Sleep disorders affect a significant proportion of the population. Problems can vary from simple snoring to life-threatening obstructive sleep apnoea. Most sleep disorders affect both the patient who has the condition and the sleep partner.
Most common effects of sleep disorders are daytime tiredness, irritability and difficulty concentrating. More serious problems caused can be high blood pressure with risk of heart attack or stroke, diabetes, extreme daytime tiredness, including falling asleep while driving and anti-social daytime sleeping.
What is Snoring?
This is the noisy vibration caused the partial closing of the airway by the tongue contacting the back of the throat and the soft palate. It usually occurs when the patient is sleeping on the back. Snoring is made worse by overweight, alcohol and sleeping tablets. The patient very often is not aware of the condition, and does necessarily feel tired during the day. At least 30% of adults snore, rising to 60% depending on age and sex.
What is Obstructive Sleep Aponea?
This is a much more serious condition and can be life-changing in its effect. Obstructive sleep apneoa is also produced by the closing off of the throat airway by the tongue and surrounding tissues. Loud snoring is usually present followed by cessation of breathing with periods of total quietness and lack of movement. The patient then moves about in bed, often kicking the legs and gasping or snorting when breathing is recommenced. These episodes can be frequent and might occur twenty times per hour. The result is a very poor quality of sleep and a lowering in the oxygenation of the blood. Raised blood pressure is often present. General fatigue and daytime tiredness is very common. Normal living is often impossible due to falling asleep in the day and lack of the ability to concentrate.
It is important to gauge the extent and severity of sleeping disorders to help make a provisional decision about what treatment is indicated. A questionnaire is completed by the patient with the sleep problem and also the sleep partner. This asks about medical conditions, the patient’s opinion about the problem and how it affects daytime tiredness. The sleep partner is also questioned about the nature of the patient’s sleep and what noise is produced.
Further dental investigations are carried out in the surgery and measurements, such as weight assessment, are made to finalise the diagnosis. In severe cases of sleep apnoea, a patient will be referred to the medical practitioner for possible referral to a consultant at a hospital sleep centre.
Simple snoring is treated with a custom made appliance inserted in the mouth before sleeping which holds the jaw forwards, this is called a Mandibular Advancement Appliance (MAA). One-piece appliances that carry out this function can be bought on-line. These are invariably uncomfortable to wear and are poorly fitting and almost never successfully worn. Appliances made in this clinic are two part and are connected in a way to posture the jaw forward to allow an enhanced airway at the back of the throat. Appliances can be made relatively inexpensively in plastic acrylic, or in a much less bulky and more sophisticated way, in chrome-cobalt metal.
Surgery (uvulectomy and palatoplasty) involving re-shaping the soft palate is sometimes offered by ENT surgeons. Treatment of this type is very intrusive, can be very difficult to tolerate and has an unknown outcome. It is irreversible, and if the result is unsatisfactory, cannot be rectified.
OBSTRUCTIVE SLEEP APNOEA
The diagnosis of this condition is carried out by a specialist sleep consultant. Hereford is fortunate to have a sleep centre in our hospital. All referrals must be made through the patient’s medial practitioner. Investigations might involve a sleep study (polysomnograph) which might be carried out at home, or in the hospital’s sleep centre “sleep house”. Treatment could be by constructing a mandibular advancement appliance, and/or fitting the patient with a CPAP machine. This is a Continuous Positive Airway Pressure machine which has a mask and air pump, forcing air through the patient’s nose and ,therefore, throat. This is considered to be the “gold standard” treatment for obstructive sleep apnoea.
Contact us or ask the receptionist for a sleep assessment form and an appointment for a consultation.