Your condition is as important to us as it is to you.

Craniofacial Conditions: Sleep Apnea & Airway Obstructions

Sleep apnea is a disorder involving pauses in breathing while asleep that affects nearly 1 in 15 Americans. The Greek word, apnea, means without breath.

Those with untreated sleep apnea stop breathing repeatedly throughout sleep, which may lead to adverse health consequences including: high blood pressure (in approximately 50% of patients), cardiovascular disease, memory problems, weight gain, and headaches.

When a person stops breathing while sleeping, their blood oxygen level goes down, alerting the brain to stimulate breathing with a brief awakening. Sometimes the person may then snort, choke or gasp (as often as 30 times per hour) to correct the problem. The person is often unaware of these awakenings and assumes they have slept through the night. Estimates are that more than 85% of cases are undiagnosed, and therefore, untreated.

There are three distinct forms of sleep apnea:

1. obstructive – breathing is interrupted by a physical block to airflow due to structural issues in the mouth and/or throat. More than 80% of sleep apnea cases are obstructive. During sleep, the muscles at the back of the throat relax, which may cause the airway to collapse temporarily, such that the soft surrounding muscles block the opening. The relaxed muscles may not support enlarged or bulky throat muscles as they should, allowing the structure(s) to fall back into the breathing passageway. These structures may include the soft portion of the roof of the mouth (palate), the triangular flap hanging from the soft palate (uvula), the tonsils, and/or the tongue.

2. central – breathing is interrupted by a lack of respiratory effort due to neurological issues. During sleep, the brain doesn’t send the right, automatic signals to maintain activity of the breathing muscles. In turn, they relax, allowing breathing to stop briefly. This condition is frequently related to heart disease.

3. complex/mixed – breathing is interrupted by a combination of the two forms above (obstructive and central).

Common signs of sleep apnea include: fatigue, irritability, moodiness, depression, gastroesophageal reflux, loud snoring (most common in obstructive sleep apnea), gaps in breathing during sleep, abrupt awakenings and shortness of breath (most common in central sleep apnea), difficulty staying asleep, frequent night urination and morning headaches.

What to Do?

Correcting sleep apnea/airway obstruction may be as simple as making changes such as:
• losing weight to eliminate fat deposits that narrow the airway
• eliminating alcohol, sedatives and tranquilizers
• eliminating tobacco use
• altering sleeping position (sleeping on one’s side can be a successful preventive for central sleep apnea)
• taking prescription to lower blood chemistry pH
• treating high blood pressure

Other treatment options include:

• continuous positive airway pressure (CPAP) device
This machine delivers air pressure to the nose through a mask. Because the air pressure is greater than the surrounding air, it keeps the upper airway passages open for breathing. To make the device more comfortable, a customized mouthpiece may be created to shift the lower jaw forward and open the airway. Known as oral appliance therapy, this treatment is often successful with mild to moderate cases.

• surgical procedures
For example, having the tonsils, adenoids and uvula removed from the back of the mouth/top of your throat area to stop vibrations and snoring. However, this can lead to nasal-sounding speech while not correcting other structures further down the throat contributing to the obstructive sleep apnea. Another somewhat helpful surgery involves increasing air flow through the exterior nasal passages by straightening a deviated septum (nasal partition).

The most successful long-term treatment for sleep apnea involves moving the face’s skeletal framework forward, rather than removing or altering throat/airway structures. Called maxillo-mandibular advancement or MMA (maxilla= upper jaw; mandible= lower jaw), this procedure does not affect the speech intonation, the bite (how the upper and lower jaws come together), or even the facial appearance. MMA provides immediate and lasting relief 95% of the time by changing the relationships of all the critical structures in the airway regions, including the back of the nose, back of the throat, and frontal area of the nose/mouth. Once the airway is thus opened, the problem of sleep apnea is eliminated, not merely managed.