How Does Snoring Occur?

Snoring occurs when the air passages at the back of the mouth and nose do not have a free flow of air. Obstruction of the airways usually occurs when the soft tissues in that area collapse during sleep, causing the tongue to meet briefly with the soft palate (top part of your mouth in the back) and the uvula (the hanging bell-shaped tissue in the back of your throat). The vibrations are what cause the actual sound of snoring.

Snorers may also suffer from:

• Poor oral muscle tone. Relaxed tongue and throat muscles can cut off airflow. Deep sleep, alcohol and sleep medications can contribute to poor muscle tone.
• Large tonsils and adenoids. Excess throat tissue can cause snoring. Being overweight can cause excess neck tissue, which is why snoring is more common in overweight individuals.
• Long uvula and/or soft palate. Individuals with a long palate have a narrower opening between the nose and throat that can create noise during the relaxed breathing of deep sleep. A longer than normal uvula worsens the situation.
• Nasal airway obstruction. Stuffy noses do not have a free flow of air. The extra effort it takes to breathe through a stuffed up nose creates a strong pull on floppy throat tissues, causing a snoring sound. That is why some people experience snoring only during hay fever attacks, a cold or a sinus infection.
• Nose or nasal septum deformities, such as a deviated septum, can cause obstruction.

To learn more about snoring and sleep apnea, please contact Gurnee, Illinois dentist and sleep apnea specialist, Dr. Ira L. Shapira today to schedule your initial consultation.

UPPP Failure and limited success at Cleveland Clinic. Is it time to Abandon UP3 surgery as pPrimary Apnea Treatment

An article "UTILITY OF UPPP IN OSA: THE CLEVELAND CLINIC EXPERIENCE by Lee-Iannotti JK, Bae CJ, Kominsky A, Alsheikhtaha Z reviews the results of UPPP (UP3) surgery on 28 patients who met study criteria from 250 charts reviewed.

These 28 patients unerwent Uvulopalatopharyngealplasty, with or without tonsilectomy and/or septoplasty. ONLY 2 PATIENTS (6.6%) WERE "CURED" HAVING AN AHI OF LESS THAN "5". THE STUDY STATES THAT THERE WAS A 43 % SUCCESS RATE. HOWEVER SUCCESS WAS DEFINED AS 50% REDUCTION AND AHI OF LESS THATN 20. THESE PATIENTS STILL HAD MILD TO MODERATE SLEEP APNEA!

THE STUDY REPORTED " Overall, there was a decrease in the overall AHI in all the patients undergoing surgery (mean AHI ± SD, 45.6 ± 29.2 pre-UPPP vs. 30.4 ± 26.1 post-UPPP, P = 0.019*.) Thirteen patients (43%) achieved a 50% or greater reduction
in the AHI and/or an AHI of 20 or less.

The study showed no reduction in CPAP pressures: " Of the patients requiring CPAP therapy post-UPPP, there was
no significant decrease in pressure requirements (mean CPAP pressure
± SD, 9.4 ± 0.5 pre-operatively vs. 9.1 ± 0.7 post-operatively, P = 0.35.)"

The authors concluded that: "UPPP achieved surgical success in 43% of our patients. Younger patients (< 40 years) with lower Friedman scores (≤ 2) seemed to have greater surgical success rates. BMI, neck circumference, tonsil-
lar size, severity of OSA and presence of retrognathia did not seem to be predictors of outcome.

EXCEPT FOR YOUNGER AGES AND LOWER TONGUE POSITION THERE WERE NO PREDICTORS OF POSITIVE SUCCESS. BASED ON THIS STUDY THE USE OF UPPP SURGERY IN ADULTS OVER 18 IS QUESTIONABLE AT BEST.

BOTH CPAP AND ORAL APPLIANCES ARE MUCH MORE SUCCESSFUL EVEN WHEN POOR CPAP COMPLIANCE IS CONSIDERED.

COMPARED TO SURGERY ORAL APPLIANCES ARE DEFINITIVELY A BETTER TREATMENT CHOICE. CPAP IS A SUPERIOR CHOICE IF IT IS USED ALL NIGHT ON A REGULAR BASIS.

ONE ADVANTAGE TO SURGERY IS THAT PATIENT COMPLIANCE IS A NON-ISSUE.

Simple Saliva Test for Sleep Apnea.

A abstract published in the SLEEP abstract supplement "AMYLASE mRNA IS ELEVATED IN SALIVA OF SUBJECTS
WITH OBSTRUCTIVE SLEEP APNEA" by Thimgan M1, Gottschalk L1, McLeland JS2, Toedebusch C2, Duntley S2, uses a measure of amylase mRNA to test for sleep apnea.

The authors conclude that " Saliva is a readily accessible biofluid that offers a source
of analytes that can be used to assess sleepiness" I believe this is false but it can be used to assess amount of sleep apnea, sleepiness is a subjective symptom of sleep apnea........ The authors also conclude that "Salivary Amylase is a practical and objective test that can be used, in conjunction with other indicators, to encourage patients to visit the sleep lab for testing and treatment of OSA.

I believe this is ideal. If a simple 2 second swab can predict apnea we now have an excellent method of selecting patients who definitively need sleep evaluation. We must consider that there will be some false positives that sleep studies will be normal or show another sleep disorder other than apnea causing the rise in saliva measures. The false negatives would be a larger concern if a sleep test wasw not given due to low saliva levels and a serios problem was missed.

Diet Change May Not Stop Snoring

We've all heard about different foods and drinks affecting the way we sleep at night and the amount you snore or not. Unfortunately, if you are suffering from sleep apnea, simply changing the foods you eat and liquids you drink might not prevent you from snoring.

Snoring at night can seriously affect the way you and even your sleeping partner sleep at night. Depending on how severe your snoring is it may be a symptom of sleep apnea, a sleeping disorder that can impact many other aspects of your life. Sleep dentists like Dr. Ira Shapira in Gurnee, Illinois, help people diagnose their sleep apnea when there is something more serious involved.

For some people, snoring is simply a disturbance that could be caused by many different factors. Drinking alcohol, eating dairy products, or eating a large meal before going to sleep might make this type of snoring worse.

Millions of other people who snore are actually suffering from a much more dangerous condition called Obstructive Sleep Apnea (OSA). When someone has OSA, the passageways in their throat temporarily close and prevent oxygen from reaching the lungs. To correct this problem, the brain wakes you from sleep so the body can open the passageway.

With the body and brain constantly waking up throughout the night, the body can’t get the deep, restful sleep it needs to perform correctly and it can suffer from a few different dangers of sleep apnea.

If you or your sleeping partner is suffering from snoring a night and changing diet habits haven’t helped, sleep apnea might be causing the sleep problems. To find out if you or one of your loved ones is suffering from sleep apnea, please contact Dr. Ira Shapira in Gurnee, Illinois to schedule a professional sleep analysis.

GENIOGLOSSUS STIMULATION DOES NOT HELP SLEEP APNEA

THE STUDY "STATE-DEPENDENT EFFECTS OF GENIOGLOSSAL STIMULATION ON UPPER AIRWAY" BY Buterbaugh J1, Ahmed O2,3, Wynstra C1,3, Morrison-Barrios M, Koebnick J1, Parthasarathy S SHOWED THAT STIMULATION OF THE GENIOGLOSSUS MUSCLE WHICH INCREASED AIRWAY DIMENSION IN AWAKE PATIENTS WERE NOT RELATED TO REDUCTIONS IN SLEEP-RELATED BREATHING DISORDERS AT NIGHT. THE AUTHORS POSTULATE THAT THERE ARE OTHER FACTORS THAT DETERMINE NOCTURNAL AIRWAY.

ACOUSTIC PHARYNGOSCOPY IS FREQUENTLY USED TO EVALUATE AIRWAY SIZE BASED ON ACOUSTIC ECHOES. THIS STUDY WOULD PROVOKE QUESTIONS AS TO THE VIABILITY OF THOSE AWAKE MEASUREMENTS FOR EVALUATING A SLEEP DISORDER. THIS IS NOT TO SAY THAT ACOUSTIC PHARYNGOSCOPY DOES NOT HAVE A ROLE TO PLAY BUT RATHER TESTING OF TREATMENT EFFECTIVENESS MUST BE DONE DURING SLEEP.

Structural Changes to Brain from Sleep Apnea and Correction with Treatment.

Can the brain recover from damage caused by Sleep Apnea. The answer is yes according to a study done in Italy that showed that in addition to clinical improvement there was also brain-structural recovery. The study emphasizes that adherence to CPAP therapy is key. Unfortunately 60% of patients are not adherent to CPAP therapy and even those that are adherent average only 4-5 hours of use a night which has been shown to be far less that ideal. A recent article "Long-term effect of continuous positive airway pressure in hypertensive patients with sleep apnea."in Am J Respir Crit Care Med. 2010 Apr 1;181(7):650-2 showed that treatment of hypertension with CPAP required an average of 5.6 hours of nightly CPAP use. The actual conclusion was " In nonsleepy hypertensive patients with OSA, CPAP treatment for 1 year is associated with a small decrease in BP. This effect is evident only in patients who use CPAP for more than 5.6 hours per night."

if 5.6 hours of nightly use is necessary for improvement and if the typical patient only uses cpap 4-5 nights for 4-5 hours than we should not expect improvement in hypertension. Does the same hold true for repair of structural damage from sleep apnea?

THE REAL ADVANTAGE TO ORAL APPLIANCES IN TREATING APNEA IS THAT PATIENTS GENERALLY USE THEM ALL NIGHT LONG. IF ORAL APPLIANCE ARE NOT EFFECTIVE IN A SMALL NUMBER OF CASES CPAP SHOULD BE UTILIZED. PATIENTS WHO USE THEIR CPAP ALL NIGHT/EVERY NIGHT NEED NOT CONSIDER THE ORAL APPLIANCE ALTERNATIVE.

This interesting study published in abstract form in sleep explains the importance of treatment of sleep apnea. The study "BRAIN STRUCTURAL CHANGES IN OSA PATIENTS BEFORE AND AFTER TREATMENT" by Ferini Strambi L, Canessa N, Castronovo V,Alemanno F, Aloia MS5, Marelli S1, Falini A6, Cappa SF2,3,4 concludes that "Conclusion: Our study provide evidence of a neuro-structural damage in OSA patients (decrease of grey-matter volume compared with controls) affecting specific cerebral regions and an increase of grey-matter volume in specific hippocampal and frontal brain regions with treatment. This study offers hope to patients and physicians that adherence to CPAP therapy can lead not only to clinical, but also to brain-structural recovery.

Am J Respir Crit Care Med. 2010 Apr 1;181(7):718-26. Epub 2009 Dec 10.
Long-term effect of continuous positive airway pressure in hypertensive patients with sleep apnea.
Barbé F, Durán-Cantolla J, Capote F, de la Peña M, Chiner E, Masa JF, Gonzalez M, Marín JM, Garcia-Rio F, de Atauri JD, Terán J, Mayos M, Monasterio C, del Campo F, Gomez S, de la Torre MS, Martinez M, Montserrat JM; Spanish Sleep and Breathing Group.

Collaborators (16)
Coordinating Center, Institut de Recerca Biomèdica Lleida, Lleida, Spain. fbarbe@arnau.scs.es
Comment in:

Am J Respir Crit Care Med. 2010 Apr 1;181(7):650-2.
Abstract
RATIONALE: Continuous positive airway pressure (CPAP) is the current treatment for patients with symptomatic obstructive sleep apnea (OSA). Its use for all subjects with sleep-disordered breathing, regardless of daytime symptoms, is unclear. Objectives: This multicenter controlled trial assesses the effects of 1 year of CPAP treatment on blood pressure (BP) in nonsymptomatic, hypertensive patients with OSA. METHODS: We evaluated 359 patients with OSA. Inclusion criteria consisted of an apnea-hypopnea index (AHI) greater than 19 hour(-1), an Epworth Sleepiness Scale score less than 11, and one of the following: under antihypertensive treatment or systolic blood pressure greater than 140 or diastolic blood pressure greater than 90 mm Hg. Patients were randomized to CPAP (n = 178) or to conservative treatment (n = 181). BP was evaluated at baseline and at 3, 6, and 12 months of follow-up. MEASUREMENTS AND MAIN RESULTS: Mean (SD) values were as follows: age, 56 +/- 10 years; body mass index (BMI), 32 +/- 5 kg x m(-2); AHI, 45 +/- 20 hour(-1); and Epworth Sleepiness Scale score, 7 +/- 3. After adjusting for follow-up time, baseline blood pressure values, AHI, time with arterial oxygen saturation less than 90%, and BMI, together with the change in BMI at follow-up, CPAP treatment decreased systolic blood pressure by 1.89 mm Hg (95% confidence interval: -3.90, 0.11 mm Hg; P = 0.0654), and diastolic blood pressure by 2.19 mm Hg (95% confidence interval: -3.46, -0.93 mm Hg; P = 0.0008). The most significant reduction in BP was in patients who used CPAP for more than 5.6 hours per night. CPAP compliance was related to AHI and the decrease in Epworth Sleepiness Scale score. CONCLUSIONS: In nonsleepy hypertensive patients with OSA, CPAP treatment for 1 year is associated with a small decrease in BP. This effect is evident only in patients who use CPAP for more than 5.6 hours per night. Clinical trial registered with www.clinicaltrials.gov (NCT00127348).

PMID: 20007932 [PubMed - indexed for MEDLINE]

Some Questions and Answers about OSA and CPAP

What is sleep apnea?

During sleep, some peoples' breathing briefly stops many times throughout the night. Obstructive sleep apnea is caused by the soft tissue at the back of the throat collapsing and blocking the airway. Central sleep apnea occurs when air cannot flow into or out of the person's nose or mouth through efforts to resume breathing because of confused signals from the brain to the diaphragm.

What causes sleep apnea?

Mechanical and structural problems in the airway interrupt breathing during sleep. The throat muscles and tongue relax too much during sleep, blocking the airway.
Am I at risk for sleep apnea?

This can affect anyone, however, it's more prevalent in men. Loud snoring, weight problems and high blood pressure are risk signs. If you never feel rested, suffer from being overweight, smoke, or notice behavioral changes, such as depression, see an experienced sleep apnea specialist. Snoring is also a sign of sleep apnea, but isn’t the only indicator.

Does obstructive sleep apnea require surgery?

Oral appliance therapy is an alternative to surgery. Therapeutically, they reposition the lower jaw and tongue to reduce apneic occurrences.

If I use a CPAP do I still need surgery?

By correctly adhering to treatment, Continuous Positive Airway Pressure, or CPAP, can be very successful. However, studies also show only 23-45% of patients attain success. CPAP is a commitment, those who think they can’t devote themselves to the program should look into oral appliance therapy. Surgery is a last resort.

For many, CPAP is uncomfortable. Less cumbersome methods use simpler mouthpieces that properly align the jaw for safer sleep. These mouthpieces resemble sports mouth guards and helps patients breathe through the nose and mouth. If CPAP is uncomfortable, look into the alternate treatment options.

Why should I seek treatment for sleep apnea?

Quality sleep is essential to wellness. Sleep apnea creates lack of energy, inhibits concentration and slows metabolism. Even worse, lost sleep increases chances for high blood pressure and heart attacks.

If you suffer from sleep apnea, would like to be learned more about it, or know someone who does suffer from it, please visit the website of experienced sleep apnea specialists at www.ihatecpap.com.