If I Should Die Before I Wake
Sleep apnea can lead to far worse things than snoring
By Megy Karydes
It’s been two years since Barbara Wolke, 68, slept in the same bedroom as her husband. Her snoring was so loud that she could be heard throughout her two-story house. She woke herself up so often that she needed four to five naps throughout the day to get enough rest to function—something she was barely able to do.
“My daughter lives 45 minutes away, and I couldn’t make the drive [to visit] because I was worried I’d fall asleep at the wheel,” she says. “I couldn’t even make it through a whole episode of ‘Jeopardy!’.”
Wolke was diagnosed with sleep apnea following a two-night sleep-lab visit. However, treatment would prove elusive because, as it turned out, she was not a good candidate for the commonly used CPAP (continuous positive airway pressure) appliance. It was only after hearing a dentist’s radio ad that she learned of another treatment that just might work.
More than 18 million Americans have sleep apnea, according to the National Sleep Foundation (NSF). Of those, many are not receiving treatment or are undiagnosed. Sleep apnea occurs when tissue in the back of the throat collapses and blocks the airway, reducing the amount of oxygen delivered to all of one’s organs including the heart and brain. A less common form of sleep apnea, central sleep apnea, is caused by irregularities in the brain that affect signals that tell the body to breathe rather than being caused by airway obstruction.
“Snoring is the tip-off,” says otolaryngologist Michael Friedman, MD, medical director of ChicagoENT and author of Sleep Apnea and Snoring: Surgical and Non-Surgical Therapy. “A bed partner usually complains of a loud or disruptive snoring, and that’s the number one reason people come to us.”
Snorers shouldn’t dismiss this symptom as simply inconvenient to themselves or their family members. Snoring can cause serious health issues, Friedman notes. “When you snore, the oxygen level in your body drops. Depending on the length of time and how often that happens, it can result in hypertension, weight gain, mood changes and heart disease.
According to Friedman, the most significant cause of snoring is genetic. “The shape of the throat, which is genetically determined, predisposes people to partial obstruction and snoring,” he says. “Weight gain and aging increase the likelihood of snoring in patients with a predisposition. Alcohol, extreme fatigue and sedating medications all cause more laxity in tissues during sleep and will further increase snoring.”
“Snoring is the result of breathing through an obstructed, or blocked-off, airway,” he adds. “When air flows through a tube, and there is partial obstruction, turbulence occurs. The result is snoring. If complete obstruction occurs, the result is called an apnea.”
For some, snoring can indirectly lead to death. Many snorers often don’t get enough quality sleep and subsequently experience fatigue. According to the NSF, drowsy driving is much like driving while under the influence of alcohol. Sleepiness slows reaction time and impairs your judgment, which can lead to a crash. In short, drowsy driving can be just as fatal as driving drunk.
This explains Wolke’s fear of driving the 45 minutes to see her daughter. But how was it that a dentist’s radio ad could help her sleep apnea?
Sleep dentistry isn’t new, but it’s also not widely known. The American Academy of Dental Sleep Medicine (headquartered in Darien) was established in 1991 as an organization dedicated exclusively to sleep dentistry. Still, the practice flies below the radar of even some dentists.
Timothy Stirneman, DDS, owner of All Smiles Dental in Algonquin—whose ad Wolke heard on the radio—didn’t know about it himself until he started hearing rumors that sleep apnea might be the root of his own health issues. He tried using a CPAP appliance but, like so many others, abandoned it because the device was cumbersome and uncomfortable. Stirneman enrolled in a continuing-education course called Wasted Days and Sleepless Nights taught by Kent Smith, DDS, in Dallas, Texas, which taught him about the causes and symptoms of sleep apnea and how to help his patients who are suffering from this chronic sleep disorder.
The most common treatment is CPAP. It’s a mask that fits over the nose and/or mouth that gently blows air into the airway, thus keeping it open during sleep. Friedman says the most common reason that people let sleep apnea go untreated is out of fear of CPAP. “Patients are misinformed and believe CPAP is the only treatment when, in fact, there are different protocols for treatment of snoring and sleep apnea. They vary from simple in-office procedures to complicated surgical procedures. Many patients can choose from multiple options.”
If a CPAP mask doesn’t work, another option is a custom oral appliance. It is designed to reposition one’s lower jaw, which allows more room for a patient’s tongue and thereby allows air to pass through. Stirneman currently treats 10 to 12 patients per month, and the number is rising every month, he says.
Stirneman is now more proactive when he sees his patients, and he asks them questions that a dentist would not normally ask.
“Do you grind your teeth? Are you constantly tired? Do you use coffee to get yourself through the day?” he asks his patients.
Well, this sounds like most of us. And Stirneman admits that our lifestyles might contribute to our fatigue, but the answers to these questions can direct him to look more closely into his patients’ mouths to see if there is enough room for their tongue to move and for air to pass through the passageway.
It’s important to note that dentists are not medically qualified to diagnose sleep apnea, although dentists who have undergone training, like Stirneman, can treat it. A board-certified sleep physician or a sleep specialist, which could be a pulmonologist, an ENT specialist, a neurologist or a psychiatrist, should make the initial diagnosis, usually with the aid of a sleep-lab visit or a home sleep test.
In Wolke’s case, Stirneman treated her sleep apnea after she was diagnosed by a licensed sleep medical doctor. “She took home a sleep test and administered it herself,” Stirneman says. “Then we downloaded the results from the device, after which we then uploaded the data to the sleep doctor, who then provided [Wolke] and us with her diagnosis based on his interpretation of her data.”
A newer treatment modality for obstructive sleep apnea is hypoglossal nerve stimulation, notes Friedman. “The procedure involves implanting an electrode that wraps around the hypoglossal nerve and selectively stimulates it,” he says about the newer treatment. “The hypoglossal nerve is the nerve that controls many of the tongue muscles. Stimulation of the nerve subsequently maintains an awake tone in the tongue, which then prevents snoring and sleep apnea.”
If surgery is required, minimally invasive and in-office techniques can often correct and improve mild to moderate sleep apnea, he adds.
Obstructive sleep apnea treatments are usually covered by insurance companies, whether it’s surgery, CPAP or a custom oral appliance.
For Wolke, it’s been life changing, even though she knows she will need to wear the appliance for the rest of her life. “I’ve been able to see my daughter more regularly,” she says. “And now I can finally watch a whole episode of ‘Jeopardy!’.” +
Originally published in the Winter/Spring 2015 print edition
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