Snoring is the noisy breathing that occurs when the upper airway (nose, mouth, throat) gets narrowed or becomes occluded, during sleep.
The soft tissues in the nose, soft palate, uvula, tongue, lateral walls of the throat, epiglottis, encroach on the airways, and vibrate as respiring air blows over them, to generate the noise.
Intensity of Snoring varies from very soft to very loud noise.
Almost, everybody snores occasionally, when they fall asleep, however, some are habitual snorers.
Sleep period is a continuous repetition of the sleep cycle every 90 minutes.
A sleep cycle is divided into 4 stages. The first 3 stages are grouped under non-REM, the 4th stage occurs when there is rapid eyeball movement (REM) during sleep, and is known as REM sleep stage.
NON-REM sleep (approximately 70 minutes duration)
This begins early in sleep.
Stage 1 starts with light sleep, associated with hypnic jerks/jolts, as individuals try to stay awake.
Stage 2. There is loss of awareness but individuals can easily be aroused from the sleep.
Stage 3. Deeper sleep state where it is difficult to arouse someone in this stage. When aroused from sleep, they would still feel sleepy with impaired mentation for about 30 minutes
Stage 4. REM Sleep (approximately 20 minutes)
The last 20 minutes of a sleep cycle is known as REM sleep. Two events occur during REM sleep
Vivid dreams occur during this stage.
Muscles lose their tone (except the muscles of eyeball and the diaphragm).
SLEEP CYCLE AND SNORING
Light snorers do snore uniformly throughout all the sleep stages.
Heavy snorers, snore more during REM sleep when there is generalized loss of muscle tone.
CAUSES OF SNORING
Snoring occurs anytime the airways are partially or completely occluded.
Nasal congestion (from nasal allergies and viral colds), Swollen nasal turbinates, Nasal polyps
Abnormalities of Nasal septum (deviations, dislocations and hematoma)
structures that may narrow the airways include
Enlarged Tonsils (especially in children)
Large and/or soft tongues preclude air passage from nose/mouth into the lower airways
Long and soft uvula. Uvula of habitual snorers contain less muscles than non-snorers
Long soft palate.
Loss of tone in Throat muscles due to Alcohol, Sleep deprivation, Sedative medications
RISK FACTOR FOR SNORING
- Being overweight/ Obese leading to bulky neck/throat tissue that could narrow the airway
- Use of Central Nervous System depressants: Alcohol consumption, sleeping pills
- Family history of snoring
- Daytime mouth breathing
- Frequent sore throats
- Low maternal Education is a risk factor for boys.
- Tobacco exposure
- Sleeping supine/back position, allows tongue to fall back, under gravity, to block the airways
COMPLICATIONS OF SNORING
Snoring disturbs the sleep of bed-partners and room-mates. Loud snoring may even, strain relationships.
The vibrations of snoring may damage lining of blood vessels and promote atherosclerosis formation (1)
Heavy snoring may interfere with sleep and results in inadequate sleep. Snorers may fall asleep while driving
Snorers may also complaint of tiredness and headaches.
Snorers may develop Depressive disorders, Inattention and inability to complete tasks and school home works
Snoring becomes a major health problem when it as associated with sleep apnea. 50% of snorers have sleep apnea
Most heavy snorers do experience repetitive interruptions of their sleep cycle. They snore loudly, then stop breathing for 10-20 seconds, then restart breathing. This stop and start breathing pattern may occur throughout the sleep period. It is due to narrowing/occlusion of upper airway during sleep. It interrupts their sleep cycle.
A bed-partner may observe the following signs of Sleep apnea:
- Loud snoring
- Pauses in breathing
Affected persons may have these symptoms:
- Frequent awakening
- Dry mouth
- Non-refreshing sleep
- Men would get up to void urine several times at night
RISK FACTORS FOR SLEEP APNEA
Risk factors are Same as the risk factors for snoring.
Obesity which causes fat to be deposited in the neck region is the most important risk factor
DIAGNOSIS OF SLEEP APNEA:
History of pauses in breathing, observed by bedmates History of daytime sleepiness
This is the gold standard to assess airway obstruction. Polysomnography has to be performed in a sleep laboratory. The test monitors brain activity, muscle activities, heart rhythm. Airflow through nose and mouth, chest wall motions and oxygen saturations.
OUT OF CENTER SLEEP TESTS (OCST)
Devices that monitor. airflow through nose/mouth. Chest wall motion and oxygen saturations. These self-monitoring devices do not monitor brain, muscular and heart activities during sleep.
TREATMENT FOR SLEEP APNEA:
Dental Sleep Medicine is an area of clinical expertise which focuses on the management of sleep related breathing disorders, including snoring, noisy disturbed sleep, sleep apnoea, CPAP intolerance and sleep bruxism (teeth grinding), with the design and fitting of customised oral / dental appliances.
What is Oral Appliance Therapy?
An oral appliance is a device worn in the mouth only during sleep. The device fits similar to a sports mouth guard or orthodontic retainer and prevents the airway from collapsing by either supporting the tongue or jaw in a forward position, thereby opening the airway.
With a custom fitted oral appliance, we can help minimise or eliminate the symptoms of Sleep Disordered Breathing. Sleep apnoea (in mild to moderate cases) including loud snoring, gasping and unpleasant noises.
The device can also act as an alternative treatment for patients (on medical advice only) who have been prescribed CPAP by their medical consultant, finding it difficult to adhere to this therapy for management of their sleep apnoea condition.
How does Oral Appliance Therapy Work?
Oral appliances hold the lower jaw in a forward position, dilates the upper airway and preventing it from collapsing. This helps to:
- eliminate or reduce snoring noise levels
- improve sleep quality and general energy levels on wakening
- treat sleep apnoea disease progression
- improves bed partners sleep quality of life.
The Beacon Dental Clinic provide the following additional services
- Referral from consultant led medical diagnosis of sleep disordered breathing, noisy loud snoring and suspected sleep apnoea.
- CBT referral or medical advice for sleep disorder management.
- Dietician and weight management referral if indicated.
- Dental health care education.
- Routine in office dental healthcare
- Process of our Oral Appliance Therapy Program
If you are referred to the Beacon Dental Sleep Medicine Clinic by a medical consultant, we will then assess your suitability for Oral Appliance Therapy. This will involve a dental examination, an x-ray and a trial oral appliance, if indicated.
If you have not been seen by a doctor, we will refer you to the appropriate medical consultant before further assessment.
In the Treatment phase, you will be fitted with an oral appliance by an experienced restorative dentist with expertise in the field of dental sleep medicine, who will control and monitor your progress and response to treatment. All patients of the Beacon Dental Sleep Medicine Clinic are seen one week and one month following initial appliance delivery. You will also be provided with clear instructions as to the best use and care of your oral appliance.
Follow up appointments
All patients with sleep apnoea diagnosis are referred back at this stage to their medical consultant for evaluation. The oral appliance is re-evaluated at the Beacon Dental Clinic at specified internals to evaluate its mechanical integrity and performance.