Sleep disorders

Sleep is primordial, as it helps the body to heal, to gain in physical performance and help the brain, known as the hard drive, to reset.

Sleep disorders affect the recovery of the body, and lead to problems that can be very serious.

Minor snoring is not dangerous on the short term, but it alters the quality of the oropharyngeal tissue increasing highly the risk of developing the more dangerous sleep apnea.

SNORING AND SLEEP APNEA

Breathing-related sleep disorders are extremely frequent:

  • 1 out of 4 adults snore regularly
  • 2 to 4% of the adult population suffers from sleep apnea. (1)

(1) Young, Peppard et coll. Epidemiology of sleep Apnea. American Journal of respiratory and Critical Care 2002

The 2 disorders have the same root cause: partial or total obstruction of the upper airway around the pharynx.

Snoring comes from the vibration of the soft tissue (avula, soft palate) caused by the acceleration of air movement. This acceleration happens during a partial obstruction or post total obstruction of the upper airway.

SLEEP APNEA

Sleep apnea corresponds to a complete interruption of the respiratory flow for more than 10sec.

The term hypopnea refers to a 50% loss of respiratory flow for 10sec. the number of apneas and hypopneas during sleep, measured in hours, gives the apnea hypopnea index (AHI index). If, this index is higher than 10 then the term Sleep Obstructive Apnea Syndrome (SOAS) is used. SOAS is a more severe form of snoring which will have evolved, predominantly with age and weight gain.

The mechanism of SOAS:

During deep sleep, the muscles will relax, especially in the manducatory system, which leads to a pharyngeal collapse which in turn will collapse the upper airway of the patient.

WHAT ARE THE ASSOSIATED RISKS?

Very often snoring is overlooked but could hide a serious sleep disorder such as sleep apnea.

Sleep apnea is recognized nowadays as a contributing factor to cardio-vascular disease, strokes and metabolic disorders such as diabetes.

Were you aware?

Scientists believe that a patient with untreated sleep apnea has:

  • 2.8 time more risk of death due to cardio-vascular issues
  • 2.4 time more risk of suffering a stroke
  • 2.9 times more risk of hypertension

A Swiss study (2) has shown that an untreated sleep apnea patient has up to 15 times more risk of having a road traffic accident.

(2) Horstman S et coll. Sleep. 2000 May 1; 23(3):383-9

Frequency of Sleep Apnea Sndrome (SAS)  is estimated to be 10% of the male population with less prevalence in the female population. Nevertheless we find similar numbers in post-menopausal women.  Many patients are unaware of their condition and attempt to treat the results of SAS (fatigue, drowsiness, depression) instead of the cause: sleep apnea.

HOW TO KNOW IF I AM AT RISK?

The most common symptoms of SAS are:

  • Constant snoring
  • A feeling of tiredness even after a good night sleep

  • Hyper-drowsiness during the day (risk of RTA, or accident at work)

  • Obesity and/or increase of size of the neck
  • Morning headaches

  • The need to urinate 2-3 times a night
  • Symptoms of depression or cognitive issues

In case of treatment by benzodiazepine for the depressive symptoms, which actually is not depression, will in turn make the sleep apnea worse!

In order to differentiate sleep apnea from a common snoring, a detailed analysis will be performed by a sleep specialist aka. a somnologist. It is possible today to have measured the presence of sleep apnea in sleep clinics or with simple portable machines at home that will quantify the severity of the disorder and the associated risks.

A SIMPLE SLEF-EVALUATION TEST

Epworths sleepiness scale (ESS)

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
SituationChance of dozing
Sitting and reading  
Watching TV  
Sitting, inactive in a public place (e.g. a theatre or a meeting)  
As a passenger in a car for an hour without a break  
Lying down to rest in the afternoon when circumstances permit  
Sitting and talking to someone  
Sitting quietly after a lunch without alcohol  
In a car, while stopped for a few minutes in the traffic  
Total  

A score > 12 indicates pathological drowsiness.

TREATMENT

You just need to surf the internet to realize the numerous tools invented to cure snoring and sleep apnea, ranging from the relatively cheap gadget to special home-made apparatus. The problem with self-medication, is that it bi-passes the diagnosis of the presence of sleep apnea or not.

Depending on the cause of the snoring and the severity of the associated disorder, different treatments can be put in place.

  • A continuous positive airway pressure  (CPAP) mask
  • A surgical solution
  • Mandibular advancement splint

Nowadays, for sleep apnea the basic treatment involves continuous positive airway pressure (CPAP).

Unfortunately this treatment is not suitable for some patients. 30% of patients stop wearing the mask during the night.

Mandibular advancement splints are simple and relatively comfortable and very effective in most cases. A mandibular advancement splint is an apparatus that maintains the bottom jaw forward during sleep. The mandibular advancement frees up the air passages around the pharynx and decreases the phenomenon of obstruction.

Many clinical trials have demonstrated the effectiveness of these made-to-measure splints for the treatment of snoring and mild to moderate sleep apnea (3). The effectiveness causes:

  • A reduction in drowsiness
  • Less tiredness at wake-up
  • Better quality sleep

Effectiveness is immediate form the first night of wearing the splint.

Medical consensus (4) also recognises the use of the splint for severe cases of sleep apnea where the CPAP in not possible nor tolerated by the patient.

(4) Cistulli et coll Sleep Medicine Review 2004 8, 443-457
(5) 
Schmidt-Nowara et coll Sleep 1995 Jul ; 18(6) :501-10

The splint named mandibular repositioning device (MRD) is a new generation splint. Made to measure; uses soft comfortable materials, enabling patients to have an effective and easy treatment.

To be effective, Mandibular advancement splint need to respond to strict criteria such as retention to ensure a good advancement to prevent a pharyngeal collapse.

We will be able to choose with you the best splint for you depending on your habits such as bruxism.

Extremely precise imprints will allow the confection of the splint in specialized labs. The degree of advancement will be done by the dental surgeon, specialized in sleep apnea, in collaboration with the somnologist.

For the patients with sleep apnea a second analysis of their sleep will be performed once the splint is in place in order to evaluate the effectiveness of the treatment.