Obstructive Sleep Apnoea Treatment Dublin

Obstructive sleep apnoea (OSA) is a condition that causes interrupted breathing during sleep. For people with OSA, two types of breathing interruptions have been defined:

apnoea – the muscles and soft tissues in the throat relax and collapse sufficiently to cause a total blockage of the airway; it is called an apnoea when the airflow is blocked for 10 seconds or more
hypopnoea – a partial blockage of the airway that results in an air flow reduction of greater than 50% for 10 seconds or more

Because of the episodes of hypopnoea that occur during OSA, doctors sometimes refer to the condition as ‘obstructive sleep apnoea-hypopnoea syndrome’. The term ‘obstructive’ distinguishes OSA from rarer forms of sleep apnoea, such as central sleep apnoea, which is caused by the brain ‘forgetting’ to breathe during sleep.

Sleep

Sleep is driven by natural brain activity. You need to have a certain amount of deep sleep for your body and mind to be fully refreshed. Having only limited episodes of deep sleep will leave you feeling very tired the next day.

In order to function properly, most adults need seven to eight hours of sleep. Around 15-25% of that time should be spent in the deepest phase of sleep, known as slow wave sleep (see box).

What happens during OSA?

During the night, people with OSA may experience repeated episodes of apnoea and hypopnoea.

The lack of oxygen causes the person to come out of deep sleep and into a lighter state of sleep, or a brief period of wakefulness, in order to restore normal breathing. However, after falling back into deep sleep, further episodes of apnoea and hypopnoea can occur. Such events may occur more than once a minute throughout the night.

The repeated interruptions to sleep caused by OSA can make the person feel very tired during the day. A person with OSA will usually have no memory of breathlessness, so they are often unaware that they are not getting a proper night’s sleep.

How common is OSA?

OSA is a relatively common condition that affects men more than women. In the UK, it is estimated that around 4 in 100 middle-aged men and 2 in 100 middle-aged women have OSA. We do not have detailed data on the number affected in Ireland.

The onset of OSA is most common in people aged 35 to 54 years old, although it can affect people of all ages, including children. The condition often goes undiagnosed. Only one in four people with obstructive sleep apnoea are diagnosed with the condition.

Studies have also shown that 60% of people over 65 years old have OSA.

Outlook

OSA is a treatable condition and there are a variety of treatment options to reduce the symptoms. Left untreated, OSA can increase the risk of:

high blood pressure (hypertension)
heart attack
stroke
obesity
type 2 diabetes

Untreated OSA also increases a person’s risk of developing heart failure and irregular heartbeats, and it can lead to poor performance at work and at school.

Symptoms of Sleep Apnoea

Most people with obstructive sleep apnoea (OSA) snore loudly. Their breathing may be noisy and laboured, and it is often interrupted by gasping and snorting with each episode of apnoea.

If you have OSA, you may have no memory of your interrupted breathing during the night. However, when you wake up you are likely to feel as though you have not had a good night’s sleep.

Symptoms of OSA include:

feeling very sleepy during the day
waking up with a sore or dry throat
poor memory and concentration
headaches (particularly in the morning)
irritability and a short temper
anxiety
depression
lack of interest in sex
in men, impotence (inability to get or maintain an erection)

Some people with OSA may also wake up frequently during the night to urinate.

Driving

As someone with OSA can suffer a lack of refreshing sleep, they run an increased risk of being involved in a life-threatening accident, such as a car crash. Their risk of having a work-related accident also increases.

Research has shown that someone who has been deprived of sleep due to OSA has the same impaired judgement and reaction time as someone who is over the drink-drive limit.

If you have OSA, it could affect your ability to drive. It is important that you inform your doctor and the Road Safety Authority (RSA) about a condition which could impact on your driving ability.

Sleep Apnoea Treatment Options

Lifestyle changes

Mild cases of obstructive sleep apnoea (OSA) can often be treated by making lifestyle changes, such as:

losing weight (if you are overweight or obese)
stopping smoking (if you smoke)
limiting your alcohol consumption

The recommended limits for alcohol consumption are 17 standard drinks a week for men and 11 for women. A standard drink of alcohol is equal to about half a pint of beer, a small glass of wine or a pub measure of spirits

Sleeping on your side, rather than on your back, may also help to relieve the symptoms of OSA, although it will not prevent the condition.

Other options

The severity and medical significance of your snoring is investigated by referral to a specialist physician for a sleep test. This test, known as polysomography or PSG, is non-invasive, and may be carried out in your home or in a sleep centre.

The test consists of attaching a series of leads, like an electro-cardiogram, to your head, body, arms and legs. This test will measure the various stages of your sleep and physiologic functions like breathing, heart rate, and oxygen content of your blood, leg movements, and eye movements.

A PSG will tell us about the quality of your sleep and just how much problem you may be having with sleep apnoea. The sleep test helps our office and your sleep physician determine what type of treatment would be best for your problem. Treatments range from things you can do to help yourself to use of devices to help maintain the size of your airway during sleep to surgery.

There are a number of things you can do to help yourself. These include :

- Weight loss If you are overweight, losing weight can help your snoring and sleep apnoea by reducing the size of the fat deposits around your soft palate, tongue and neck.
- Sleep Position Many people find that their snoring is worse if they sleep on their back. One way to train yourself not to sleep on your back is to place a tennis ball in a sock and sew it to the back of your pajama tops.
- Avoid drugs and alcohol Many people find that their snoring is worse if they sleep on their back. One way to train yourself not to sleep on your back is to place a tennis ball in a sock and sew it to the back of your pajama tops.

Devices Used to Control Snoring & Sleep Apnoea

Two main devices are available for the control of snoring and obstructive sleep apnoea. These devices must be worn every night to control your sleep problem.

CPAP (Continuous Positive Air Pressure) is a device that controls apnoea by providing a stream of air, under slight pressure, through a tube into your nasal passage. This positive air pressure acts as a splint holding the tissues in the back of your throat open to prevent collapse. Use of this device requires a sleep study to determine the proper pressure to use.

Oral Appliances – Oral appliances are devices very much like sports mouth guards or removable orthodontic appliances that hold the airway open by either holding the tongue or jaw in a forward position. Oral appliances are non-invasive and easy to use and as such they may be considered an early treatment option and may be the most appropriate treatment for your condition.

Surgery

The goal of any surgical procedure is to provide and maintain an open airway to prevent collapse during sleep. Surgical procedures are known as site-specific procedures because they treat a particular portion of the airway.

Surgery can be performed on the nasal passages to provide a clear passage for the flow of air by correcting a deviated septum, removing polyps and/or reducing the size of the bones in your nose known as turbinates.

Removal or reduction in size of the soft palate, uvula and back of tongue can be accomplished by a procedure known as:

Uvulopalatopharyngoplasty (UPPP) – which involves removal of the uvula, soft palate and redundant tissue in the back of the throat and requires hospitalization.

Surgical procedures may on occasion only provide a partial resolution to sleep apnoea and snoring and may need to be complimented with for example an oral appliance treatment to provide a more optimal outcome.

Oral Appliance Therapy for obstructive sleep apnoea and snoring

Oral Appliance therapy involves the selection, design, fitting and use of a specially designed oral appliance that, when worn during sleep, maintains an opened, unobstructed airway in the throat. Oral appliances that treat snoring and obstructive sleep apnoea are customised devices made from impressions of the teeth. They are worn in the mouth while sleeping, dilating or enlarging the airway. When successful they have several advantages over other forms of therapy.

Oral appliances are comfortable and easy to wear and care for. They are small and convenient, making them easy to carry with you when you travel. Treatment with oral appliances is reversible and non-invasive.

Oral appliance therapy is recognised in the area of Sleep Medicine as an effective treatment option in the management of sleep breathing disorders. Medical and dental researchers have joined together to evaluate and improve the outcome of treatment with oral appliances.

Designs are constantly evolving and can be customised to individual dental configurations. In the case of individuals who have missing teeth or dentures for example, appliances can be modified and a suitable design provided. This could possibly include using dental implants, designed around these differing dental configurations, which can be used to help improve the fit of the oral sleep appliance and improve the effectiveness of the device.

Patients may have differing experiences following the need to wear a device while sleeping for either medical or noise reduction reasons. Customised appliances can accommodate individual tolerances and differences. Oral appliances may be used alone or in combination with other means of treating OSA, including general health and weight management, surgery or nasal continuous air pressure (CPAP). Oral appliances work in several ways:

By repositioning the lower jaw, tongue, soft palate and uvula
By stabilizing the lower jaw and tongue
By increasing the muscle tone of the tongue

Oral appliance therapy can take from several weeks to several months to complete. Even after the initial phase of treatment is complete, we will continue to follow you to be sure that treatment remains successful and to evaluate the response of your teeth and jaws.

If a medical diagnosis of sleep apnoea has been made, as opposed for example to simple snoring / noise problem, a follow up sleep study with your sleep physician is required to evaluate the effectiveness of the contribution of wearing a customised oral appliance to the medical management of this condition. Necessary modifications and adjustments, called titrations, can be carried out if required following the results of this study.

To make an appointment with the Beacon Dental Clinic, call 01 2135644 – or please click here

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Beacon Dental Clinic, Beacon Consultants Clinic, Dublin, D18 E7P4, Ireland

Tel: +353 1 213 5644 | Fax: +353 1 213 5645 | Email: info@beacondental.ie