Snoring And Sleep Apnoea Appliances

Whether your snoring is mild or shakes the whole house, snoring can lead to both poor levels of sleep quality and quantity. Your snoring may also be a symptom of a sleep disorder, such as sleep apnoea. Whilst your snoring is probably a nuisance to your partner and therefore, really a good enough reason to come see us for possible treatments, if you also suffer from sleep apnoea, there may be more serious health consequences for you as well.

What is sleep apnoea and snoring?

Before we go any further we always get asked, if I snore does that mean I also have sleep apnoea or vice versa? Generally speaking, if you have sleep apnoea you will also snore, however, that is not always the case, as some people are non-snorers and have sleep apnoea. Therefore, we really need to look at them as separate issues when treating them.

During the hours of the day that you are awake, you breath in and out oxygen at regular intervals without even thinking about it. Your body simply takes over this process and keeps the airways open to allow a healthy supply of oxygen to enter, to keep you alive. Naturally, the body needs to recharge it's energy levels, therefore, we need to sleep. Thankfully, during this period of time where we relax to recharge and our conscience mind turns off, our body or subconscious is still there regulating our breathing to ensure we don't run out of oxygen.

Despite this vital requirement for oxygen and our breathing to continue whilst we sleep, the muscles in your throat or airways may have missed the memo that they need to stay open for business. These muscles include the uvula, the soft palate and the tongue. When these muscles partially relax, they collapse a small amount together. This relaxing of the throat muscles can cause a partially (hypopnea) blocked airway. When air rushes past this point it may vibrate, which is what we refer to as snoring. The loudness of this snoring will vary from individual to individual.

The important thing to keep in mind with snoring, however, is that despite this partial relaxation of the muscles, enough oxygen is still passing through the airways. This means that despite the fact the snoring maybe incredibly noisy and disruptive to those around, it will not cause a 'shortness of breath' feeling or a gasping of air for the individual.

Sleep apnoea is similar to snoring in that the muscles in your throat relax, however, with sleep apnoea the relaxation causes a closure or severe restriction of the airways. This collapse of the airways can result in a person effectively stopping breathing for a period of time, possibly 10 secs or even up to a minute or more.

Stopping breathing when you are asleep is very much like when you stop while you are awake. The levels of oxygen in your blood will drop and a build-up of carbon dioxide will begin. Your brain will sense this "out of balance" oxygen and carbon dioxide levels and temporarily wake you up from your sleep to get the airways to open again. When the breathing resumes, it may sound like you are gasping for air and can be fairly distressing for a partner next to you in bed. For you, however, you won't even remember waking up in the night to restart your breathing, as it will be for such a short period of time. This can happen hundreds of times in a single night.

What are the risk factors for sleep apnoea?

Whilst anyone can develop sleep apnoea during their life, some factors may put you into a higher risk category. These include:

• Being overweight, as fat deposits may build up around the upper airway which may obstruct the airways. Other conditions related to obesity can also lead to sleep apnoea, such as hypothyroidism and polycystic ovary syndrome.
• Asthma suffers have been found to have an association with a higher risk level of sleep apnoea.
• A narrowed airway due to your genetics or larger tonsils, which can in effect have the same effect of restricting the size of the airways.
• Diabetes.
• Higher blood pressure or hypertension.
• Chronic sinus or nasal congestion, which maybe cause itself by a narrow airway.
• Smoking
• Gender, with males more likely to develop sleep apnoea than premenopausal women.
• Alcohol consumption.

How do I know if I have sleep apnoea?

In short, most people will come to us because their partner has forced them to see someone due to their concern about the irregular breathing patterns and pauses in breath. This is usually a fairly good indicator that something is going on during your sleep, as your partner will have heard this over several nights and can provide a fairly good description of the breathing patterns.

If you don't have a bed partner, other signs that you may be suffering from sleep apnoea include:

• Extreme sleepiness during the day.
• Morning headaches.
• Waking up with a dry mouth.
• Lower pain threshold.
• Mood changes and irritability.
• Waking up frequently to urinate.

It should be noted with the above, these factors are not really good tools to 'diagnostically' prove sleep apnoea. This is because, as you may have gathered when reading through them, they can be experienced due to a wide range of other problems and conditions. We mention them, however, because these symptoms usually show up in those suffering from sleep apnoea.

More scientifically, the only real way to know if you have sleep apnoea is to have a sleep test. This is where you will go in to a sleep centre and get hooked up to various monitoring machines to record your entire nights sleep. Doctors can then analyze this data and provide a diagnosis.

What treatments are available for snoring and/or sleep apnoea?

Given that the two are, whilst having some correlation, actually different issues, the treatments can vary slightly. It is important to first determine if the snoring is simply that, just snoring, or if sleep apnoea is also present.

If the issue to be treated is merely snoring, the first step can be to simply try to change your sleeping position, elevating your head or changing the location or the pillows. Other simple treatments can include simply wearing a nasal strip to better hold open the airways.

The next progression for snoring treatment and possibly treatment of sleep apnoea depending on its severity, can by 'Oral Appliance Therapy' (OAT), or using a dental appliance similar to a mouthguard to prevent the airways from collapsing during sleep. This is usually achieved by holding the jaw forward, thus opening the airway. Generally speaking, this is usually the least invasive of the treatment options.

If sleep apnoea is present, the next step may be to provide the patient with a 'Continuous Positive Airway Pressure' (CPAP) device. In effect, this is a small air flow machine that continuously pressurises the air inside the throat, thus preventing it from collapsing.

The third main treatment available is that of surgery. This is naturally the most invasive, however, may be the only option available to some people. Whilst the surgery will be very specific to the individual, targeting the actual cause of the obstruction, 'Maxillomandibular Advancement Surgery', or jaw surgery, is often considered the most effective for sleep apnoea suffers, particularly for those where the above OAT and CPAP have failed.

Finally, you may also consider looking at the list above of risk factors and simply trying to remove some of them. For example, if you are overweight, try shed some kilos or if you smoke, consider quitting, not just for a better nights sleep, however, for improved oral and overall health as well. By reducing these risk factors, mild forms of snoring or sleep apnoea may resolve themselves.