HOW TO STOP SNORING/ SLEEP APNEA

 

WHAT IS SLEEP APNEA?

 

Obstructive sleep apnea (OSA) is a common sleep disorder where the sleeper momentarily stops breathing due to complete or partial upper airway obstruction or a narrow upper airway. Excess tissues in the throat can collapse, obstructing the airway.  This upper airway obstruction causes breathing to stop (apnea) causing snorting or choking sounds as you try to breathe. When oxygen levels drop, heart rate and blood pressure increases (hypertension).

 

 

In some people, nocturnal tooth grinding (sleep bruxism) can occur together with sleep apnea. In mild apnea, sleep bruxism may be the earliest sign of airway restriction.

 

 

1 in 3 Singaporeans snore/have Obstructive Sleep Apnea, and 30% of these patients have moderate to severe OSA.” 

 

 

 

WHAT IS SNORING?

 

 

Snoring is the sound caused by the vibration of the tissues in the nose, mouth and throat.

 

 

HOW DO I KNOW IF I HAVE OSA?

 

Do you have/have been told that you have any of the following

 

During the day:

  • Excessive sleepiness or tiredness
  • Poor concentration
  • Poor memory
  • Morning headaches
  • Dry mouth/throat upon awakening
  • Mood changes
  • Irritability

 

During the night:

  • Choking sensation at night
  • Gasping for air at night
  • Frequent awakening
  • Frequent urination
  • Loud snoring
  • Teeth Grinding

 

Check out our sleep questionnaire to find out if you are at risk of having sleep apnea!

 

 

IS SNORING / OBSTRUCTIVE SLEEP APNEA DANGEROUS?

 

The wee hours of the morning are the most dangerous for people with obstructive sleep apnea. Between midnight and 6am, patients with sleep apnea are 6 times more likely to die from a stroke or a heart attack triggered by chronic high blood pressure and low blood oxygen can trigger.

 

Patients with sleep apnea have shorter life expectancy compared to people without sleep apnea. 

 

 

HOW IS SLEEP APNEA TREATED?

 

Patients with sleep apnea may have a “global” problem, i.e. obesity, or a “local” anatomical problem (those with huge tonsils, long thick palate, big tongue and/or a small jaw).

 

General tips to improve OSA:

  • weight loss
  • exercise
  • regular close follow up

 

BMI, neck circumference, oral cavity adequacy, tonsil size, palate size / length, tongue size, upper airway assessment, and the nasal passage size are assessed to guide treatment.

Treatment of snoring and sleep apnea may be non-surgical and/or surgical.

 

 

NON-SURGICAL MANAGEMENT

 

ORAL APPLIANCES FOR SLEEP APNEA /BRUXISM

 

Oral appliances are designed to widen the airway.  Oral appliances useful if you cannot have surgery, or are unable to tolerate CPAP.

 

Mandibular Advancement Devices (MAD) clip on to the upper and lower teeth and reposition the lower jaw forwards.

 

More patients are able to tolerate regular continued use of MADs compared to CPAP (see below).

 

 

 

Close monitoring of a sleep appliance is mandatory.

 

CPAP 

 

The CPAP system uses compressed air forced through a mask worn by the patient on the nose or the face.  The mask must be throughout the entire night and for every night for life, which is difficult to do.

 

CPAP is effective only if the mask is worn, and only 34% of patients do so.

 

Common reasons for poor compliance with CPAP include:

  • nasal problems
  • mask problems
  • equipment problems

 

 

Heart attack and stroke risk are similar for CPAP-treated OSA and untreated OSA.”

 

 

 

HOW IS SLEEP APNEA DIAGNOSED?

 

 

 

Sleep Questionnaire

 

Check out our sleep questionnaire to find out if you are at risk of having sleep apnea!

 

 

Sleep Assessment Tests

 

 

HOME SLEEP TESTS

 

Watch PAT

 

 

 

 

The Watch PAT is a USFDA and Singapore HSA-approved home sleep apnea test system.

 

Watch PAT results have been shown to mirror hospital sleep testing very closely.

 

 

NightOwl

 

 

The NightOwl is currently the world’s smallest home sleep apnea test.

 

The NightOwl system consists of a small sophisticated sensor which is placed on the fingertip and the cloud-based NightOwl software. The NightOwl sensor is able to measure all parameters recommended by The American Association for Sleep Medicine (AASM) Manual for the Scoring of Sleep and Associated Events for home sleep apnea testing.

 

The test results will be interpreted and this will be used to see if you require more extensive sleep testing (polysomnography).

 

 

HOSPITAL SLEEP TEST

 

Polysomnography measures multiple parameters such as brain wave activity, muscle activity, eye movement during sleep etc.

 

Although the in hospital overnight sleep test is the most comprehensive, there are some drawbacks:

  • high cost,
  • long waiting lists,
  • intensive labor requirements (requiring a sleep technician overnight),
  • difficulties for elderly or very ill patients to travel to the hospital and spend the night in the sleep laboratory,
  • many patients often find the equipment too cumbersome and
  • the first night effect (due to new environment, patients might not be able to sleep at all)

 

Due to these short-comings, it is better that patients have their sleep monitored at home to start.

 

 

SNORING/SLEEP APNEA MANAGEMENT AT ELITE DENTAL

 

Step 1: Assessment

Breathing patterns and tooth wear rate is assessed as part of the new patient examination and active maintenance.  Your nose, sinus abnormalities and lower jaw disproportion can be assessed on dental x-rays.

 

Further testing will then be done to assess the severity of your condition. A home sleep test (Watch PAT/ NightOwl) may be prescribed.

 

Step 2: Making and fitting of your oral appliance

If you have been advised that you only require a customized oral appliance, molds of your teeth and bite records will be made.

 

Once made, the appliance will then be fitted and adjusted, to ensure maximum comfort. Expect a period of adjustment when you first start using the appliance. It is common to experience difficulties falling asleep, increased salivation and mouth dryness. Several adjustment visits may be needed to fine tune the appliance.

 

Sleep testing may be repeated to monitor treatment effectiveness.

 YOUR SLEEP QUESTIONNAIRE

STOP BANG




Snoring - Has anyone ever mentioned you snore loudly?

Tired - Do you often feel tired, fatigued or sleepy during the daytime?
Observation - Has anyone ever observed you stop breathing during your sleep?
Blood Pressure - Have you got high blood pressure?
BMI - Are you overweight?
Age - Are you over 50 years old?
Neck - Is your neck circumference greater than 40cm?
Gender - Are you male?


GENERAL QUESTIONS


Do you feel refreshed when you wake after 7 hours sleep?

Has anyone in your family ever been diagnosed with Obstructive Sleep Apnea?
Have you been diagnosed or are you being treated for depression?
Have you been diagnosed with type 2 diabetes?
Do you wake often during the night to go to the bathroom?
Do you suffer with headaches upon waking?


EPWORTH SLEEPINESS SCORE


For each situation listed below, circle a number from 0 to 3 that best reflects how likely you are to fall asleep. Be as realistic as you can.


0 – No chance of falling asleep 1 – Slight chance of falling asleep     2 –Good Chance of falling asleep 3 – High chance of falling asleep



Sitting and reading
Watching TV
As a passenger in a car for an hour
Lying down in the afternoon
Sitting and talking to someone
Sitting quietly after lunch without alcohol
In a car stopped while in traffic

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