“OSA” is the pneumonic expression for obstructive sleep apnea. OSA is when you have short episodes of not breathing when you are asleep. It is much more serious than snoring. OSA is caused by the temporary collapse of the airway when you are asleep. It is only reopened with a gasp, choke or the “fight-or-flight” response of your adrenalin. Over the years this constant deprivement of oxygen will over stress your metabolism and especially your heart.
What are the most obvious symptoms of OSA?
- The most meaningful symptom is when your sleeping partner witnesses your cessation of breathing while you are sleeping. This can last from ten seconds to forty-five seconds; the gasping for your breath may not even awake you
- Daytime tiredness and fatigue are very common but are often overlooked because you may be so driven during the day to get things done that you don’t realize how tired you are. When you sit down and relax you may find yourself quickly falling asleep at inappropriate times
- Snoring is commonly associated with OSA but is not the cause of OSA. This may be due to the inability to breathe through your nose. Chronic loud snoring is not only detrimental to the health of your partner, but it is also a chronic irritant to throat tissues.
- Gasping and choking that awaken you from sleep
- Constant awakening with dry mouth, sore throat or night sweating
- Early morning headaches are also very common
How does OSA affect my health?
Other diseases that are commonly associated with OSA are called co-morbidities. Some of the more common co-morbidities are:
- Uncontrolled high blood pressure
- Heart Arhythmias
- Episodes of heart failure
- Uncontrolled diabetes
- Poor concentration, memory loss, ADD and ADHD, progression of Alzheimer’s
- Depression and anxiety
- Sexual dysfunction
- Certain types of cancer
Can children have OSA?
Absolutely, but the management of OSA in a child is much different. Proper airway development is the primary focus. The problem could be underdeveloped upper or lower jaws or the presence of tonsils in an already narrow airway. Children with OSA commonly snore loud everynight. They experience daytime fatigue and concentration problems. OSA could also be the underlying cause of ADD or ADHD.
Why is the dental office involved in treating OSA?
The discipline of the family dental practice is to see patients twice a year to maintain their dental health. This is a much stronger social habit than seeing the physician twice a year, therefore a knowledgeable dentist will commonly survey his/her patient base for general health issues, such as, high blood pressure, diabetes and sleep disordered breathing. OSA is commonly overlooked by the physician because they may be focusing on sympomatic relief or they may just feel that the common treatment (CPAP) is as difficult as the disease.
Our office approaches the treatment of OSA in a very disciplined manner. Dr. McCoy is dedicated to thoroughly understanding sleep disordered breathing. He has acquired training in the screening and treatment process for OSA. This is a medical disorder and must be diagnosed by a physician. Dr. McCoy collaborates with your physician to best manage your OSA.
The role of this office is two-fold. First, we screen our OSA-suspected patients with a simple overnight pulse-oximeter test. The next day the results from the sleep test are uploaded to a website. An analysis of the your oxygen-hemaglobin saturation and pulse is provided within minutes. This is not an official diagnosis but it is certainly a strong indicator of the presence of sleep disorder breathing. These results are explained to you and forwarded to your physician. The physician will order a sleep test that will be interpreted by a sleep-specialist physician; the diagnosis comes from this sleep specialist.
The treatment for OSA may be behavioral in nature, such as, recommendation for weight loss, to reduce alcohol consumption, to change or eliminate certain medications, or to change sleep posture. The most common treatment recommended is the use of a CPAP machine. This machine provides airflow to a facemask that is strapped onto your head while you sleep. As bulky and clostrophobic as it sounds, some people can tolerate it and sleep great without any OSA. But there are many who can not tolerate the CPAP and that is where the second role of our dental office comes into play. We can fabricated an oral appliance that will gently and comfortably advance the lower jaw forward to maintain an open airway while you sleep. The use of the oral appliance is not without the need for your personal patience and discipline. It is an effective way to manage OSA, but you do have to get used to it. For many people this is the first time they have had to wear an appliance in their mouth. It takes some getting used to! The benefits of a good night’s sleep will immediately be noticeable after the first night of use; you will feel much more energized in the morning. Improvement of the other co-morbidities will take a few weeks to a few months to show up.
In more advanced cases when the airway is compromised by the tongue being displaced disproportionately back into the throat area, the dental office could also be needed for orthodontic treatment or maybe even a consultation with an oral surgeon. These are obviously aggressive treatments but may be the only alternative in some situations.
Are these oral appliances covered by insurance?
The answer is “yes” but only partially. These appliances are covered under the “durable medical equipment” part of your medical insurance. An insurance pre-authorization can be completed prior to any personal financial commitment. Many times the deductible is very high in this category and the cost of the oral appliance is out of pocket for the patient.
- Ten percent of women and twenty percent of men have undiagnosed OSA
- The incidence of OSA increases with age and weight gain
- Fifty percent of the people diagnosed with OSA are not being treated effectively
Effective treatment for OSA can provide a person with a 20% longer and healthier life!