ARNOLD L CHASSANOFF, DMD
Diplomat, American Board of Dental Sleep Medicine
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NORMAL SLEEP, SNORING AND SLEEP APNEA
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NORMAL SLEEP AND BREATHING
During the day, the muscles surrounding the soft tissues and muscles of the airway tighten enough to hold the structures in place and allow the free passage of air. During sleep, the structures of the throat relax and are capable of collapsing enough to partially or completely block the passage of air.
Normally, this does not occur and air will flow freely into the nostrils, over the soft palate, behind the tongue and into the trachea. The nose filters and warms the airflow; breathing is effortless and automatic.
During normal sleep, the brain passes through 4 stages of continuously deepening sleep and finally into REM sleep (where dreaming occurs). This cycle occurs about 5 or 6 times per night and is necessary for restful, refreshing sleep. Time spent in stages 3 and 4 are particularly needed for sleep to be refreshing, but time in these stages is markedly decreased in individuals with sleep breathing disorders and often results in abnormal daytime fatigue.
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Snoring occurs when the soft tissue structures of the upper airway collapse unto themselves and vibrate against each other as we attempt to move air through them. This produces the sound that we know as snoring. Large tonsils, a long soft palate, a large tongue, the uvula and excess fat deposits in the throat all contribute to airway narrowing and snoring.
Depending on the amount of air passing through the breathing passage and the speed at which the throat is vibrating, snoring may be extremely loud, soft as a whisper, or somewhere in-between. Snoring can be an indicator for sleep apnea which is a risk factor for vascular and cardiac complications.
Snoring can cause:
- Headaches
- Fatigue
- Difficulty in concentration
- Reduced work performance
The effects of snoring can annoy the bed partner whose sleep quality might also be affected by their mate's snoring.
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OBSTRUCTIVE SLEEP APNEA (OSA)
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Obstructive
sleep apnea occurs when the tongue and soft palate collapse onto the
back of the throat. This blocks the upper airway causing air flow to
stop. When the oxygen level drops low enough, the brain moves out of
deep sleep and the individual partially awakens. The airway then
stiffens and opens causing the obstruction in the throat to clear. The
flow of air starts again, usually with a loud gasp. When the air flow
restarts, the individual moves back into a deep sleep, the airway
muscles again collapse and the individual awakens again with a gasp.
The airway clears once again as the process repeats itself. This
scenario reoccurs continually during the night and adverse
cardiovascular effects may occur. The combination of low oxygen
levels, fragmented sleep and cardiovascular effects are major
contributors to most of the ill effects that the sleep apnea patient
suffers.
In addition to excessive daytime sleepiness, studies show that sleep apnea patients are much more likely to suffer from:
- Heart attack
- Congestive heart failure
- High blood pressure
- Stroke
- Diabetes
- GERD ( stomach acid reflux )
- Depression
- Sexual dysfunction
- Obesity
- Automobile accidents
- Learning and memory difficulties.
Obstructive sleep apnea is serious and can be fatal!
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UPPER AIRWAY RESISTANCE SYNDROME (UARS)
This sleep breathing disorder lies somewhere between snoring and obstructive sleep apnea in symptoms and behavior. Patients usually have snoring and/or noisy breathing , hypertension and daytime fatigue. UARS is similar to obstructive sleep apnea in that partially obstructed airflow interrupts the normal sleep patterns causing similar symptoms to sleep apnea. The major difference is that individuals with UARS do not have significant decreases in oxygen levels. The normal sleep patterns are nevertheless continuously disrupted and these arousals (going to a less deep sleep stage) are thought to be responsible for the sleep apnea symptoms. UARS is treated similarly to sleep apnea.
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