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Sleep apnea sufferers have new treatment options
Dallas Morning News
Tuesday August 29, 2006
Page 12H

Most people at some point in their lives have trouble either falling asleep or staying asleep. Stress, noise, medication, depression, caffeine or any number of factors can contribute to the broad complaint called insomnia.

A change in circumstances, daily habits or a prescription medication can usually bring back the z’s.

But others have physiological sleep problems that require a more serious fix. Obstructive sleep apnea, for example, is the most common sleep disorder to cause excessive daytime sleepiness. Apnea, which means “no air” in Latin, is a condition where a sleep stops breathing for up to 10 seconds. Short pauses can occur 20 to 30 times or more an hour. Typically, the condition is diagnosed by the number of times patients stop breathing in a given time period and by the percent of time their blood oxygen level falls below 90 percent when they are asleep.

In people who have obstructive sleep apnea, the airway behind the tongue or soft palate closes and blocks air from reaching the lungs.

“When muscles relax during sleep,” says Keith Thornton, D.D.S., an area dentist who specialized in dental sleep medicine, “the jaw often rotates back and open, This change in jaw position pinches off the airway like a kinked water hose.”

Snoring and gasping breaths usually accompany sleep apnea, he explains. Men, middle-aged and overweight populations are affected most often, as are African-Americans and Hispanics. Obstructed breathing will wake the sleeper, but often the person doesn’t realize what caused the interruptions. Typically, a family member or bed partner is the first to notice the problem. Unfortunately, most patients or their bed partner only complain of the snoring and are minimally aware of other signs and symptoms.

Only after a sleep study can doctors diagnose the problem. Most patients go to a sleep lab for an overnight test, called a polysomnogram, but some choose to take a portable machine home to gather data on their sleep.

There are three common treatments for obstructive sleep apnea. For many years, patients have been treated with a device called a CPAP (Continuous Positive Airway Pressure), which consists of a mask, tubes and a fan that deliver air pressure to push the tongue forward and open the throat during sleep. A less cumbersome alternative to CPAP is an oral appliance. Similar to an orthodontic retainer, oral appliances work on the principles of airway management taught in basic CPAR training, says Dr. Thornton, who also invented the TAP – a dental appliance sold worldwide for the treatment of snoring and sleep apnea. By moving the jaw forward, the TAP mechanically opens the airway so the “water hose is no longer kinked.” A specialist typically performs the third treatment option, surgery. The procedure involves removing excel tissue from the back of the throat to create more space for air to flow to the lungs.

The severity of the apnea generally determines which treatment option is chosen. According to new guidelines released by the American Academy of Sleep Medicine in February 2006, oral appliances are recommended when a patient has mild to moderate sleep apnea or when the patient prefers them to CPAP. For patients with severe sleep apnea, typically CPAP will be recommended as a first line of therapy. “It’s exciting that there is now a solution for patients with severe sleep apnea,” Dr. Thornton says. “We make custom CPAP masks for our severe patients that can be used in combination with the TAP. For the first time, it’s possible to have a strapless CPAP with no leakage and reduced pressures.”

Estimates vary, but some degree of sleep apnea reportedly occurs in 9 percent to 25 percent of adult men and 4 percent to 15 percent of adult women. According to the National Institutes of Health, untreated sleep apnea can lead to high blood pressure, congestive heart failure memory problems, emotional or personality changes, strokes and diabetes. It also increases the risk for work-related accidents and driving accidents because sleep interruptions result in poor sleep quality.

Another condition that interferes with sleep is Restless Leg Syndrome, which occurs when a creeping sensation in the leg causes someone to keep it in constant motion to relieve the discomfort. Even if the sufferer does manage to fall asleep, leg movement can persist, leading to a lousy night’s rest. These abnormal movements are caused by an imbalance of transmitters in the brain, according to the National Institutes of Health. Treatment may include medicine, vitamins or sleep aids. The condition affects men and women, all ages, including children, but often worsens for older adults. Some cases of RLS are related to other conditions, such as pregnancy, iron deficiency, anemia or kidney failure, according to the American Academy of Family Physicians.

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