SLEEP DISORDERED BREATHING
PLEASE TAKE A MOMENT TO RATE THE FOLLOWING SITUATIONS:
In
contrast to just feeling tired, how likely are you to doze off or fall
asleep in the following situations? Use the following scale to choose
the most appropriate number for each situation:
0 = Would never doze
1 = Slight chance of dozing
2 = Moderate chance of dozing
3 = High chance of dozing
SITUATION
Sitting and reading
Watching Television
Sitting inactive in a public place (i.e. theater)
As a car passenger for an hour without a break
Lying down to rest in the afternoon
Sitting and talking to someone
Sitting quietly after lunch without alcohol
In a car, while stopping for a few minutes in traffic |
0 1 2 3
0 1 2 3
0 1 2 3
0 1 2 3
0 1 2 3
0 1 2 3
0 1 2 3
0 1 2 3
|
THE EPWORTH SLEEPINESS SCALE KEY:
1-6
7-8
9 and up |
Congratulations, you are getting enough sleep!
Your score is average
Seek the advise of a sleep specialist without delay |
A
score of 9 or above indicates that you may be having a problem with
daytime sleepiness, but below 9 does not necessarily mean that you
don’t have a problem.
 What is Snoring?
Snoring
is very common. It is estimated that as many as 75 million Americans
snore. Snoring is defined as breathing during sleep with harsh noises
caused by vibration of the uvula or soft palate. Some snorers can be
woken by the sound of their own snoring. However, their harsh noises
usually only affect the quality of someone else’s sleep.
What is Obstructive Sleep Apnea?
It
is estimated that 20 million Americans have some degree of Obstructive
Sleep Apnea (OSA). Obstructive Sleep Apnea occurs during sleep when the
tongue and soft palate relax to the point that they block the flow of
air. Without air, the oxygen level in the body drops. This causes the
brain to come out of a deep sleep, partially awakening the individual.
The airway then opens, clearing the obstruction in the throat--usually
with a loud gasp. Breathing then returns to a normal state as one moves
back into a deep sleep. As one reaches deep sleep, the airway muscles
collapse, breathing can stop for 10 minutes or more, and you awaken
again with a gasp. This cycle can occur many times during the night and
as high as 700 per night in severe cases.
How serious is Obstructive Sleep Apnea?
It
can be very serious. As a result of having intervals of nighttime
lowered oxygen levels and continual interrupted sleep, patients with
OSA much more likely to suffer from heart attack, congestive heart
failure, hypertension, strokes, personality changes such as
irritability or depression, as well as having a higher incidence of
work related and driving related accidents due to excessive daytime
sleepiness. The National Highway traffic safety administration (NHTSA)
estimates conservatively that each year drowsy driving is responsible
for at least 100,000 automobile crashes, 71000 injuries, and 1550
fatalities.
How is Obstructive Sleep Apnea Diagnosed?
The
only sure way to diagnose OSA is with an overnight test known as a
polysomnography that is performed at a specialized sleep center. This
test monitors a number of things, including airflow through the nose
and mouth, snoring, oxygen saturation, certain electrical activity of
the brain and body position.
What is CPAP?
CPAP
is an acronym for Continuous Positive Airway Pressure. A machine
provides air under light pressure through the nasal cavity, usually
with a face mask, in order to prevent the upper airway from
obstructing. CPAP is quite effective for sleep apnea and is considered
the gold standard for treatment. However, some people just can not
adjust to the apparatus. Compliance is low. In this case, alternative
treatment modalities need to be considered.
How can an Oral Appliance Help?
Such
an oral appliance is similar to an Orthodontic retainer. In most cases,
they are custom fabricated to fit over ones teeth. The most recent
appliances are called mandibular advancing appliances. They are
designed to bring the lower jaw forward and help prevent airway closure
during sleep. Most patients find them comfortable to wear and easy to
care for. They can be very successful for simple snoring as well as in
the treatment of mild to moderate Obstructive Sleep Apnea.
Are there other treatment options?
There
is a procedure known as UPPP, or Uvulopalatopharyngoplasty. It involves
surgery to the structures in the back of the throat in order to
eliminate them from collapsing during sleep. It has proven to be 40
percent successful. Another, more successful but advanced, surgical
procedure involves repositioning the bones of both the lower and upper
jaw.
What lifestyle changes can be beneficial?
Exercise
and weight loss are both helpful in treating most mild cases of sleep
apnea. In addition, it is important to practice good sleep hygiene,
which includes the following: Don’t go to bed unless you are sleepy; If
you are not asleep after 20 minutes, then get out of the bed; Begin
rituals that help you relax each night before bed; Get up at the same
time every morning; Get a full night’s sleep on a regular basis; Avoid
taking naps if you can; Keep a regular schedule; Don’t read, write,
eat, watch TV, talk on the phone, or play cards in bed; Do not have any
caffeine after lunch; Do not have a beer, a glass of wine, or any other
alcohol within six hours of your bedtime; Do not have a cigarette or
any other source of nicotine before bedtime; Do not go to bed hungry,
but don’t eat a big meal near bedtime either; Avoid any tough exercise
within six hours of your bedtime; Avoid sleeping pills, or use them
cautiously; Try to get rid of or deal with things that make you worry.
Are there other Sleep Disorders?
There
are more than 70 sleep disorders, the most common being insomnia, sleep
apnea, restless legs syndrome, and narcolepsy. In most cases, your
doctor can effectively manage the disorder once it has been correctly
diagnosed.
Helpful resources:
Academy of Dental Sleep Medicine: www.dentalsleepmed.org
Academy of Sleep Medicine: www.sleepeducation.com
National Sleep Foundation: www.sleepfoundation.org
American Sleep Apnea Association: www.sleepapnea.org
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