Sleep Apnoea & Overall Health

Sleep Apnoea and Your Overall Health Cairns

Sleep apnoea stops sufferers from having a good night’s rest and impacts daily life

Sleep apnoea is a serious sleep disorder that occurs when breathing repeatedly stops and starts. This can be caused by several reasons, depending on the sleep apnoea the patient suffers.

Types of sleep apnoea

Obstructive sleep apnoea (OSA)

The most common form and occurs when the throat muscles relax and collapse the airway. The muscles support the soft palate and when the muscles relax, it causes the airway to narrow or even close.

In some cases, narrow nasal airways caused by a deviated nasal septum (vertical midline bone of the nose) which is often accompanied by inferior turbinate (the lowest of the 3 roles of bone lining the outer wall of the inside of the nose on each side) hyperplasia (enlargement).

Often nasal polyps or swelling of the lining of the nose through allergies like hayfever, will restrict nasal airflow and force mouth-breathing.

Lung and heart disease issues like COPD, chronic obstructive pulmonary disease, and CHF, congestive heart failure, AF, atrial fibrillation, all are closely related to OSA, with OSA often being a substantial part of the cause of these problems.

This means you cannot get enough air, which lowers your oxygen level and notifies your brain causing you to wake up so briefly that you will not remember; disrupting your sleep.

The levels of oxygen in your blood that feed your brain, heart and every cell in your body, can drop to very low levels.

While you are awake, if you have no lung issues, your blood oxygen level will be between 96% and 100%.

In sleep apnoea, this may drop into the high sixty and 70 percent levels. Anything below 90% (we describe that as T90) is dangerous.

People die in their sleep with very low oxygen levels.

Most heart attacks that happen during sleep are from OSA.

The issue is that you may choke or gasp many times an hour every night. This completely impairs the ability to have a good night’s sleep.

We describe these obstructive events that occur as an Hypopnoea which is a partial blockage of the airway, Apnoea, which is a total blockage of the airway, and RERAs Respiratory Effort Related Arousals.

Central sleep apnoea (CSA)

This form is less common and occurs when the brain is not sending the proper signals to muscles that control the breathing. This means you will not breathe for a very short period, causing you to possibly wake up gasping for air.

Complex sleep apnoea syndrome.

Occurs when a patient suffers from both OSA and CSA

Did you know?

Sleep apnoea affects your whole body: stroke, hypertension, diabetes, libido, depression, anxiety, heart disease, and obesity.

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Apnea-hypopnea index (AHI)

The severity of a patient’s sleep apnoea can be measured using the apnoea-hypopnea index which takes the patients apnoea events (pauses in breathing) per hour and places them into a category. The apnoea events must last for at least 10 seconds and cause oxygen desaturation in the blood.
For an adult, it is normal for up to 5 apnoea events to occur in an hour while asleep, anymore is considered suffering from a form of sleep condition, however for children, an AHI of more than 1 apnoea in an hour is considered abnormal and should be seen by a doctor.

Normal: AHI<5

Mild sleep apnoea: 5≤AHI<15

Moderate sleep apnoea: 15≤AHI<30

Severe sleep apnoea: AHI≥30

RDI, Respiratory Disturbance Index, is the measure number of times per hour that hypopnoeas, apnoeas, and RERAs occur, and is a better measure of severity of OSA, than AHI, Apnoea Hypopnoea Index.

Other factors are good markers of severity including Nadir which is the lowest level of oxygen saturation in the blood, and T90 which is the time below 90% oxygen saturation. These are probably more important measures than AHI or RDI which, by convention, is the typical marker of OSA.

Who does sleep apnoea affect?

Unfortunately sleep apnoea can impact anyone, however there are factors which can increase the chances, including the following:

  • Overweight, obesity, and morbid obesity
  • Narrows airways, high, narrow palate
  • Neck circumference over 41 cms in a female and 43 cms in a male
  • Nasal congestion through allergies like hayfever
  • Being older
  • Being male
  • Use of alcohol especially within 2 hours of going to bed
  • Sedatives especially within 4 hours of going to bed
  • Smoking
  • Family history
  • Heart disorders
  • Certain medications
  • Stroke
  • Mouth breathing
  • History of silent Reflux
  • Grinding or clenching teeth.

Symptoms and complications of sleep apnoea

Symptoms

  • Snoring
  • Stopping breathing during sleep
  • Gasping for air
  • Morning headaches
  • Waking up with a dry mouth
  • Habit of grinding and clenching the teeth during sleep
  • Silent Reflux (Laryngopharyngeal Reflux)
  • Difficulty sleeping
  • Insomnia
  • Daytime tiredness
  • Difficulty paying attention during the day
  • Irritability
  • Mood changes
  • Cognitive decline
  • Poor academic or work performance
  • Loss of libido or erectile dysfunction
  • Depression and anxiety  
  • High blood pressure that is difficult to control
  • Risk of an accident is greatly increased

Complications

  • High blood pressure – the sudden drops in oxygen levels overnight lead to increased blood pressure, which puts a strain on the cardiovascular system.
  • Heart problems – it is known that the obstructive sleep apnoea may increase the risk of heart attacks, stroke and abnormal heartbeats. This is a major health risk as these together could lead to death.
  • Liver problems – sleep apnoea can lead to liver scarring and abnormal results on liver function tests.
  • Type 2 diabetes – sleep apnoea increases your bodies risk of insulin resistance, which may lead to diabetes type 2.
  • Surgery complications – after having major surgery, patients who suffer from sleep apnoea are exposed to greater risks.
  • Higher risk of cancer and poorer cancer outcomes.
  • Postoperative complications after surgery.

These symptoms and complications are all the reasons to why a person suffering sleep apnoea should seek treatment from Dr Gibbins at Dental Sleep Medicine.

Please also remember that if you suffer from sleep apnoea, it can impact your daily life in all aspects and make you dangerous while driving.

Tongue Exercises

The tongue is frequently involved in Obstructive Sleep Apnoea (OSA) and TMJ and Oro-Facial Pain conditions and should not be overlooked in management. Lack of strength and tone in the tongue contributes to many jaw pain and airway problems.

Myofunctional Therapy, as used for OSA and Sleep Disordered Breathing, has been clinically proven to improve OSA by as much an 50%.

While this strategy of tongue strengthening is rarely undertaken as the only management in OSA, it is certainly a useful additional mode of treatment to use along with CPAP therapy or Oral appliance therapy, as well as various other modes of treatment.

Anybody with OSA should be instructed in terms of simple exercises they can do regularly to assist in their home-care.

Incorrect tongue posture and positioning and incorrect swallowing techniques that linger from infancy can be addressed.

  • A very useful exercise for relaxing painful masticatory muscles and also to strengthen the tongue and increase the muscle-tone of the tongue, the Lateral Pterygoid and Medial Pterygoid Muscles, is to raise the tip of the tongue to the roof of the mouth and hold the tongue on the palate and scrape the tip of the tongue back to the back of the palate.

Repeat this particular exercise 20 times at least twice a day and whenever else you think of it, eg in the shower, while driving etc..

This exercise is also very useful in repositioning the head of the jaw (condyle) back into its resting position on removal of the Mandibular Advancement Device in the morning.

  • Open the mouth widely and close again immediately. Repeat 20 times at least twice a day.
  • For actual TMJ pain cases, an additional exercise that can be done is to place the tip of the tongue on the palate just behind the upper front teeth, hold it firmly against that spot and open the jaw as wide as you comfortably can and hold it about 5 seconds with the tongue still on the palate. Close again and simply, and repeat 2-3 times a day along with the above set of exercises.
  • Tik Toks. This exercise involves sucking the tip of the tongue to the palate behind the upper front teeth and “clicking” it off the palate with the lips first in a smiling position, the TIK, and then with the lips pursed as in saying “Oooh” as the TOK position. Repeat 20 times 2-3 times daily.
  • Close the lips and push the tongue firmly into the upper and lower lips and cheeks, moving the tongue from upper lip, to lower lip and both cheeks. This needs only to take 15-20 seconds each time. Repeat it 3 times each exercise session and 2-3 times daily.
  • Drink sips of water through a straw with the teeth held together.

A very useful relaxation technique used in many chronic pain conditions:-

  • Lie flat on the floor on your back on a gym or yoga mat, not a bed. If the neck is chronically inflexible, use a folded towel so the head is passively held neither head forward nor head backward. The eyes should face straight up.
  • Tuck the chin in.
  • Place the tip of the tongue on the palate just behind the upper front teeth and close the lips.
  • Place one hand on the stomach and the other on the chest.
  • Concentrate on regular breathing into the belly not the chest.
  • Hold this position for 10 minutes, although longer is fine.
  • Repeat this relaxation pose twice a day for at least 2-3 weeks although it can remain a permanent habit.

Self-administered diagnosis tests for you

STOP-BANG Questionnaire:

The questionnaire has a score range from 0 to 8 and asks questions regarding snoring, sleepiness, breathing difficulties while sleeping and high blood pressure. Any score over 3 means there is a high risk of OSA in the patient.

OSA-50 Screening Questionnaire:

This test calculates a score between 0-10 by asking about questions related to OSA symptoms. A score ranging from 5-10 means the patient may be at risk of OSA.

Epworth Sleepiness Scale (ESS):

The ESS is a questionnaire which determines daytime sleepiness by asking 8 questions related to the chance of dozing off while performing the 8 different activities. Each question has a 0-3-point scale system and the questionnaire has a total score between 0-24. The higher your score, the higher the chance of suffering from OSA.

Please have a look at the three self-administered diagnosis test here.

In Australia, an ESS score of 8 or more, a STOP-BANG Score of 4 or more and an OSA 50 Score of 5 or more qualifies a patient to have Medicare cover part or all the cost of a Home Sleep Study. Medicare will only cover any part of the cost of a Home Sleep Study if it has not been done in the last 12 months. If you think you may suffer from sleep apnoea, please do not hesitate to contact Dental Sleep Medicine by clicking here Contact Us or calling our friendly staff on (07) 4051 4580 .