OSA IN ADULTS
This is the group we hear about the most. OSA is usually found in children 8 and under, in men 40+ and in women after menopause. Men have OSA at twice the rate of women. UARS however, is found in all age groups and affects men and women equally (see the comparison chart of symptoms of OSA and UARS below).
There is an extensive list of diseases that has been shown to be associated with OSA. UARS has been associated with neuromuscular diseases that OSA is usually not including:
- Fibromyalgia (more than 30% of people with FM have OSA) note: more 40% of FM patients test positive for Lime Disease!
- Chronic Myofascial Pain
- Chronic Fatigue Syndrome
Causes of OSA
OSA is a physical blockage of the airway. This can occur from large tonsils and adenoids that were not removed or have grown back since childhood. It can be caused by a long soft palate, a large tongue and/or a narrow or constricted palate. As discussed, all of these problems can be corrected in childhood and, in families with a history of OSA, special consideration should be given to children of adults with OSA. Removal of enlarged tonsils and adenoids, orthodontic correction of constricted palates, tongue reduction surgeries, etc. should all be considered as early as possible to prevent the need for invasive treatments later in life. Central Apnea, which can occur with obstructive sleep apnea as mixed apnea, occurs when the respiratory center of the brain (in the Medulla Oblongata and Pons region of the brainstem) malfunctions and the brain forgets to tell the body to breath.
Problems in the upper airway such as a deviated septum, swollen turbinates or swollen tissues in the upper airway can restrict airway as in UARS.
We cannot overlook the direct connection between obesity and OSA. Many people with mild OSA simply need to reduce their weight to alleviate the symptoms. Many people with simple snoring rapidly progress into OSA with a modest gain in weight. Inversely, a modest loss of weight can sometimes alleviate OSA symptoms in some.
Symptoms of OSA in adults are extensive and include:
- poor quality sleep
- frequent waking with snorting or choking
- increased need to use the washroom at night
- snoring (1/3 of married couples in the UK sleep in separate rooms due to snoring!)
- headaches upon waking (due to low oxygen levels or Sleep-Related Bruxism)
- chest pains (cardiac muscle due to low oxygen levels)
- reliance on coffee to “make it through the day” (ever notice the lineups at the coffee shop drive-throughs at 7am)
- poor concentration, mind drifts off easily
- sleepiness in the day (fall asleep at computer, can’t keep one’s eyes open, eyelids heavy)
- poor memory (forgetting to do things, misplacing items, difficulty learning new tasks)
- feeling very tired mid-morning, mid-afternoon and in the early evening
- falling asleep while reading a book
- falling asleep watching TV
- falling asleep at the movies or at plays/concerts
- grinding of the teeth while sleeping (Sleep-Related Bruxism occurs in 25% of OSA patients)
- falling asleep at the wheel while driving (in Canada, 1 out of 3 accidents on the 401 highway in Ontario are due to people falling asleep at the wheel!)
- increased risk of use of stimulant drugs to “get through the day”
- increased risk of occupational accidents due sleepiness on the job or to coordination problems associated with OSA. The nuclear accident at Chernobyl was due to the operator having sleep apnea and failing to initiate emergency protocols because he was asleep. The effects of this are still being seen today.
This is only a partial list and there are many more symptoms not listed above. Considering there are between 50 and 70 million people in the USA with OSA or UARS and only 5-7% are being treated, we have a serious problem on our hands. The stats are similar in Europe and the World Health Organization estimates 100 million people globally have OSA! That is a lot of people!
Treatment of OSA
Treatment of OSA and UARS depends upon the severity of the disease as well as physical findings. An oral appliance will not work if there are huge tonsils in the back of the throat. If the patient has mixed apnea (central apnea with OSA), a CPAP or oral appliance must be supplemented with treatment for the central apnea or treatment may fail. Lifestyle changes are needed in many cases. Patients should discuss this with their medical doctor or sleep specialist.
In some cases, such as with severe malocclusions, surgical or surgical-orthodontic treatment is preferable as a CPAP or oral appliance may not for correctly. Surgically widening the upper jaw, surgically lengthening the lower, tongue reduction surgery, shortening a long soft palate etc. are all effective and well researched options for treating OSA.
The Luco Hybrid OSA Appliance is clinically proven in the treatment of sleep apnea. This appliance can be used on at least 2/3 of the OSA cases. In the design stage, the appliance was developed first and foremost a comfortable appliance that was as small as possible. The metal framework is light, strong and very thin. In most areas it is 1.5mm or less thick. The tongue can barely feel it. The framework is custom deigned for each case. If you have a strong gag reflex, the appliance can be easily modified so that there is no metal at the back of the soft palate without affecting the strength or efficacy of the appliance.
If you are a mouth breather, there is no material in the front of the appliance so that there are no restrictions in mouth breathing. If you have a pre-existing TMJ condition, this appliance was designed for this and may be used in cases of painful muscle spasms/headaches very effectively. This appliance was designed using clinical information over the last 27 years, treating sleep apnea and TMD patients. I has been and is being used as a night appliance for patients with severe sleep-related bruxism.
Always remember that the big three of OSA are heart attack, stroke and sudden death! Treatment is a much better option!
To find out if you might have a sleep disorder, take the Epworth Sleepiness Scale.