Obstructive Sleep Apnea

What is Sleep Apnoea and why should I worry if I or my child has Sleep Apnoea?

Sleep Apnoea or Obstructive Sleep Apnoea, is part of a range of sleep-disorder breathing and falls on the severe end of the scale. Sleep apnoea occurs when the flow of air through the upper airway reduces during sleep. Strong vibrations of the soft tissues along the airway caused by turbulent airflow produces loud snoring. The brain suffocates and sends emergency signals to heart, lungs and muscles to wake the person. Here’s a list of famous people and celebrities who suffer from sleep apnea

Sleep apnoea is horrible! Imagine not having enough sleep every night for months and even years. The sleep deficit that builds up handicaps our performance at work and at school; reduces our productivity; affects our mood and social behaviour and can even cause us to doze off when driving! A 2015 study  published in the journal Sleep, found that people with sleep apnoea were 2.5 times more likely to be the driver in a motor accident than people without the sleep disorder.

Children with sleep apnoea often fall asleep in class; present more often with behavioural problems and may struggle with their grades. Research has shown that kids with sleep apnoea actually suffer from brain changes!

Sleep Apnoea is physically and mentally tiring and hints at possible underlying medical risks. The American Heart Association recognises that sleep apnoea is associated with high blood pressure, arrhythmia, stroke and heart failure. These are serious and dangerous medical conditions that should not be ignored.

How do I know if I or my child have sleep apnoea?

Patients who suffer from Sleep Apnoea often do this during sleep:

  1. Snore and snort noisily during sleep, disturbing (and annoying!) their bed partners
  2. Stop breathing repeatedly at night, which frightens their bed partners and causes interrupted sleep for both parties
  3. Display frequent, restless leg movements during sleep
  4. Partially wake up many times through the night
  5. Feel like they are choking
  6. May gasp for air suddenly during sleep, which briefly helps with snoring
  7. May need to sleep propped up on extra pillows because lying flat to sleep makes breathing difficult
  8. Frequent nightmares
  9. Frequent bed wetting

Patients with Sleep Apnoea are sleep deprived and suffer during the day from:

  1. Excessive daytime tiredness and sleepiness during the day
  2. Morning headaches, giddiness, grogginess
  3. Feel irritable during work or school and get frustrated easily
  4. Often feel ‘in a daze’ during the day
  5. Reduce concentration and memory
  6. Mood swings

In addition, children who suffer from sleep apnoea are sleep deprived and when they do sleep, have poor quality sleep. Because of sleep deprivation and constant tiredness, they are unable to maximise their potential in school and social settings. They often present with:

  1. Behavioural problems
  2. Difficulty concentrating in class
  3. Inhibited creativity
  4. May struggle with their grades

Patients with the following physical features are at greater risk of obstructive sleep apnoea (OSA):

  1. Obesity (body mass index: >30 kg/m2)
  2. Enlarged neck circumference (men: >43 cm [17 in]; women: >37 cm [15 in])
  3. Short lower jaw
  4. Short chin
  5. Double chin
  6. Front teeth that protrude or stick out
  7. High palatal arch (roof of the mouth)
  8. Narrow dental arches
  9. Enlarged, ‘kissing’ tonsils
  10. Hypertension

Epworth Sleepiness Scale

The Epworth Sleepiness Scale (ESS) is a self-administered, simple questionnaire that assess the severity of ‘daytime sleepiness’ of a person who maybe suffering sleep deprivation. It was first developed by Dr Murray Johns in 1990 and was named after the Epworth Hospital in Melbourne. The higher the score indicates a worse ‘daytime sleepiness’.

An ESS score of:

11-12 = Mild Excessive Daytime Sleepiness

13-15 = Moderate Excessive Daytime Sleepiness

16-24 = Excessive Excessive Daytime Sleepiness

Sleep study

Sleep studies are the gold standard in diagnosing, recording and quantifying the severity of sleep apnoea. As you sleep, many parameters are recorded during the sleep study. Hospital based sleep studies are done under supervision of a sleep technician. Home based sleep study done under the guidance of a sleep technician is done in the comfort of your own bedroom. Familiar surroundings, the absence of being watched and hooked up to less machinery is a more natural setting to study your sleep patterns.  The WatchPAT is a US FDA approved home based sleep study which has good correlation with sleep studies done in hospitals.

Image credit: itamar medical- What is WatchPAT?

Worried you or your bed partner may have sleep apnoea?
Take the Epworth Sleepiness Test to find out!

How an orthodontist can help me sleep better?

If you suspect your spouse suffers from obstructive sleep apnoea (OSA), let us help YOU sleep better! You deserve a good night’s sleep too.

Sleep apnoea is a multi-factorial problem and we work with several specialists (ENT, Paediatric Doctors and Oral Surgeons) to ensure proper diagnosis and management.

Management of OSA should always start from the cause or contributing factor for your OSA. It is a team effort. It starts from you maintaining a healthy weight and lifestyle and treatment is broadly divided into non-surgical or corrective surgical approach.

An Orthodontist’s conservative, non-invasive and discreet management of OSA:

An Orthodontist can help OSA patients by prescribing a customised Mandibular Advancement Splint to help open up your airway while you sleep. This is a custom-fitted medical-dental appliance that gently postures your lower jaw and the tongue base forward while you sleep to open the posterior airway. Patients who have mild to moderate OSA love it for its small size, portability and discreet look.

Coordinate bite correction for Jaw surgery for OSA.

Patents with moderate to severe OSA may require Telegnathic Surgery to permanently advance both the upper and lower jaws, as well as the chin, so as to achieve a dramatic opening of the airway to help patients breathe better. Jaw surgery for sleep apnoea is an option when conservative alternatives have been unsuccessful or are too cumbersome and troublesome for patients to use on a long-term basis. When patients present with a short lower jaw and a retrusive chin, jaw surgery for sleep apnoea can target such contributing factors.

With telegnathic surgery, jaw correction will change the way your teeth fit together. Therefore, an orthodontist can help with OSA management by coordinating with our highly experienced, specialist oral surgeons to help you breathe better, sleep better, look better and bite better!

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