SNORING

• Simple snoring is distressing but only unsociable.

• Sleep apnoea can be detrimental to your health and be very dangerous.

•  In many cases of sleep apnoea can be treated. This is by a machine which when patient is sleep, intermittently  pushes  air into their chest  through a mask or similar  device. It can be life changing. 

• In simpler cases, many patients benefit from a  splint worn over teeth which keeps  the lower jaw forward during sleep .It reduces snoring and often improves air flow into lungs .

We provide  SLEEPWELL dental appliances to help with snoring and mild to moderate  sleep apnoea. Please click  Here

   Snoring   

    Snoring  on its own  is just a social nuisance .It effects a quarter of men and  some 10% of women. Even more common as one gets older. Other than keeping the sleeping partner awake, it does little harm. However if the snoring is also associated with reduction or obstruction of breathing, then this can be much more harmful. This is called sleep apnoea and can be very detrimental to health and requires effective treatment.  The harm is proportional to the amount of obstruction.

   What is the cause of snoring:  Click for animation

      Snoring is the  sound made during sleep whilst breathing  by   vibration of  the flesh at the back  of the mouth, nose and throat     . It is the result of narrowing of the space through which air passes into lungs. This leads to turbulence of air.  As in a musical wind instrument, the vibration causes sounds. The noise can be soft and even reassuring, or very loud  and unpleasant .

      Narrowing of the throat  is caused by : 

• Sleeping on one's back helping gravity to pull the jaw and the  lax tongue back.
• Reduction of  airway   by the weight and volume of  fat  deposited  around the throat(This is  shown by increase in neck size.)
• Blocked nose due to deviate nasal septum  or nasal polyps  and so reducing air    passing   through the nose.
• Alcohol or drugs ( specially sleeping tablets) increasing the relaxation of jaw  and

throat muscles and resulting in further sagging .

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  Harm done by  snoring 

   Mainly social or to the sleeping partner  

  Harm done by  sleep apnoea   

          Snoring  plus obstruction of  breathing ( similar effect as becoming partly  strangled )  can cause  frequent waking up ( not remembered) and therefore lack of  relaxing deep sleep. More seriously ,frequent episodes of reduction of oxygen to the  body results in :  

• Restless sleep.
• Gasping or choking during the night .  
• Frequent toilet visits during the night ( pressure on the bladder from the abdomen)
• Tired on waking up.
• Morning Headaches.
• Excessive day time sleepiness.    
• Irritability.
• Reduced  Libido.
• Poor job performance.
• High blood pressure.
• Heart attacks.
• Strokes.
• Diabetes.
• Depression.
• Death or Injury from road traffic accidents.

  Diagnosis  of snoring  can be made from the account given by sleeping partner ( or a recording)

  Diagnosis of sleep apnoea   is initially from the description  provided by  the sleeping partner .   Total obstruction of breathing followed by a gasp for air and choking may be observed. Further assessment can be made by the person themselves  answering a series of questions  in   Epworth sleepiness score .Patients are asked to  express the likelihood of feeling sleepy on the following situations :

1  Sitting and reading.

2  Watching television.

3  Sitting inactive in a public place (e.g.   a theatre or a meeting).

4  As a passenger in a car for an hour without a break.

5  Lying down in the afternoon, when circumstances permit.

6  Sitting and talking to someone.

7  Sitting quietly after lunch (without alcohol).

8  In a car, while stopped for few minutes in traffic.

However additional  proper scientific investigations are required to confirm these findings . There are sleep laboratories in some hospitals usually under leadership of a chest physician .  For such sleep studies, patients are admitted for overnight observation.   Many recordings are made including that of  reduction  of oxygen in the blood and frequency of blockage of air going into lungs. Some patients experience disruption of their sleep  and lowered oxygen levels   as  often as   200 -500 times  per night.

It is now possible to have similar assessment at home .The necessary equipment can be hired for use during sleep ( Stardust II ) .  The collected data can then be analysed by specialists. This is more convenient and less expensive than Hospital admission.

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  Treatment of  Snoring 

 Aim to  Improve the  entry of air   into lungs by various means such as :

   Losing weight to increase the space at the back of throat.

    Stop smoking as inflammation and catarrh  increase blockage.

   Nasal strips to keep nostrils open and improve passage of air through  nose. 

  Throat lubricants to reduce vibration

  Avoid sleeping on the back .(By sewing a tennis ball on the back of sleeping  garment.)

   Strengthen throat muscles by playing wind instruments

    Throat surgery. ( Various types are carried out  )

                   Dental appliances  

    Advancement Dental appliances

       These are designed to move the lower jaw (  and therefore the base of tongue and part of soft palate  ) forward  to increase  air-flow . They often reduce snoring and improve mild to moderate  cases of  airway obstruction. There are many designs.   The most basic types resemble two gum shields fused together. The more sophisticated versions are slimmer and allow adjustments of the amount of forward movement of the jaw as well as some sideway movement. We provide Sleepwell appliances.

 Side effects  of appliance include :

·      Excessive salivation when first worn

·      Discomfort in the jaw muscles and jaw joints, improve by massage and gentle exercises.

·      Mild bite  changes and very slight movement of teeth (  often towards  a better     direction)    

·      Dry mouth sensation, especially with mouth breathing;  

Most of these effects are mild and are compensated by the improvements that the device provides.

 

 Treatment of Sleep apnoea.

Above measures plus CPAP

Mild to  Moderate  sleep apnea .Mandibular advancement appliance can be tried if    cannot tolerate CPAP

CPAP.  Continuous positive airway pressure. Is considered the best treatment for sleep apnoea  ( effecting some 2-4% of men but less in women)   .  Used in bed, on breathing in, pressurised air is pumped into the lungs. Although effective, it usually requires wearing a mask and so is rather cumbersome and unsociable. Sleep apnoea is important enough to make the device available under NHS. However some  90% of patients are unrecognised and so untreated despite all the harm sleep apnoea  could be  doing to    them , and through road traffic accidents  a danger to others.

 Surgery for snoring

Involves tightening of the soft palate or shortening them. This is achieved by scarring deep parts of the soft palate or making it more rigid .In more major operations, excess flesh at the back of the throat including tonsils and adenoids  are  removed. Such surgeries can have their own problems.

In summary, if you have concerns about having sleep apnoea, you should contact your own Doctor. Correct treatment can improve the quality of your sleep, improve your health and make you less of a danger to those around you.

Recommended  websites :   

http://www.nhs.uk/snoring.aspx

http://www.britishsnoring.co.uk/snoring/what_can_i_do_to_stop_snoring.php