It is not very often that a long-term study can conclusively state that lack of sleep can harm you, but this study does reflect that and more. It has also concluded that treating OSA slashes your daytime sleepiness by 45%. This is remarkable. Now, because of studies like this, individuals or employers who count on themselves or their team to be awake and alert will now pay more attention to how serious OSA can be. Most insurance carriers cover the diagnosis of OSA (getting a sleep study), but some restrictions may apply.

The way to determine if OSA is present, and to what extent, is by doing a PSG (Polysomnograph) analysis. This is a fairly simple test and is often done at home initially. If the home test shows serious issues, then the MD does a more advanced test at their in-office facility. The PSG generates a value called the AHI (Apnea Hypopnea Index) that describes how many times the patient stops breathing for more than 10 seconds, along with the times that breathing is slowed. This is not an exact science, and some doctors argue that AHI is an antiquated technique to measure the problem, but for now, this is what they have. Here is a quick review of the meaning of the numbers and the severity:

• None/Minimal AHI = <5 recorded events per hour
• Mild AHI = ≥ 5, but < 15 recorded events per hour
• Moderate AHI = ≥ 15, but < 30 recorded events per hour
• Severe AHI = ≥ 30 recorded events per hour

Back to the infamous, or soon-to-be-infamous, study. The Wisconsin Cohort Study also looked at death rates and concluded that cardiovascular mortality accounted for 26% of deaths for people who did not have SDB (Sleep Disordered Breathing), and the death rate for severe SDB was 42%. This is substantial. For those who had OSA and did not wear a CPAP, the death rate was significantly higher than for those who wore their CPAP. In other words, if your sleep MD dictates that you need a CPAP, then you need a CPAP! If you are CPAP intolerant, then you should discuss this with your MD. The conversation may lead to an alternative suggested use of a dental appliance to help keep the airway as open as possible. Generally, this is a great alternative for patients.

The study concluded that premature death occurred in severe OSA patients. Additionally, the estimate of a 3-fold greater odds of cardiovascular mortality may be underestimated when compared to community controls and patients without SDB. The death rate amongst those who did not use CPAP was significantly higher than that of patients who were dedicated to wearing the CPAP. The bottom line is that although many patients typically do not like the CPAP, it is keeping them alive, and that is what counts.

If you have OSA or symptoms, get it checked! You will likely be saving your own life or the life of a loved one. To learn more about OSA treatments in Falls Church, Virginia? Dr. Jeffrey Brown and our team at Sleep & TMJ Therapy are here to help. Please call 703-821-1103 today to book a reservation.

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Sleep apnea is a condition with multiple symptoms and even more treatment options. When a person sleeps at night, they should stay asleep all night with minimal movement and there should be no snoring. Unfortunately, many people these days snore and have little control over this. Snoring can be a symptom of obesity or might be present in even the slimmest people – there is no true rhyme or reason here. The best way to diagnose the problem is to do a sleep study – a polysomnogram. This requires wearing all sorts of wires across the head and neck for a two-night study in most cases. Then a board-certified sleep MD reads the results. Without getting too technical, the measurement achieved is called the AHI – Apnea Hypopnea Index. If the AHI is quite high, then the usual first measure is to wear a CPAP – continuous positive airway pressure – to force the air into the lungs. For some people, it really works well,  yet for others, it just cannot be tolerated.

Depending on who the doctor is,  the next level of treatment is usually a dentist-fabricated device that opens the jaw and brings it more forward – just like if you did CPR on a person. The dental sleep device is a very good way to help open the airway in most mild to moderate apnea cases. Sometimes the device is used along with the CPAP to allow the machine to use less pressure to get the air into the lungs.

There are many other techniques to help sleep apnea cases – they involve surgery to cut away the palatal area – often referred to as UPPP (Uvula Palatal Pharyngeal Plasty) or even balloon plasty to just temporarily open the airway. Another surgery is called MMA -Maxillary Mandibular Advancement. This effectively brings the upper and lower jaws forward permanently. Beware of these surgeries as they might disrupt the TM joints. Other techniques include various medications that serve many different purposes.

Recently, HNS (Hypoglossal Nerve Stimulation) has been developed. This involves putting, for lack of a better word, an electrical ‘shock’ wire into the hypoglossal nerve in the tongue, then running a wire down the inside of the neck to a battery pack under the skin just below the collar bone. As with any surgical procedure to do an implanted device, there are risks associated with the procedure. Once the therapy is turned on, what happens next is when the patient has an apneic event, the sensor detects this and sends a ‘shock’ and in turn the tongue begins jutting forward to open the throat. Some people seem to tolerate this technique fairly well, others not so much. Some patients may experience discomfort from the stimulation, notice tongue abrasion, experience mouth dryness, or experience discomfort from the presence of the device. Overall, this is a relatively simple technique. The question brought up there is some concern that after a year or two the tongue may no longer be responsive to the shock wire.

Overall, there are many treatments for sleep apnea and no one system of therapy is right for every patient.  Based on the AHI, the most non-invasive treatment, a dental sleep appliance,  does still work and is highly recommended.

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