Sleep Apnea

If you wake up as tired as when you went to bed, you may suffer from sleep apnea. Characterized by short lapses in breathing, sleep apnea affects an estimated 12 million Americans. Although sleep apnea can seem like just a mild annoyance, this condition has been linked with other health concerns such as high blood pressure, heart disease, memory problems, and daytime drowsiness.

Defining Sleep Apnea
Sleep apnea is a sleep disorder in which the patient experiences shallow breathing or pauses in breathing during sleep. These pauses can occur several times during sleep, leading to health complications and lifestyle hindrances.

Because sleep apnea can impact other areas of your life, it's important to take any symptoms seriously. If you suspect sleep apnea, talk to Dr. Davoud or your physician about having a complete exam. At Dr. Davoud's office every patient is screened for sleep apnea and if there is indication of sleep apnea we recommend a sleep study to help confirm sleep apnea. We work with board certified sleep physicians to make sure that a proper diagnosis is made. 

Common symptoms of sleep apnea can include:

• Snoring                                           
• Frequent pauses in breathing and sudden awakening to restart breathing
• Choking during sleep
• Waking up in a sweat
• Abnormal sleep patterns
• waking up multiple times during night to urinate
• Daytime sleepiness
• Fatigue
• Difficulty with concentration
• Irritability or mood swings
• Depression
• Morning headaches
• Dry mouth or sore throat in the morning
• Erectile dysfunction
• GERD or Acid Reflux
• Falling asleep at inappropriate times i.e. while driving
• High blood pressure
• Congestive heart failure
• Irregular heart beat 
• Increased risk of heart attack
• Increased risk of stokes
• Increases risk of motor vehicle accidents

The four types of sleep apnea are:

• Obstructive sleep apnea - The most common form of this disorder, obstructive sleep apnea (OSA) occurs when a patient's throat closes as the individual inhales during sleep and the patient can not suck air into their lungs. Since muscles relax during sleep, the soft tissue of the pharynx relaxes and expands, obstructing air flow in the upper respiratory tract. This obstruction reduces the amount of oxygen in the blood and forces the patient to wake up and take a deep breath. Anyone from new borns to elderly, men or women, obese or thin and pregnant women can be affected by OSA. Chronic OSA requires medical attention ASAP.

• Central sleep apnea - Central sleep apnea, or Cheyne-Stokes respiration, is a relatively rare form of sleep apnea that occurs when the region of the brain responsible for controlling the breathing muscles temporarily fails. Central sleep apnea differs from OSA in that the patient's pauses in breathing are due to a lack of effort to breathe.

• Mixed apnea - Mixed apnea is a combination of OSA and central sleep apnea. Chronic OSA can sometimes cause central sleep apnea. Although the exact cause is still unknown, weight-related, cardiovascular, and respiratory conditions can contribute to mixed sleep apnea.

• Complex sleep apnea - Complex sleep apnea is a form of mixed sleep apnea. With this unusual condition, a patient still experiences sleep apnea even when the physical obstruction to breathing is removed.

Factors that Influence Sleep Apnea
Obstructive sleep apnea is caused when soft tissue in the airway relaxes. Usually, OSA occurs because of changes in the neuromuscular tone, increase in the soft tissue due to obesity, and structure issues with the skull and face. Obese people are at a great risk for OSA because they carry more muscle and tissue mass. Over 50 percent of those who have Down's syndrome suffer from OSA, brought on by poor neuromuscular tone, narrow nasopharynx, and a large tongue. Nasal congestion and alcohol consumption can also contribute to OSA. OSA can also occur as a part of the natural aging process when the brain's capacity to transmit instructions telling the throat muscles to maintain rigidity decrease.

Enlarged tonsils and adenoids are the most common causes of obstructive sleep apnea in children. At Dr. Davoud's office, we screen the children for proper breathing and cranio-mandibular development. We work closely with ENT specialists to make sure that the airway is patent for proper breathing and development of the facial and cranium bony and musculature structures. Furthermore, there are strong scientific evidence that ADD or ADHD in some of the children is closely related to improper breathing especially during sleep due to tonsils and adenoids. Such children may suffer form bed wetting as well.

Central sleep apnea often accompanies a medical condition and is rarely found in healthy individuals. Since the brainstem controls breathing, any medical condition involving that part of the brain can cause central sleep apnea. Cardiovascular conditions, neurodegenerative conditions such as Parkinson's disease, advanced arthritis, and encephalitis are some medical conditions that can trigger central sleep apnea.

 

The Importance of Treatment
Complications from sleep apnea can include inattentiveness at work, tiredness, risk of accidents, mood swings, high blood pressure and erectile dysfunction. Sleep apnea can also increase the risk of congestive heart failure and stroke. It can lead to difficulty in the treatment processes for conditions such as arterial fibrillation. Children affected by sleep apnea can be hyperactive, high strung, aggressive, and prone to bed wetting. They may have also unusual sleeping positions. Overall, a person suffering from sleep apnea experiences deterioration in the quality of life.

Diagnosing Sleep Apnea
To look for sleep apnea, Dr. Davoud or your physician can recommend diagnostic testing, particularly if the patient is suffering from conditions such as high blood pressure, heart failure, and epilepsy. Physical examination for adults includes measuring for a wide neck, looking for enlarged tonsils, and assessing upper body obesity. In evaluating children, doctors check for enlarged adenoids and determine if the child has attention deficit issues.

Doctors use the patient's medical and sleep history in diagnosing sleep apnea. Symptoms such as drowsiness, headaches, heartburn, and patient medications can influence the diagnosis. A sleep study, where the patient is monitored in a sleep lab, can also help determine an individual has sleep apnea. When testing rules out sleep apnea, then the patient must be evaluated for other potential sleep disorders.

Treating Sleep Apnea
After a diagnosis of sleep apnea, your doctor will review treatment surgical and non-surgical options. Non-surgical treatments include medications, behavioral changes, dental appliances, and use of a Continuous Positive Airway Pressure (CPAP).

• Medication - Nasal steroid sprays may effectively control sleep apnea caused by nasal airway obstruction. Hypothyroidism treatment helps manage sleep apnea caused by the thyroid condition.
• Behavioral changes - In many cases, lifestyle and behavior changes are often the only treatment required to treat sleep apnea, particularly the milder cases. Exercising to reduce weight and avoiding sleep positions that lead to increased snoring have been shown as effective treatments.
• Dental appliances - Mild to moderate sleep apnea can be controlled by using dental appliances that hold the jaw froward and keep the airway open. Any dental appliance should be custom fit by a dentist so that it works properly. At Dr. Davoud's office we have treated many patients successfully with such appliances. The Oral appliances used are easy to wear and carry with you any where you travel. The appliance is also maintenance free. 
• Continuous positive airway pressure (CPAP) machines use air pressure to ensure that the soft palate does not sag during sleep. The pressurized air is delivered to the patient through a face mask. As the person breathes, gentle air pressure keeps the air passage open and prevents sleep apnea.

Sleep Apnea

Snore Treatment
Teeth Grinding (Bruxism)
Mouth Guard