have control over these muscles. Depending on the person and the severity of the suffocation, some people do wake up choking and gasping for air. Most of these people never make the connection that they stopped breathing because of sleep apnea, and their arousal is attributed to a need to use the bathroom.
There are 2 types of events in OSA. There are apneas and hypopneas. The physiologic consequence of both are the same. An apnea is a complete blockage of the airway for at least 10 seconds. A hypopnea is a partial narrowing of the airway resulting in a 30% decrease in airflow accompanied by an oxygen drop of at least 4% for at least 10 seconds.
The problem with this definition is that it is an arbitrary definition. In essence it says that if you stop breathing for 11 seconds you have a problem, but if you only stop breathing for 9 seconds you are OK. Those 9 seconds of suffocation still have an impact on your health but would not be counted in the sleep study scoring.
Many chronic diseases can be directly attributed to sleep apnea. You can survive for 3 weeks without food, 3 days without water, but only 3 minutes without oxygen. This helps put into perspective the importance of oxygen for survival. If your blood oxygen drops below 90% at the hospital, the nurses rush in and hook you up to pure oxygen. It is common for people with sleep apnea to get down into 80% but even as low as 50%! A fresh corpse has about 50% blood oxygen saturation. Any time spent with an oxygen saturation below 90% is considered to cause brain damage, reversible at first, but becomes permanent over time!
Oxygen is needed by every single cell in the body to function properly. Your body repairs itself during your REM cycle. It is crucial that there is oxygen flowing to all parts of the body so that the repairs can happen. Years and decades of low blood oxygen levels can cause a wide variety of diseases depending on your genetic weaknesses.
Fear and Denial
Many people are justifiably afraid to find out if they have sleep apnea. Some see it as an accusation of obesity or poor health. The idea of having to be attached to a machine for the rest of your life is real and legitimate. Unfortunately the gold standard for sleep apnea therapy is the CPAP (Continuous Positive Airway Pressure). It is not a good fit for most people. The American Academy of Sleep Medicine has approved the use of a dental device as first line therapy for all mild to moderate cases of sleep apnea, and even for more advanced cases where CPAP therapy fails. How is Modern Sleep Solutions different? While most medical professionals believe that Obstructive Sleep Apnea is a lifelong disease we want you to know that we feel sleep apnea is both preventable and reversible. We would like to help you get your sleep back! We have a forward thinking and advanced Sleep Restoration Program that was designed to be streamlined and easy to implement. Poor sleep causes premature aging and shortens our lifespan. Poor sleep can make one feel terrible, and progressively becomes worse the longer you are chronically sleep deprived.
Sleep apnea is usually diagnosed through a polysomnogram (PSG). This is usually done at a sleep lab or hospital overnight. Here at Modern American Dentistry, we make this process easier. We have home sleep test (HST) devices that are dispensed to the patient so that you make take your sleep study in the comfort of your own home. The sleep study is read and interpreted by a board certified sleep physician who makes a diagnosis.
Treatment options for sleep apnea are CPAP’s (continuous positive airway pressure), surgery, and oral appliance therapy. The oral appliance therapy (OAT) is the same as described above. By gently repositioning the lower jaw forward and down, the tongue can be moved forward along with the jaw resulting in an increase in space behind the tongue. For people with mild to moderate sleep apnea this is usually enough to stop the airway collapse.
Follow-up is crucial with OAT. We use a pharygometer (safe, easy non-invasive acoustic reflection that maps the size of the airway) to “dial-in” an ideal jaw position where the airway is open. This is verified over the course of a few months by follow-up Home Sleep Tests that confirm that treatment has been effective.
When our sleep is interrupted by our lack of healthy air exchange, two very serious and dangerous problems arise. Firstly, hypoxia (the lack of oxygen) causes a toxic effect on the entire body, while constantly stressing our body’s emergency arousal systems, in essence, keeping us fighting to stay alive all night long. This is very hard on the body in general. If we add the lack of quality sleep into the picture, this reduces our bodies own natural repair systems from working as they should, resulting in failure to maintain a healthy balance, and allowing dysfunction and disease to affect our health.
Vitamin D is not actually a vitamin, but a sun hormone. It is a chemical we make by absorbing the sun’s UVB rays in conjunction with our naturally produced cholesterol. Vitamin D is important for bone health and tooth development. We often hear vitamin D referred to when discussing bone conditions such as osteoporosis. What we don’t often hear about is how vitamin D is crucial to enter and stay in restorative sleep.
More Information on Vitamin D
Vitamin D plays a critical role in all cellular functions, including accessing more genes in our DNA. Unfortunately, in North America, most people suffer from a vitamin D deficiency (due to sunscreen, our distance from the equator, and our lack of time outdoors), which can lead to bone disorders, certain types of cancers, and sleep disorders.
By having the correct levels of vitamin D, our DNA can be fully accessed and unlock the key to more restorative sleep. Restorative sleep is as essential to your overall health as proper nutrition and exercise. The brain receptors in the posterior brainstem are where sleep and sleep paralysis are controlled. Vitamin D is the key that unlocks this area of the brain.
Sleep paralysis is a neurological response during restorative sleep that allows you to “turn off” certain body functions in order to achieve fully restorative sleep. Waking up at night to make a trip to the bathroom, clenching and grinding your teeth, and tongue thrusting are all examples of improper sleep paralysis - your muscles and sensations failing to properly shut down during sleep.
While low Vitamin D can lead to some muscles not being paralyzed sufficiently, muscles can also be overly paralyzed. When the airway muscles get “too relaxed,” they can actually collapse when you try to take a breath. This is known as sleep apnea. Obstructive sleep apnea (OSA) refers to a condition caused by airway obstruction.
Dr. Stasha Gominak’s pioneering work explains that the real cause of OSA and the subsequent collapse of the airway is not a large tongue or a fat neck, but that it is actually the brainstem malfunctioning in the area which manages sleep and sleep paralysis.
In light of Dr Gominak’ s work and the clinical observations of our doctors at our three locations we have defined a new syndrome. We are calling it DDA for Vitamin D Deficient Apnea. We feel that this expression and name better suits a disease that didn’t have all of the answers when called obstructive sleep apnea. Vitamin D Deficient Apnea refers to patients who suffer from vitamin D deficiencies and subsequently suffer from sleep apnea.
Symptoms of DDA closely resemble those of OSA:
• Feeling tired and irritable upon waking
• Bruxism (teeth grinding and clenching)
• Head and neck pain
• Frequent nighttime urination
• Heartburn, acid reflux, or GERD
• Sinus problems
• Anxiety, depression, and other mood disorders
• Problems focusing
• High cholesterol
• Fungal infections
• Unexplained weight gain
As you can see, improper sleep or poor quality sleep can negatively impact almost every body system and decrease your quality of life, ability to reach your full potential, and increase both physical and mental suffering.
The eight B vitamins essential to our bodies are not supplied by the food that we eat. They come from the healthy bacteria in our intestines. When we are not creating enough healthy bacteria, the “unhealthy” bacteria take over and create conditions such as irritable bowl syndrome.
The B vitamins created by our intestines require sufficient vitamin D to thrive. Therefore, the lack of D creates a systemic lack of B vitamins, as well.
Our unique approach based on the work of Dr. Stasha Gominak, combines supplementation to achieve proper levels of vitamin D and the B vitamins combined with sleep apnea treatment, using oral appliance therapy or CPAP treatment) to help the body regain its natural balance. Both aspects of treatment are necessary to achieve optimal results.
By simultaneously addressing both the symptoms and the cause of DDA, we can “retrain” the body to return to its naturally balanced state of proper sleep and wake cycles.