Snoring and Obstructive Sleep Apnea (OSA) Information
If you suffer from annoying snoring possibly resulting in the need for separate bedrooms, your problem may be reduced or even eliminated using modern appliance therapy. Between 10 and 30% of all adults snore, and in the age group 40 to 60, 60% of men and 40% of women snore, so you are not alone.
How does the disturbing snoring noise develop?
If the gap between tongue base (fig. 1 "A"), rear throat wall (fig. 1 "E"), soft palate (fig 1 ,,0") and uvula (fig. 1"C") becomes too small, the pressure and flow rate of the inhaled air increase. The soft parts within the airway begin to vibrate, and the typical snoring sounds develop. Snoring in most cases does not require special treatment, since, apart from the irritating noise which puts a great strain on relationships, it does not otherwise represent a serious health risk.
Fig. 1: The upper respiratory system
This form of snoring (without breathing arrests and without any reduction in the blood oxygen levels, "Hypoxaemia") is often called primary or habitual snoring. Heavy snoring can on the other hand be a good indication of obstructive sleep apnoea syndrome (OSAS), which is a more serious breathing disorder. Patients with obstructive sleep apnoea have repeated breathing arrests ("Apnoeas"), sometimes lasting up to one minute -or longer, and this occurs several hundred times each night. The apnoeas result from the temporary blockage of the airway during inspiration (See fig. 1 "A"). Sometimes the cause is a collapse of the bronchial tube. In the age group> 35, obstructive sleep apnoea occurs in approx. 2% of all women and 4% of all men. There are 2 to 3 million people alone in Germany suffering from this disease, which therefore has all the character of a public disease. Risk factor No.1 is obesity. Further predisposing factors include among other things: anatomical abnormalities in the jaw area, e.g., a receding chin, enlarged palate and throat tonsils, long and pendulous uvula, an enlarged tongue (fig. 1 "A"), blocked nose, alcohol consumption and sleeping pills.
Symptoms of the illness are: regular heavy snoring, excessive daytime sleepiness, reduced physical and mental agility, restlessness during sleep, sleeping partner worried when breathing stops, disturbed sleep by micro-arousals, reduced libido, impotence and depression. If the respiratory system is not working properly, the organs are not properly oxygenated. Additionally, sleep apnoea can cause high blood pressure, heart failure and stroke. It is important for your health and well-being that a proper diagnosis differentiating primary snoring from obstructive sleep apnoea is made by your physician. Before your appointment you should fill out the questionnaire in this brochure, preferably with your partner, and take it with you when you see your doctor. After taking a history your physician will examine the upper respiratory system and if necessary perform further investigations to determine the type and cause of your sleep disturbances, such as:
- Measurement of your breathing patterns, oxygen saturation, heart rate, body position and body movement as well as snoring sounds with an ambulatory screening device that can be used at home during sleep.
- Test sleep in the sleep laboratory ("polysomnography") to determine the following parameters: sleep stages (EEG, EMG and EGG), breathing flow, chest and abdominal movements, leg movements, cardioactivity (ECG), muscle tone (EMG), body position, oxygen saturation and snoring sounds.
Depending on the result of the tests the following therapy options may be proposed. There may be others not listed.
- Conversion of life style, e.g, weight reduction, improvement of the sleep hygiene, reduced alcohol consumption.
- Drug treatment, e,g. with Theophyllin
- Use of mandibular advancement appliances which advance your lower jaw and improve the airway at the base of the tongue. This option is most effective with obstructions at the tongue base.
- Machine based artificial pressure respiration, e.g. with nCPAP devices, for maintaining an open airway during sleep.
- Surgical intervention, e.g, removal or reduction of the soft palate and/or tonsils, uvula, and/or tongue base, lower jaw advancement.
Mandibular Advancement Device for the Treatment of Snoring and Nocturnal Breathing Arrests. Worn in the mouth like a sports mouthguard, reduces nocturnal snoring and apnoea occurring with obstructive sleep apnoea.
Modern appliance therapy Effectively Stops annoying Snoring and reduces nocturnal respiratory arrests.Description: modern appliance therapy consists of a hypoallergenic thermoplastic body. It was developed in conjunction with the sleep laboratory of a German ENT university clinic and is based on clinical experiences over several years with the predecessor model SnorBan®. Fitting the appliance can be carried out without special equipment. After heating the mouthpiece in boiling water the appliance is carefully fitted with the lower jaw advanced by approx, 50 to 75 % of the maxi- mum lower jaw extension, If necessary the appliance can be fitted for a second time in order to improve the fit. In the front of the appliance there is a small rectangular hole for situations which require emergency breathing, (e.g., blocked nose).
Clinical experience: Since the development of modern appliance therapy is based on the clinical experiences made with its predecessor, its equivalence of efficacy was confirmed at 26 patients before market launch in comparison with the predecessor model SnorBan® since middle of 1997. Regarding the reduction of snoring and the Respiratory Disturbance Index (RDI, being a measure for the number of breathing arrests and phases with decreased respiration per sleep hour) SomnoGuard® proved thereby just as effective as the predecessor model. However, regarding tolerabilty and the mouthpiece's duration of life, clear improvements could be obtained with modern appliance therapy.
The clinical studies accomplished before with SnorBan® are already published and furnished essentially the following results: In a clinical study enrolling 39 patients with sleep apnea performed at the sleep lab of the ENT university clinic of Mannheim (Germany) the authors J.T. Maurer, K. Hoermann et al. demonstrated that under SnorBan® both the sleep architecture and the breathing disturbances as well as the snoring significantly improved. The period of snoring was lowered likewise highly significantly from 16,3% to 6,6%. A subjective improvement of snoring indicated 76.9% of the patients on asking. Likewise the ADI value was high-significantly lowered by SnorBan®". The success rate, defined as a reduction in the ADI to <10 as success, amounted to 59.1 % under polysomnographic control. Isolated observed side effects were brief morning toothache, temporary jaw pain as well as increased salivation during the first few nights of use. A few patients also reported nausea. The acclimatizing time was between 0 and 21 days but only 4 days on average. In a second study of patients suffering predominantly from obstructive sleep apnoea, which was performed at a respiratory hospital at Schmallenberg, in cooperation with the dental medicine university hospital of Marburg (both sites located in Germany), the authors B. Schoen hofer, D. Koehler et al. reported a clinically significant improvement of 50% in 22 patients using SnorBan®. Side effects observed in this study were comparable to those of the first study noted above. From the extensive clinical investigations with modern appliance therapy and the predecessor model we conclude that modern appliance therapy is a very inexpensive, safe and effective mandibular advancement device at least for the temporarilly limited treatment of snoring and also, under strict medical control, for obstructive sleep apnoea.
Snoring and Obstructive Sleep Apnoea, self-check questionnaire for Snorers. You may want to consult with a specialist if you have sever snoring that has just started recently and you haven't gained any weight.
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