Sleep Apnea Could Really Be Stressing You Out!

raised hand saying "need sleep"Inhale, then exhale, but don’t inhale right away. Count out 10 seconds until your next breath.

Take that breath. How do you feel?

Relieved, probably. Maybe you even noticed the tension releasing from your whole body as you inhaled again.

Now imagine experiencing that over and again through your night’s sleep. That’s a bit of what obstructive sleep apnea (OSA) is like. Not getting the oxygen it needs to survive, the body perceives a threat and reacts accordingly. You wake with a gasp, taking in as much air as you can.

Then you go back to sleep only to wake once the airway is again blocked – by excess tissue around the top of the windpipe, for instance, or the tongue or lower jaw slipping backwards.

New research in the Journal of Clinical Endocrinology & Metabolism shows just what an impact this has on the body as it sleeps.

Now, most studies on OSA collect data during the day, when patients are awake. But

“This is one of the first studies to show real-time effects of sleep apnea on metabolism during the night,” says Jonathan Jun, M.D., assistant professor of medicine at the Johns Hopkins University School of Medicine and the paper’s senior author.

Jun and his team collected a range of metabolic data from patients while they slept both with and without CPAP – the usual treatment for OSA symptoms, which uses continuous positive airway pressure to keep the airway open. They measured free fatty acids in the blood, glucose, insulin, and the stress hormone cortisol. They measured brain waves, blood oxygen levels, heart rates, and eye and leg movements.

Jun and colleagues found that CPAP withdrawal caused recurrence of OSA associated with sleep disruption, elevated heart rate and reduced blood oxygen. CPAP withdrawal also increased levels of free fatty acids, glucose, cortisol and blood pressure during sleep. The more severe the OSA, the more these parameters increased. In addition, glucose increased the most in patients with diabetes. Increases in fatty acids, glucose and cortisol have all been linked to diabetes. The Johns Hopkins team also found that blood pressure increased and the arteries showed signs of stiffness in the morning without CPAP. Over time, increased blood pressure and vascular stiffness can contribute to cardiovascular disease.

That’s the very picture of a body under stress. It also suggests that OSA may be more than just a manifestation of obesity and related health issues. It may actually aggravate them.

CPAP is hardly the only solution, though – and it’s a good thing, too. Many people find reasons to quit it. Compliance rates are notoriously low. But there are other effective options for dealing with mild to moderate sleep apnea – from lifestyle changes to oral appliance therapy.

In fact, according to the most recent American College of Physicians guidelines for managing sleep apnea, the first recommendation is to encourage overweight and obese OSA patients to lose weight. Other research suggests that exercise can likewise have a big impact on at least some OSA symptoms.

And these, of course, can be pursued in tandem with oral appliance therapy, in which custom appliances are used to keep the tongue from blocking the airway or gently repositioning the lower jaw to keep the airway free and clear.

One 2016 study found that airflow may be greatly improved by appliance therapy.

Our findings suggest that oral appliance therapy not only improves the upper airway collapsibility but also improves the upper airway compensatory effectiveness. Thus, oral appliances appear to unload the upper airway, thereby enabling patients to exhibit more effective compensatory dilator muscle responses for improved airflow.

OSA is much more common today than just a couple decades ago. According to one study, between 1993 and 2010, OSA diagnoses jumped 14.6-fold! But many more treatment options and tools have been developed during that same period – and continue to be developed – offering options beyond CPAP.

And you just might find some of those options in your dentist’s office.

Image by Dmitry Kugarov

Sleep Like Your Health Depends on It (Because It Does)

bedA recent article over at CNN offers a good reminder that running a sleep debt can have far greater effects than daytime sleepiness and general grouchiness.

It can mean more accidents due to weakened reflexes and an unfocused mind. It can mean weight gain. It can mean a higher risk of depression, anxiety, diabetes, heart disease – in general, a shorter, unhealthier life span.

Recent research has also supported the suspected link between Alzheimer’s and sleep loss. A study in Brain, for instance, found that when sleep is constantly interrupted – as in cases of obstructive sleep apnea (OSA) – more of the proteins suspected to cause Alzheimer’s build up in the brain. (Normal sleep helps clear them.)

What’s more, research in the Annals of the American Thoracic Society found that those who are genetically susceptible to Alzheimer’s appear to be at greater risk of the cognitive decline that OSA and other forms of sleep disordered breathing can contribute to.

Many don’t realize that dentists are in a unique position to help identify sleep breathing problems and even, in mild to moderate cases, offer solutions that can enhance both oral and systemic health. Many signs of OSA can show up in the mouth, from inflamed tonsils to scalloping along the tongue, from tooth wear from bruxing (grinding the teeth during sleep) to headaches and other TMJ symptoms. If exam findings suggest OSA, a sleep test may be recommended for diagnosis.

Dental options for treating apnea provide welcome alternatives to CPAP. Most often, dental treatment involves appliance therapy – comfortable devices that typically keep the airway open by gently pulling the lower jaw forward. On the whole, research suggests that oral appliance therapy (OAT) can be at least as effective as CPAP, yet much more comfortable and well-tolerated.

We may also recommend diet, activity, and other lifestyle changes to support improved sleep, as well as additional therapies such as acupuncture or chiropractic care. As ever, everything depends on the individual and the specific causes of their symptoms. After all, it’s causes we want to address.

While tending to symptoms can bring short term relief, only attention to causes can bring about good long-term results.

Many people don’t even realize the impacts a little lack of sleep can cause. We all know those who like to brag of only getting four to six hours of sleep a night, almost like it’s a competition. Yet according to a 2003 paper in Sleep, such folks are likely unaware of what they’re losing in the course of gaining those extra waking hours.

Since chronic restriction of sleep to 6 h or less per night produced cognitive performance deficits equivalent to up to 2 nights of total sleep deprivation, it appears that even relatively moderate sleep restriction can seriously impair waking neurobehavioral functions in healthy adults. Sleepiness ratings suggest that subjects were largely unaware of these increasing cognitive deficits, which may explain why the impact of chronic sleep restriction on waking cognitive functions is often assumed to be benign.

For the sake of your health, happiness, and those around you, it is worth a quick conversation with your dentist to identify warning signs or offer suggestions for improving your sleep. And if dental factors aren’t at the root of your running a sleep debt, here are some great tips from Harvard Medical School on getting a better night’s sleep.

Image by ellas quezada

Help for Sleep Apnea from Your Dentist? Yes!

sleep apnea diagramMost people with obstructive sleep apnea (OSA) probably don’t know it. In fact, it’s often a sleeping partner who first notices the common signs. After all, the snoring’s not keeping you awake.

But there’s another person who can tell you if you may have OSA: your dentist.

According to a study published last year in the Saudi Medical Journal, dentists have a unique advantage to hone in on the signs of sleep apnea. Because they see into patients mouths more often than physicians do, they have more opportunities to notice indications of airway obstruction – specifically, enlarged tonsils and scalloping along the sides of the tongue.

Other research has suggested even more dental signs of possible OSA, including worn teeth, morning headaches, gum problems, and TMJ pain.

Of the more than 18 million adults in the US affected by sleep apnea, those who are obese are 10 times more likely to report symptoms than their slender counterparts. According to the National Sleep Foundation, many of those 18 million go undiagnosed. Without diagnosis and treatment, the sleep apnea issues compound. OSA has been linked to heart disease, diabetes, depression, memory loss, and more.

Once sleep apnea is diagnosed through a sleep test, dentists can play a role in effective treatment, as well.

Whether you have a history of OSA and use a CPAP device or are searching for help with a recent diagnosis, you may be interested to learn about how less invasive oral appliance therapy can treat mild to moderate cases of sleep apnea. Appliance therapy tends to be more comfortable than CPAP, while also effective in keeping the airway open.

In fact, oral appliance therapy is now the recommended treatment of the American Academy of Sleep Medicine and the American Academy of Dental Sleep Medicine for adults who are CPAP intolerant or prefer an alternative.

“This evidence-based guideline reinforces the fact that effective treatment options are available for obstructive sleep apnea, a chronic disease that afflicts at least 25 million adults in the U.S.,” said AASM President Dr. Nathaniel Watson. “Although CPAP therapy is still the first-line option for treating OSA, oral appliance therapy is an effective alternative that is preferred by some patients. Sleep medicine physicians and dentists can promote high quality, patient-centered care by working together to identify the optimal treatment for each patient who has sleep apnea.”

Most appliances work by supporting the lower jaw in a slightly forward position. This forward position keeps the tongue from dropping back toward the throat. Over time, this helps tone the tissues that line the throat. Wearing an appliance can sometimes double and even triple the size of the airway opening.

These appliances are not “one-size-fits-all” devices. There are dozens of options available. Only a dentist well-versed in breathing disorders such as OSA can help determine the best choice for your unique situation and help get you on the path to better sleep – and better overall health for the long haul.

Is Snoring Keeping You Awake?

insomniaIf you snore – or live with someone who does – it can be more than just irritating. If it’s associated with sleep apnea, it can put you at risk for some serious health problems

Sleep apnea is a condition that causes you to periodically stop breathing. Each pause can last 10 seconds or more, and in severe cases, these episodes can happen more than 30 times an hour. This can be frightening and fatiguing. More, it deprives your body of an essential nutrient: oxygen.

Fortunately, there are things you can do about it – including, new research suggests, exercise.

This review of the science, published online last month in Respiratory Medicine, analyzed data from eight sleep apnea studies that used exercise as a measure. Subjects – 180 in all, most in their 40s, all diagnosed with obstructive sleep apnea – were split between those who exercised, from two to seven days, and those who did not.

According to WaPo,

The studies lasted from two to six months. Among people who exercised, sleep apnea symptoms improved. It became less severe, according to a standardized scale based on the frequency of their breathing interruptions, and the participants reported better sleep overall and less daytime drowsiness. Improvements were similar regardless of the type of exercise people did and were determined to be independent of any weight loss.

Your Dentist Can Help

Improvement of symptoms is one thing, but you still may need additional support to help you get the best of sleep apnea – so it doesn’t get the best of you. And the clunky facial mask of CPAP is hardly your only option.

Oral Appliance Therapy can be a big help – and far more comfortable than CPAP. The best appliances are all designed to hold the lower jaw forward just a bit, enabling an open, unrestricted airway.

They also work to keep the tongue from falling back into a fleshy pile. This structural support helps create more tone in the tissues lining the throat.

If you suspect you, or someone you love may have obstructive sleep apnea, reliable home tests are available. And testing is worth your while. The American Academy of Sleep Medicine holds that as many as 80% to 90% of us with sleep apnea are still undiagnosed.

The benefits of finding the right treatment, and exercise to your routine can be dramatic. With deeper levels of sleep, many people experience lasting health benefits, including

  • Lower blood pressure.
  • Weight loss.
  • Improved insulin sensitivity.
  • Improved productivity.
  • Improved cognitive skills.
  • Reduced risk of depression.
  • Reduced medical expenses.
  • Increased energy and vitality.

But more than that, better sleep might just save your life – or the life of someone you love.

Image by Pauliina Seppälä