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Snoring, Sleep Apnea

There is a great deal of correlation between sleep apnea and poor jaw alignment. If the lower jaw needs to go backwards in order to get the teeth to come together…to bite, chew etc., then the tongue has to go back towards the throat. This impairs the airway.

Those that have TMD, have damaged and loosened joints. So in sleep, the jaw falls further back, worsening the airway.

Tim Russert, NBC News’ Washington bureau chief and the moderator of “Meet the Press,” died June 13, 2008 after suffering a heart attack at the bureau. He was 58. Russert’s physician, Michael Newman, said cholesterol plaque ruptured in an artery, causing sudden coronary thrombosis. He had a massive heart attack. This is a common cause of death in reasonably healthy 50 year olds.

Russert had earlier been diagnosed with asymptomatic coronary artery disease, but it was well-controlled with medication and exercise, and he had performed well on a stress test in late April, Newman said. An autopsy revealed that he also had an enlarged heart, Newman said.

My first thought after hearing the news of his death was that it probably was result of sleep apnea. As a regular viewer of “Meet the Press”, I had noticed the large neck, hanging jowls, retruded lower jaw, narrow upper jaw and obesity as clear markers for SDB (Sleep Disordered Breathing). I shared that on an e-mail forum which revealed that a lot of doctors that are knowledgeable in this area had thought the same thing.

I later read similar views from an expert. J. Steven Poceta, M.D., is a board-certified neurologist and board-certified sleep disorders specialist. He writes, “I wonder if Mr. Russert had sleep apnea”.

What is the connection? When there is airway obstruction during sleep, the blood oxygen level drops. Heart rate goes way up to get more oxygen to the brain. Some times the heart beats three times its normal rate during these episodes! Such an occurrence night after night, weakens the heart muscles, which could explain Russert’s enlarged heart. One struggles mightily in response to this “choking”. This is high stress. So the stress hormone, cortisol, is released in our body. High cortisol levels lead to weight gain, which only worsens the airway obstruction.

Surely, one might think, this would wake a person up. While this “choking” disturbs the sleep cycle, often it is not enough to completely wake a person up. I recently met a young father of 5 children. He is only in his 20’s. The moment I said hello, I could not help notice the “signs” of SDB. On questioning, the wife reported that she has observed Jimmy ‘choking’ in his sleep. Upon my insistence and referral, he had a sleep study done which revealed that he stopped breathing 94 times an hour and blood oxygen dropped to 68% from a normal 97-100%. Yet he never completely woke up. But he was often tired and sleepy during the day. He is getting the necessary treatment now.

What exactly is SDB?

The most common Sleep Disordered Breathing is related to obstruction of airway. It is a continuum with varying degrees of blockage of airway. On the milder end of the spectrum is snoring. If the obstruction is partial, there is vibration of the soft palate that constitutes the noise of snoring. If the blockage leads to a mild (less than 4%) drop in blood oxygen level it is termed a Hypopnea. RERA (Respiratory Effort Related Arousal) is the phenomenon of struggling for breath that disturbs the sleep. Complete stopping of breathing of over 10 seconds with effort to breath and leading to more than 4% drop in blood oxygen level is Obstructive Sleep Apnea (OSA). The frequency of events per hour determine if OSA is mild, moderate or severe (over 30 events per hour).

Sleep apnea is a public health issue that is more prominent than diabetes. It is estimated that 50 million Americans suffer from this disorder.

Obstructive sleep apnea (OSA) is associated with snoring, daytime drowsiness, obesity, and other risk factors. Patients with OSA are at increased risk for:

  • high blood pressure
  • irregular heart beats
  • heart attacks
  • stroke
  • decreased libido
  • impotence
  • gastro esophageal reflux disease (GERD)
  • heartburn
  • morning headaches
  • dry mouth
  • irritability
  • impaired concentration
  • depression
The best way to diagnose Sleep Disordered Breathing (that includes Sleep Apnea) is a Polysomnogram (Sleep Study). All except Severe Sleep Apnea and Central Sleep Apnea are best treated with oral appliances. They are easier to get accustomed to and easy to take with you when you travel.

More information may be found on the video here.


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Sleep Breathing Disorders such as Obstructive Sleep Apnea are usually treated with CPAP. People HATE CPAP. Oral appliances are a great option for a lot of people.

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