Snoring and Dental Issues

Snoring

Snoring

Lack of sleep may cause an increase in the population!

Sleep medicine divides sleep-related breathing disturbances into three basic types:

  • obstructive sleep apnoea
  • central sleep apnoea
  • primary snoring (harmless but sometimes very disturbing)

 

Obstructive Sleep Apnoea

Obstructive (constriction) sleep apnoea is the most severe and most widespread form of sleep-related breathing disorder. In sleep the muscles of the pharyngeal region relax. Due to an additional anatomical narrowing (obstruction) in the upper airways – for example due to a distorted nasal septum, enlarged tonsils, unusually small jaw or large tongue etc, - the speed of the airflow may be increased. This in turn lowers the pressure in the pharyngeal area. The pharynx is a muscular tube with more than 20 pairs of muscles.

The reduced air pressure and the muscles relaxed in sleep can lead to a collapse of the ‘tube‘. In addition, muscle tension varies from person to person. Many have open airways but a very ‘sleepy’ pharyngeal passage and this situation alone may cause obstructive snoring. Some patients however display several of these uncomfortable factors simultaneously.

When the airways collapse breathing becomes shallower or ceases completely. This leads to dangerously low levels of oxygen in the blood and thereby to a lack of supply to vital organs like the brain or heart.

The lack of oxygen in the blood leads to a wake up reaction in the brain which is usually not consciously truly followed (so called micro-arousals) but which nonetheless have a decisively negative influence on our quality of sleep. Eventually the airways are re-opened by these wake-up reactions so that sufficient oxygen can be absorbed once again.

If this kind of event occurs for a minimum of 10 seconds and more frequently than 10 times per hour we can speak of snoring which is dangerous to one’s health (pathological snoring).

Central Sleep Apnoea

In central sleep apnoea the airways do remain open but the muscles in the chest and diaphragm are not active. The signal from the brain to breathe is either not sent or not received. As a result of the failure to breathe oxygen levels in the blood fall – a signal for the brain to wake the sleeper up so that he can breathe again. The likelihood of central sleep apnoea increases with age. Sleep-related breathing disturbances affect every fourth person aged over 60. If these sleep related breathing disturbances occur frequently and in conjunction with heart problems or neurological disturbances then treatment is urgently required.

High alcohol consumption and/or the taking of sleeping pills or medication such as antihistamines (medication for the treatment of allergies) increase the effects.

Snoring also occurs if the upper airways narrow during sleep and soft tissues, such as the soft palate, uvula or base of the tongue, vibrate in the airflow. Apart from the snoring disturbing the sleep of others it can also be an important sign of a serious sleep disorder: maybe even obstructive sleep apnoea.

Possible Consequences of Snoring

Disturbed night sleep can lead to extreme drowsiness by day and to severe stress on our health and in our private and working lives. The symptoms are unfortunately often not noticed or their meaning is misunderstood. The consequences of untreated sleep apnoea could be heart rhythm disturbances, high blood pressure, coronary heart illness, heart attack, sudden heart failure and strokes.

Patients with sleep apnoea syndrome also run a higher risk of accident and injury since at any time at work or whilst driving they may fall asleep (“nod off”). The likelihood of traffic accidents is higher for sleep apnoea sufferers than for others using the roads due to their tiredness during the day.

Sleep apnoea can also lead to concentration disturbances, forgetfulness, absent-mindedness, anxiety and depression. Some patients complain of morning headaches and reduced sexual interest. In men it can also lead to erectile dysfunction.

Medical studies confirm that these events lead to high blood pressure, heart attacks and strokes and can also bring on depression.

Snoring – The Way to a Diagnosis

Whoever snores loudly enough to wake himself up or disturb his surroundings should visit his doctor in order to rule out an unhealthily dangerous variant of snoring – sleep apnoea. Snoring can have fatal consequences. When you realise that we spend 7 – 10 years of our lives sleeping it is plainly obvious that this is the least observed phase of our lives. No one really knows what’s happening whilst he’s sleeping.

Often treatment for snoring (medical term „ronchopathy”) is not required on health grounds since normal snoring doesn’t pose a danger to one’s health. On the other hand obstructive sleep apnoea requires treatment without doubt since it offers a potential risk of dangerous illnesses as a result, such as high blood pressure, coronary heart illness, heart attack, stroke and others.

Even normal snoring can be highly annoying to one’s partner, denying him/her of his/her sleep and putting great strain on a relationship. Treatment is possible here too.

Treatment

Treatment of sleep apnoea involves both conservative, particularly non-surgical, and surgical, measures.

CPAP Therapy

CPAP Therapy

CPAP Therapy

The continuous positive high pressure breathing of CPAP therapy (continuous positive airway pressure) offers an effective method of treating sleep apnoea syndrome. In it patients are respirated with ambient air via an individually fitted nose mask which produces a continuous positive pressure in the airways. Through the breathing pressure the airways are kept open so that sleep and breathing are brought back to normal. The respiration with the CPAP device is a physical measure which must be performed every night. CPAP therapy is mainly prescribed for the treatment of severe obstructive sleep apnoea.

Medication therapy

As a rule sleep apnoea patients profit little from treatment with medication. An effective medication against snoring or sleep apnoea doesn’t exist. Nonetheless some slight symptoms of sleep apnoea respond to some types of medication. Medication may also be made use of to treat accompanying illnesses such as heart rhythm disturbances, high blood pressure, or residual drowsiness. With all medication, one must be careful of side effects which can reduce the quality of life. It is recommended that the pros and cons are carefully weighed up in conjunction with a doctor.

Surgical measures

Anatomical factors which exert an uncomfortable influence on breathing may be corrected by an operation. Amongst these we include enlarged tonsils and polyps which most frequently occur in children.

Minimally invasive interventions, such as radio frequency surgery which can be carried out under local anaesthetic on an outpatient basis, are used most frequently in the area of the soft palate, the base of the tongue and the nasal muscles.
Deviated nasal septa can also be corrected surgically as can narrow areas in the soft palate region in so called Uvulopalatopharyngoplastic (UPPP).

Conservative measures

Bodyweight: attainment of normal weight plays an important role in sleep apnoea. A patient who weighs 90 kilos when his ideal body weight should be 75 kilos can noticeably improve his nightly breathing as well as the quality of his sleep by means of reducing his weight.

Alcohol and heavy meals should be avoided after 6.00 pm.

Medication: sleeping pills should also be avoided, since they can reduce the breathing force and possibly favour sleep apnoea. Medication should always be taken with extreme care. Prescription medicine for headaches and anxiety can also have negative effects on sleeping and breathing.

As a rule, sleeping on one’s side is recommended. If sleep apnoea only occurs when lying on one’s back, physical aids can help to avoid this.

Since medication for blocked noses can also reduce snoring and apnoea it may be useful in some cases. Be extremely careful however of using nasal decongestant preparations unnecessarily as they may under some circumstances become ineffectual or lead to opposite effects.

The Silensor: the individual fitting of this device (a kind of bite-adjuster) onto the teeth by your specialist dentist or mandibular surgeon may in some cases bring about a massive improvement of the situation. This is achieved by the device moving the lower jaw and tongue forward and thereby widening the airway considerably so that both snoring and the obstruction of the airway are reduced.

This post is also available in: German

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