Sleep Disordered Breathing

By Dr. Owen B. Pickus
Article Provided by Maine Centers for Healthcare courtesy of Health Technology, Ltd.

The importance of sleep to physical health has been a fundamental tenet of common medical knowledge for centuries. Sleep allows our bodies to relax, rejuvenate, and dream, permitting the mind to work on a subconscious level, solving problems and preparing for the coming day. While we sleep our bodies burn calories, create vital nutrients and hormones, and perform complex chemical processes that keep our bodies internally balanced, or in homeostasis.

However, as a result of what has become the norm in American society---a much busier life--- the healthy sleep of many adults and children is often compromised. This lack of healthy sleep in large percentages of the population is causing widespread concern within medical and dental communities all over the United States.

Physical and mental manifestations of lack of sleep, such as weight gain, hormonal imbalances, headaches, inability to concentrate, and even depression, are becoming more and more commonplace.

Some sleep deprivation can be psychological (mental stress at work, in relationships, or in family life). However, there is a serious physiological cause of lack of sleep that exists as well: airway obstruction. Airway obstruction generally affects the elderly, adult males, post-menopausal women, pregnant women, and even children. Airway obstruction at night results in what health practitioners call Sleep Disordered Breathing. Everyone is at risk. More severe airway conditions include Upper Airway Resistance Syndrome (UARS) and Obstructive Sleep Apnea (OSA). In many cases OSA can be fatal.

Sleep Disordered Breathing, the obstruction of the airway when the body relaxes to fall asleep at night, is a frightening and widespread condition. It affects millions of men, women and children---and oftentimes, because the breathing difficulty occurs at night, many of those suffering from Sleep Disordered Breathing don't even realize it. Sleep Disordered Breathing is a serious health problem, and its first appearance is usually indicated by snoring. Although snoring is generally viewed in the United States as a minor annoyance, something to be ignored or blocked out, it can be the first sign of a serious problem.

The primary objective in treating Sleep Disordered Breathing is to open the airway to allow a sufficient amount of oxygen into the lungs and bloodstream. Due to recent discoveries, opinions of treatment options are shifting drastically.

Continuous Positive Airway Pressure (CPAP) was thought for many years to be the "gold standard" of treatment for Sleep Disordered Breathing. The CPAP is comprised of a mask that fits over the mouth and/or nose and connects to a tube leading to an air compressor that sits next to the wearer's bed. The compressor forces air into the tube and then into the mask-shooting air into the nose and/or mouth, forcing the airway to open with the sheer pressure of the air coming from the compressor. Another air pressure treatment, nasal continuous airway pressure (NPAP) is accomplished through nasal canulas-little tubes that sit inside the nostrils and are hooked to the same type of air compressor that sits at the bedside.

Surgery, such as tongue reduction, surgical removal of the soft tissue at the back of the throat, removal of the uvula, modification of the palate, etc., is another treatment option. Some procedures are done at hospitals, some performed by oral surgeons, and others are in-office procedures. The American Academy of Sleep Medicine does not consider surgery an effective manner of treatment for Sleep Disordered Breathing, and surgical procedures are considered only 30 to 50% effective.

Oral Appliance Therapy, however, has come to the forefront as a very viable treatment option for Sleep Disordered Breathing. The purpose of the oral appliance is to hold the jaw in a position that allows the airway to remain as patent as possible during sleep. Oral appliances are similar to athletic mouth guards, but are less bulky. They are completely non-invasive. Some patients report and increase in saliva production or minor discomfort upon awakening, but that generally subsides.

If you manifest any of the above symptoms, wake up tired, or snore/gasp for breath while sleeping, you could be one of millions of Americans suffering from airway obstruction. You are certainly losing sleep. If the problem goes untreated, you will lose your health, and you could even lose your life. Contact your family physician for further information and testing.

Dr. Owen Pickus practices Internal Medicine at Maine Centers for Healthcare. MCHC is a large, multi-specialty practice located in Westbrook, Maine.




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