Snoring and Sleep Apnea

These terms describe parts of the continuum of sleep-disordered breathing. This spectrum ranges from slight vibration of tissues at its mildest to death from asphyxiation at its severe extreme. Between lies pathologic snoring and periods of complete closure of the airway called "apnea".

The long-term effects of such disturbed breathing dramatically increases the risk of stroke, hypertension (high blood pressure), arteriosclerosis (hardening of the arteries), myocardial infarction (heart attack), cardiac arrhythmias (irregular pulse) and others.

Sleep disordered breathing also disrupts the normal patterns of brain activity and relaxation, precluding restorative sleep. Overwhelming daytime sleepiness contributes to the risk of accident and injury from decreased attention span, judgment and reflex. The risk of automobile accident in the untreated sleep apneic is about 7 times that of a normal sleeper. Work productivity and safety suffer.

What causes sleep disordered breathing?

During the increasing muscular relaxation of deepening sleep, the airway can become very flaccid. The relaxation of the tongue can cause it to fall back, touching the back of the throat. The snoring is vibration of the uvula, soft palate and throat walls against the tongue with reduced airflow, or a complete closure of the airway resulting in periods of silence. When the body "realizes" it is suffocating due to this restricted or closed airway, adrenaline is secreted to raise blood pressure, arouse the sleeper to a less deep level of sleep and cause body movements in an attempt to restart or improve breathing. In the sleep apnea patient, this process may be repeated 300-400 times per night resulting in severe disruptions to normal brain wave activity. The ultimate result is sleep deprivation and all the dangerous side effects of that condition.

How is Sleep Disordered Breathing Diagnosed?

The gold standard for diagnosis is overnight sleep testing. The test is called polysomnography. Measurement of many parameters of physiology, including cardio-pulmonary and neurologic, are performed during the subjects' sleep.

How is Sleep Disordered Breathing Treated?

Besides weight loss and increased physical fitness that all patients should pursue, there are only three treatment modalities approved by the medical community and FDA as safe and effective. They are:

MECHANICAL: Airway collapsibility is reduced or eliminated by the incremental advancement of the mandible. The volume of the airway is increased which slows airflow and increases pressure. The lateral walls of the pharynx are tightened and the proximity of the tongue to the soft palate and posterior wall of the pharynx is reduced. The tone of the genioglossus muscle is increased which reduces the collapse of the tongue during the deeper levels of sleep.
TAP® Thornton Anterior Positioner	TAP®	TAP®
The Thornton Adjustable Positioner II (TAP II) alleviates snoring and sleep apnea by the same mechanical and physiological methods as the TAP. It allows the patient to adjust the degree to which the mandible is held forward, simultaneously allowing maximum comfort and effectiveness.
TAP II® Thornton Anterior Positioner II	TAP II®
PNEUMATIC: Airway collapsibility is reduced by the application of increased air pressure which "splints" the airway open.
Nasal CPAP
SURGICAL: Surgery can be used to remove or reposition redundant tissue to reduce the noise of snoring and the potential for obstructions. Resulting airway volume increases may increase air pressure. Radio-frequency ablation ("Somnoplasy") of the soft palate may reduce the volume of tissue while preserving its anatomy.
UPPP	Phase I Surgery [Click photo to enlarge]	Phase II Surgery [Click photo to enlarge]

How is the best treatment for individual patients determined?

It is important to be referred to a specialist in sleep medicine who can properly diagnose the severity of the disorder and to prescribe the appropriate therapy.

Dr. Richard W. Moore is retained by Comfort Acrylics, Inc as a consultant to assist visitors to our site or callers to our company. He will be able to help you find board certified sleep centers and physicians in your area to assist you. He can also help find dentists credentialed by the Academy of Dental Sleep Medicine who can assist you with oral appliance therapy and can answer or find answers to your questions in any aspect of sleep medicine.

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