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Snoring, OSA, Bruxism

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    1. What are snoring and OSA?

    2. Why do we snore?

    3. What are the consequences of snoring and OSA?

    4. How is sleep-disordered breathing such as OSA diagnosed?

    5. What is bruxism?

    6. How is snoring best treated?

    7. Are oral appliances effective in treating obstructive sleep apnea (OSA)?

  • What are snoring and OSA?

    Snoring and OSA or obstructive sleep apnea (sometimes termed ‘apnoea’) are common disorders, where sufferers struggle to breathe during sleep.

    Snoring occurs when the soft tissues of the throat and soft palate vibrate during breathing. The tongue tends to fall towards the back of the throat, causing the air passage to narrow. As we fall into a deeper sleep, we also lose muscle tone in the tongue, and the surrounding tissues start to oscillate back and forth. The tone of the snoring varies in volume and sound, depending on the narrowing of the air passage as we breathe in and out.

    OSA occurs when snorers choke in their sleep as the pressure of the air passing through the narrow walls of the airway (pharynx) causes it to collapse. Bed partners often notice periods of silence during a snoring sequence, followed by a large gasp of breath as inhalation re-starts. Apneas lasting from a few seconds to a whole minute or more can cause them serious anxiety, jeopardising their sleep quality as well. These apnea blockages can cause a dramatic increase in blood pressure, due to inadequate oxygen supply to the brain. They also frequently arouse the snoring sleeper out of the deeper, more restful stages of sleep, leaving them feeling tired on awakening and fatigued throughout the day.

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  • Why do we snore?

    We speak, sing, smell, breathe, taste, chew, drink and swallow, all through just two openings: the nose and the mouth. To allow such multi-tasking, human evolution has modified certain anatomical structures, improving the function of some, but compromising others. For example, the pharynx would be far better suited for the purpose of breathing if it were rigid like your windpipe… but then we would lose our capacity for voice, which requires muscular elasticity. As we walk upright, we must breathe also through a convoluted nasal passage, which then bends downwards at right angles towards the lungs. Muscle activity in the tongue and soft palate is high when striving to maintain an open air passage. However, during sleep, reduced muscle tone in these structures narrows the airway, making it more prone to collapse.

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  • What are the consequences of snoring and OSA?

    While many snoring sufferers simply carry on with life as usual, an estimated 9% of middle-aged men and 4% of women feel more serious sleep apnea side-effects. The resulting sleep deprivation can lead to irritability, daytime drowsiness, inattention, inability to concentrate, depression, and impotence or reduced libido. It is also a common cause of fatigue-related workplace and driving accidents.

    OSA can have more serious additional health consequences than simple snoring, because the reduced airflow to the lungs leads to a fall in blood oxygen levels and an associated rise in carbon dioxide. In response to these changes, the body’s protective reflex mechanisms arouse the sleeper out of the deeper, more restorative stages of sleep, sometimes several hundred times a night. People with sleep apnea also show an increased risk of potentially dangerous health conditions such as cardiovascular disease, hypertension and stroke. Therefore, those badly affected by OSA – and in particular those with cardiovascular conditions – should seek medical attention sooner rather than later.

    Recent research also shows that snoring and its consequences can have an impact on the whole family’s quality of life. It strains many relationships and rates highly in divorce statistics, because it affects not only the snorer, but their partner’s sleep quality as well.

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  • How is sleep-disordered breathing such as OSA diagnosed?

    Sleep-disordered breathing (SDB) is a medical condition that must be diagnosed by a suitably qualified medical practitioner, usually following an overnight sleep study called polysomnography. As it is commonly associated with a number of other health disorders, patients should be assessed by a physician with appropriate training in sleep medicine. Such specialists usually practise in conjunction with wider multi-disciplinary medical teams, often consisting of otolaryngology (ear, nose and throat) and dental specialists, working with allied technical and sleep laboratory staff.

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  • What is bruxism?

    Bruxism is the medical term teeth grinding during sleep. It often leads to excessive tooth wear, hypersensitive teeth, or persistent pain in the jaw joints brought about by clenching. It is most common in childhood, with up to 20% of children bruxing at some stage of their development. It is less common in adults, but can be associated with medication or with some medical conditions such as Parkinson's disease or stroke. Although many theories for chronic bruxism have been suggested, the exact causes are not fully understood. However, it is important that the teeth are protected from excessive wear. A well-fitting, custom-made mouthguard provides an effective barrier against further dental damage.

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  • How is snoring best treated?

    Although snoring can be reduced by some conservative techniques such as positional therapy, nasal decongestants, etc, the three main medical solutions are:
    continuous positive airway pressure (CPAP), oral appliance therapy or surgical procedures. Unless there is some anatomical structure crowding the upper airway that can be surgically corrected, the American Academy of Sleep Medicine and the equivalent European medical authorities now recommend oral appliances as the first line of treatment for chronic snoring, mild to moderate OSA and where CPAP therapy is either unsuccessful or not well tolerated.

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  • Are oral appliances effective in treating obstructive sleep apnea (OSA)?

    Several hundred research studies show evidence that the oral appliances called mandibular advancement splints(MAS) are very successful in treating OSA. However, CPAP is still regarded as the ‘gold standard’ for effectiveness, especially where obesity is a contributing factor. MAS’s are more effective when excess body weight is less of an issue and where the shape and size of the head and neck structures cause a narrowed upper airway. Many recent studies show that MAS’s are better accepted by patients than CPAP because they are easier to use and more convenient.

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