Sleep Apnea

What is OSA?

plug ears snoringObstructive Sleep Apnea (OSA) is a breathing disorder, which occurs during sleep, due to the narrowing or total closure of the airway.

OSA is when the airway becomes completely blocked and breathing stops. Snoring can be a symptom of OSA and is a noise created by the partial blocking of the airway. When you fall asleep your muscles relax, including those that control the tongue and throat. The soft tissue at the back of your throat can sag, narrowing the airway. Incoming air then makes the tissue at the rear roof of the mouth (the soft palate), the flap of skin hanging from the palate (uvula) and the throat vibrate – a sound we know as snoring.

Stop losing sleep over sleep apnea!

Snoring is often no greater problem than the noise itself. However, loud snoring may be a sign of a more serious problem – OSA. Download an informational brochure.

Obstructive Sleep Apnea (OSA) is a serious chronic breathing disorder caused by a narrowing or total closure of the airway. When the brain detects a lack of oxygen (actually an increased level of Co2 in the blood) it prompts a momentary arousal to draw breath by causing the diaphragm to contract.

While you are sleeping and without your knowledge, the body spends the entire night struggling for air and you never really get that important restful sleep you need. As a result, people with Sleep Apnea wake up tired, often with a headache, are drowsy all day and experience memory loss and have higher accident rates.

When you have OSA and your airway is blocked, your breathing can be interrupted for periods of time lasting from 10 seconds to over a minute at a time (in severe cases). Although OSA sufferers may experience hundreds of apnea episodes per night, they are unlikely to remember any of them. In fact, if the sufferer lives alone or sleeps separately they may not be aware of their condition, even after many years.

When you suffer from OSA you are literally starving your brain and body of vital oxygen! When your tissues are not being oxygenated normally as is the case in Sleep Apnea, your tissues become Hypoxic which forces them to undergo critical changes in cellular metabolism which produces enzymes and chemicals such as Isocitrate lyase which inhibit normal connective tissue metabolism (and enzymes such as Lysol Oxidase) which in turn negatively affects normal development function of muscle, bone and vascular tissues including normal airway development!

Snoring and nighttime gasps for air are indications that Sleep Apnea may be taking place. Snoring is no longer something to joke about. Besides keeping others awake, your Snoring may be causing serious medical problems if it is caused by Sleep Apnea.

The result of Sleep Apnea is a severe stress being placed on your body, especially on your cardiovascular system and metabolism. As a result, Sleep Apnea is frequently associated with the following medical conditions:

  • heart disease or irregular heart beat
  • high blood pressure
  • weight gain
  • diabetes
  • lowered libido
  • depression
  • erectile dysfunction
  • stoke and even death

Diagnosis

The first step is to take a few minutes and perform the following simple screening questionnaire to help determine if Sleep Apnea may be causing your sleepiness. It the screening indicates you may have a problem Dr. Willoughby can arrange for an overnight sleep study in the comfort of your own home using a Watch-PAT 2000 device which monitors your breathing and heart rate while you sleep. Dr. Willoughby and his team will take the information gathered by this device and send it to your Family Doctor who with the help of a Pulmonologist can definitively diagnose the presence of Sleep Apnea.

Treatment

Once you have a diagnosis of Sleep Apnea, there are two basic types of treatment you can employ to combat your snoring and OSA;

Controlled Positive Pressure Airway

Use of a Controlled Positive Pressure Airway Appliance (CPAP) which is designed to fit over and around your nose and “force” air through your nasopharynx to support and hold your airway open -increasing upper airway volume and reducing collapsibility. The challenge with CPAP is that patient compliance is less than 40% and the devices can shift while sleeping and are quite cumbersome and noisy.

Oral Appliance

Oral Appliance therapy using a SomnoDent® which is an ideal alternative to CPAP therapy for patients who suffer from snoring and mild to moderate OSA. The updated practice parameters of the American Academy of Sleep Medicine recommend the use of oral devices such as the SomnoDent® MAS for mild-to-moderate OSA (AHI < 25), or for patients with severe OSA who are either unable to tolerate CPAP or refuse treatment with CPAP.

SomnoDent®

SomnoDent® is a custom made removable oral appliance worn during sleep to increase the upper airway volume and reduce collapsibility.  There are 3 different SomnoDent devices all of which  utilize  a unique patented fin coupling component, to maximize patient comfort and compliance.

somnodent 3 types

Health Benefits

SomnoDent® treatment has also been shown to have a clinically significant impact in reducing patients’ blood pressure and has been predicted to reduce the risk of stroke. In addition, this blood pressure reduction was apparent in the early morning, which is the time of peak risk for acute myocardial infarction.

Clinically Proven

14 independent studies and over 12 years’ worth of research demonstrate SomnoDent efficacy and significant clinical benefits. Exceptional levels of compliance 88%, treatment efficacy 91% and acceptance 96% of patients with OSA have been cited.

Is the SomnoDent the right treatment option for me?

If you suffer from obstructive sleep apnea (OSA) or snore, the SomnoDent® should benefit you. It will almost certainly put an end to your snoring and will most likely eliminate or significantly reduce your OSA. For your bed partner this means peace and quiet again and a better night’s sleep. For you, it will mean better quality sleep. As a result, you will be less likely to suffer from headaches and daytime sleepiness and your ability to concentrate will improve.  If you have tried  CPAP and found it uncomfortable, wake up to a brilliant alternative treatment for OSA. The difference in comfort and tolerance will astound you.

Severity of OSA.

The American Academy of Sleep Medicine  recommends the use of oral devices such as the SomnoDent for mild-to-moderate OSA (AHI < 25), or for patients with severe OSA who are either unable to tolerate CPAP or refuse treatment with CPAP.

A viable alternative to CPAP Therapy

cpap machineMany sleep apnea sufferers find it difficult to use a CPAP machine. Oral Appliances like Somnodent are a safe and predictable alternative.

With CPAP or Continuous Positive Airway Pressure the sleep apnea sufferer has to wear a mask at night over the nose, or sometimes nose and mouth. A steady stream of air is pumped by the CPAP machine into the airway, keeping it open and allowing a good night’s rest.

However, a good quantity of sleep apnea sufferers are either intolerant to the CPAP or find it difficult to keep using. Studies report a high non-adherence to CPAP therapy – some as high as 83%. Typical issues include difficult of wearing the tight mask, too much perspiration or just dealing with constant air being blown in through the nose.

SomnoDent Oral Appliance Therapy consists of wearing a Night guard-like device that is comfortable and easy to wear. Unlike other Mandibular Advance appliances the Somnodent device is fabricated in two separate pieces which fit together via a patented fin coupling mechanism which allows for normal mouth opening during sleep. Most other devices are joined together via a set of springs or hinges and therefore interfere with or encroach on the patients tongue space. The sole purpose of a Mandibular Advancement device is to advance the mandible and the tongue and increase the patency of the airway but this cannot be done if the tongue space is being encroached upon by a hinge or spring. The Somnodent appliance is also designed to be Lingual-less so that there is no acrylic that extends beyond the teeth onto the lingual surface occupied by the tongue.

Depending on the study, compliance rates for the Somnodent are between 77% and 95% with a very high effectiveness for mild to moderate sleep apnea and moderate effectiveness for severe sleep apnea.

Why is OSA treatment with a SomnoDent Appliance so effective?

For the treatment of OSA, Dr. Willoughby utilizes a TENS machine to find the precise forward position of the mandible where the muscles of the jaw are in a relaxed and de-torqued position and the airway is most “Patent”. Rather than a subjective assessment of this bite position, Dr. Willoughby uses this real time computer driven data to identify precisely where he will take the impression for the Somnodent Mandibular Advance Appliance. The scientific literature is unequivocal – there are at least 44 internationally published peer reviewed journal articles which conclude that the use of ultra low frequency TENS and sEMG data is preferred method of determining a isotonic trajectory for the mandible.

Dr. Willoughby will sometimes take a CT 3Dimensional volumetric scan of the airway BEFORE and AFTER the placement of your Somnodent to ensure that the advancement of the mandible with this repositioning appliance has removed the blockage and increased the Patency of the Oropoharynx.

The following are images of a patient who has been treated with a Somnodent appliance. You will note the difference in the airway blockage Before and After.

somnodent ct scan

Once the Somnodent appliance has been titrated (adjusted) and the snoring habit has been eliminated our office will fit the patient with a portable PSG monitor which you will use to take home and sleep with your Somnodent appliance in place. This PSG monitor will help to demonstrate the efficiency and effectiveness of the Oral Appliance Therapy (“OAT”).

Read a copy of Dr. Willoughby Ask the Dentist article on how to treat OSA and Sleep Apnea with a Somnodent Appliance.

When you wear a SomnoDent oral appliance that has been adjusted by Dr. Willoughby, to an Isotonic Neuromuscular trajectory the patient typically wakes up with less muscle stiffness and has a better overall tongue position – all of which helps make for a more comfortable and more effective oral appliance.

Who has OSA?

Although sleep apnea can affect anyone at any age, it is usually between the ages of 45-65. Due to a lack of public awareness, the vast majority of sufferers remain undiagnosed and therefore untreated despite the fact that the disorder can have serious medical consequences.

For the treatment of OSA, the SomnoDent® Mandibular Advancement Appliance is worn during sleep to maintain the patency of the upper airway by increasing its dimensions and reducing collapsibility. It is a custom made oral device that is comprised of upper and lower dental plates with a unique patented fin coupling component to maintain mandible protrusion. The fin coupling mechanism is a key differentiator from other oral devices as it enables the patient to maintain normal mouth opening and closing while wearing the SomnoDent® MAS. Implementing a number of key design features which represent quantum improvements on existing MAS devices, the SomnoDent® MAS is both more comfortable and effective. Furthermore, the SomnoDent® MAS is now recognized by an expanding group of dental sleep professionals throughout the US and Canada as the MAS Gold Standard.

When a patient wears a Somnodent Oral Appliance the effect is much like protruding your lower jaw –because the tongue is attached via several muscle groups to the lower jaw as the jaw moves forward so does the tongue. This forward tongue posture allows for increased patency of the airway – a bigger breathing hole. As we tell our patients “Airway is King and Tongue is Queen”.

If you are seeking an alternative to CPAP treatment, call our office today at 604-541-1800.

Patient Testimonials

“ I have been a chronic snorer for many years now but my Doctor told me I had not yet developed OSA.  I was told that the CPAP breathing device might be able to help reduce my snoring but I was not willing to strap that device onto my face. My wife insisted that I make an appointment to see you after she heard one of your radio ads.  At my consult appointment you told me about an oral appliance called “Somnodent” to help with my snoring.  I have been wearing it every night for the past 2 months now and I absolutely love it!  I have stopped snoring completely, my airway is completely un-obstructed and most importantly, my wife is happy because I’m not disturbing her sleep! Thanks for the great advice Dr. W!  You really need to let more people know about this incredible device – wives everywhere will thank you!”

Milo V.

 

“I have been a chronic snorer for as long as I can remember but, last year I was diagnosed with a mild case of OSA – I have been wearing a CPAP ever since but I wasn’t tolerating it well since the chin strap was un-comfortable and left marks and the mask leaked constantly as I rolled over in bed.  My wife suggested I give book a consult with your office to discuss an alternative to CPAP.  This is when I learned about the “Somnodent” oral appliance to help with both my OSA and my snoring.  After some impressions and a bunch of computer scans you custom fabricated  a Somnodent appliance for me.  Ever since I first started wearing it to bed, I have found it to be very comfortable. I have no problems wearing it every night.  It took several weeks of simple adjustments but I  have now stopped snoring completely.  Your CT scan shows that my airway volume is now more than twice what it used to be and  I feel as if I am getting a better nights sleep with my Somnodent appliance in. Thank you for your help.”

Barry W.