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Snoring/Sleep Apnea

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Snoring is common in adults and as one ages, snoring becomes more prevalent. But oftentimes, the person snoring is not the only affected. Family members, and especially spouses, who are subjected to loud and disruptive snoring night after night, are also affected physically and emotionally. But the one who snores may also be risking developing very serious physical problems that can be life-threatening.


Sleep Breathing Disorders

Snoring and obstructive sleep apnea are two of the more common sleep breathing disorders which are characterized by the body’s inability to breathe properly while asleep. Sleep breathing disorders are widespread and can be very detrimental to your health. They might even cause a heart attack, stroke or even death.

What Exactly Are Sleep Breathing Disorders?

Sleep breathing disorders are breathing problems that occur while you sleep. There’s a spectrum of disorders starting with mild snoring to obstructive sleep apnea. As you fall asleep, your airway relaxes and might collapse itself, creating an obstruction that produces a sleep breathing disorder. On one end of the spectrum, mild, intermittent snoring might occur. On the other end of this spectrum, there might be total airway obstruction, which produces obstructive sleep apnea. (Thanks to Dr. Jennifer Krahe for much of this material)

What About Just Snoring

Who Snores? Were you aware that over 44% of American adults snore occasionally and over 24% snore regularly? Snoring itself is at most just a nuisance to your spouse or others in the room. However, snoring may be an indication of more serious, even life-threatening conditions.

Table 1: Snoring Incidence Levels in U.S. Population

  • Snores regularly
  • Snores occasion
  • Total snoring
  • Households With a snorer
  • 34%
  • 44%
  • 78%
  • Male head of household
  • 27%
  • 28%
  • 55%
  • Female head of household
  • 13%
  • 27%
  • 40%

What About Children?

The Stanford School of Medicine states that about 10% of children 10 years of age and younger snore and, of those children who snore, about 20% will have obstructive sleep apnea.

Snoring can be a sign that your child has sleep apnea as it indicates, at the very least, that their airway is partially obstructed during sleep. Sleep apnea is a serious medical condition that can interrupt or stop your child’s breathing, prevent a normal night’s sleep, impair growth, and lead to a lower quality of life. It also can cause serious fatigue during the day which is why it is so often confused with ADHD.

Sleep-disordered breathing such as snoring and obstructive sleep apnea (OSA) have long been associated with ADHD (Attention Deficit Hyperactivity Disorder). You should know that not every child diagnosed with sleep apnea has ADHD, just as not every child diagnosed with ADHD has sleep apnea. However, many studies have been performed indicating a significant correlation between OSA and behavioral issues. Children with obstructive sleep apnea do not get restful sleep, and as a result may complain of morning headaches, be irritable and have difficulty concentrating.

Children with sleep apnea may complain of being tired during the day and, at the same time, exhibit hyperactive behavior or act impulsively. Herein lays the confusion of separating sleep apnea from ADHD because many of the classic symptoms of ADHD are often exhibited in children with OSA. So, if you’re a parent of a child diagnosed with ADHD, what do you do?

Dig a little deeper into the root of what may be causing these behaviors. Watch your child sleep at night – and even record it if you can. Check for restlessness, mouth breathing, snoring, or breathing pauses. If they occur, have your child evaluated for possible sleep apnea to ensure the proper diagnosis and treatment.

Figuring out if your child has sleep apnea or ADHD may seem quite complex but it doesn’t have to be. Consult with Dr. Shankland if you can answer ‘yes’ to any or some of the following questions:

Sleep Apnea

Obstructive sleep apnea is snoring with quiet pauses in breathing ending in gasping, snoring or choking sounds. Have you or your spouse awakened suddenly in a panic, not being able to breathe? If this continues, the diagnosis may very well be obstructive sleep apnea. Apnea, or literally “want of breath,” is a serious, potentially life-threatening condition. This disorder was discovered as recently as 1965; it’s characterized by brief interruptions of breathing while sleeping for more than 10 seconds.

A person with sleep apnea may have breathing pauses or apneas that may last from 10 to 60 seconds or longer. Some people experience 20, 30 or more apneic events per hour ! During these events, the airway becomes blocked, thus blocking the entrance of air into the lungs. Here’s a list of the common characteristics of sleep apneic patients:

  1. 93% snore loudly
  2. 81% have gained weight 10 pounds or greater in the past 5 years
  3. 80% of these patients suffer from excessive EDS – excessive daytime sleepiness (fatigue)
  4. 79% of the time, the bed partner witnesses apneic events, the most common being chocking and gasping
  5. 73% of those with sleep apnea report unrefreshed sleep
  6. Believe it or not, 71% of those with sleep apnea have difficulty falling asleep and/or maintaining sleep


Medical Consequences of Obstructive Sleep Apnea

Even though Dr. Shankland has had extensive training in the study of physiology of sleep and of sleep medicine, a physician must make the diagnosis of obstructive sleep apnea, just to name one of several disorders.

The first step in detecting sleep disorders is to review your history. If you answer Yes to any of these next questions, it’s a good chance that you are suffering from a sleep disorder:

  1. Do you snore?
  2. For men, is your neck size 17 inches or greater and 15 ½ inches for women?
  3. Has your spouse of sleeping partner witnessed you experiencing apneas (chocking or gasping for breath)?
  4. Have you developed high blood pressure?
  5. Are you over-weight?
  6. Do you wake each morning and feel refreshed?
  7. Do you fall asleep at inappropriate times (that is, during meetings, while driving, while trying to carry on a conversation)?

After Dr. Shankland talks with a patient concerning these questions, if he feels there’s a good chance the patient may be suffering with one or several sleeping disorders, he refers the patient to a sleep lab and obtains consultation with a physician who specializes in sleep medicine.

Generally, a patient spends the night in a sleep lab and his or her sleep is monitored by highly trained sleep technicians. While sleeping, the several physiological functions are monitored and recorded (for example, oxygen saturation of the blood, apneic events per hours, restlessness, heart rate) and printed on graph paper so that the sleep doctor can read the results the next day. This special test, termed apolysomnogram , is very helpful for both the sleep doctor and Dr. Shankland in planning effective that could change your life.

Dr. Shankland may recommend a second sleep study after he begins providing treatment with an oral appliance. This second polysomnogram is obtained in order to make certain that you are achieving the most effective therapy.

Treatment of Obstructive Sleep Apnea

There are several types of treatment of sleeping disorders. Dr. Shankland, working in conjunction with the sleep medicine physician, often recommends more than one type of therapy. Briefly, types of treatment are as follows:

  1. A change in ones diet. For example, reducing caffeine and eating a well-balanced meal may help significantly to reduce sleep disorders
  2. Improvement in sleep hygiene (proper methods to prepare for sleep)
  3. Continuous positive airway pressure (CPAP). This is the use of a small and quiet machine. The patient wears a small mask and this machine lightly forces air through a tube, through the mask and opens the airway so that normal sleep occurs and most importantly, sleep apnea is dramatically decreased or eliminated, which means that all those possible severe medical problems can be reduced as well. CPAP therapy has helped countless patients and is considered the gold standard of therapy for sleep apnea today.
  4. Surgery. There are several types of surgery which may be recommended for obstructive sleep apnea. Unfortunately, these procedures are very painful and not generally successful long-term
  5. Dental Appliances. These are intra-oral appliances used to gradually bring the lower jaw forward, along with the tongue, to maintain an open airway during sleep. These have proved to be very effective and are a really good option for those patients who either can’t use or won’t use the CPAP machine. Dr. Shankland, with his nearly 3 decades of treating temporomandibular joint problems, has naturally added this type of therapy into his practice. Using oral appliances is simple, very safe, non-invasive, and to date, has the highest percentage of success in treating sleep disorders.

Consultation with Dr. Shankland

If you or a loved-one is interested in a consultation with Dr. Shankland concerning sleeping disorders, simply call the TMJ & Facial Pain Center at 614-794-0033 and request an appointment. A history form will be mailed to you and if you’re traveling for more than 3 hours by car, or flying to see Dr. Shankland (as so many of his patients do), ask for hotel and travel accommodations.