Obstructive Sleep Apnea
Do you awaken refreshed and rejuvenated with lots of fresh energy from a good night’s sleep, ready for a full productive day? Or do you feel tired in the morning after 7 or 8 hours of sleep?
— Yes
— No
— Sometimes
Most people think that feeling tired in the morning after a full night’s sleep is caused by increased stress, poor diet, lack of exercise, aging and the trials and tribulations of a busy life.
Although these can contribute to feeling tired, the most common cause of tiredness in the morning is a lack of sufficient oxygen while sleeping. This can be due to any blockage of the airway, including nasal congestion, sinus congestion, excessive or lax soft tissues or an anatomically narrow airway causing mild, moderate or severe obstructive sleep apnea.
Unfortunately, most people are unaware that they have mild or moderate sleep apnea, since they are sleeping and do not necessarily wake up, even during episodes of decreased oxygen uptake or arousals that occur during sleeping from a lack of oxygen.
It is during these moments of decreased oxygen uptake and perioding arousals throughout the night — without actually awakening — that one enters into a lighter stage of sleep. Upon waking in the morning, you may think you have slept all night, but the quality of sleep, including deep restful rejuvenating sleep and REM sleep, has been significantly reduced, causing you to feel tired.
Fortunately, it is possible to diagnose and quantify your quality of sleep and there are very effective solutions to allow you to attain a deep restful sleep and awaken fully rejuvenated.
What Is Obstructive Sleep Apnea?
Obstructive sleep apnea (OSA) is a common sleep disorder characterized by recurrent episodes of partial or complete obstruction of the upper airway during sleep. This obstruction can cause a person to experience brief pauses in breathing, known as apneas, which can lead to a range of symptoms and complications and result in a decreased level of oxygen in the blood while sleeping.
This can also involve gentle, moderate or loud snoring, resulting in a lack of optimal levels of oxygen. A lack of oxygen over time can cause feelings of despondency, despair, depression, cognitive impairment, memory loss, daytime fatigue and a whole host of progressive health problems, including an increased risk of diabetes, hypertension and heart disease.
While awake, we have 100% oxygen saturation. Oxygen saturation can drop significantly while sleeping, depending upon mild, moderate or severe apnea.
Obstructive sleep apnea (OSA) affects millions of people worldwide.
What Are the Most Common Symptoms of Obstructive Sleep Apnea?
The most common symptoms of OSA include:
- Mild, moderate or loud snoring
- Gentle episodes of gasping, attempts to breath deeper and even stopping breathing for very short periods of time
- Light arousals, without waking during sleep
- Excessive daytime sleepiness
In addition to these, OSA can:
- Impact a person’s feeling of wellbeing, contributing to conditions like despondency, depression and anxiety.
- Cause cognitive impairments, such as difficulty concentrating and memory problems.
- Disrupt a person’s sleep and lead to poor quality of sleep, which can have a negative impact on their overall health and well-being.
- Increase the risk of high blood pressure, heart disease, stroke and diabetes.
- Increase the risk of accidents due to excessive daytime sleepiness.
The multi-disciplinary Medical Center in Pacific Palisades, CA, has experienced board-certified specialists (see Sinus Center Los Angeles, Orthodontic Center Los Angeles, and Jaw Surgery Los Angeles) that can identify your specific condition. Fortunately, effective treatments are available.
Early diagnosis and treatment are essential to manage these conditions and help prevent the development of progressive conditions and serious health problems.
How Can I Test for Obstructive Sleep Apnea?
Diagnosis of OSA typically involves a combination of medical history, physical examination and diagnostic testing, such as a sleep study.
A sleep test can measure the Apnea Hypopnea Index (AHI). Orthodontic Center Los Angeles and Sinus Center Los Angeles, and Jaw Center Los Angeles can arrange a sleep test (polysomnogram), including providing you with a medical grade sleep test that you can do in the comfort of your own home.
If preferred, or for complex medical conditions, an overnight sleep test can also be arranged.
What Treatments Are Available for Obstructive Sleep Apnea?
The advantages of being evaluated by a team of specialists, including an Orthodontist with training and experience in OSA, an ENT and Sinus specialist and a Maxillo-Facial and Plastic Surgeon, is to comprehensively diagnose your condition and evaluate options and alternatives based on your condition.
Once OSA has been diagnosed, multiple treatment options are available, depending on the severity of your condition.
Treatment options may include:
- Behavioral changes and counseling
- Lifestyle changes, such as weight loss (for people who are overweight)
- Avoiding alcohol and sedative medications towards the eventing
Very effective treatment can also include:
- Mandibular posture appliances (MPA’s) that are custom made to fit comfortably in your mouth, much like a mouth guard, to be worn only at night, to help posture your lower jaw, very slightly, but sufficiently forward enough to allow more oxygen to enter into your lungs while breathing during sleep
- Continuous positive airway pressure (CPAP) therapy
- Nasal or minor soft tissue surgery to remove obstructions in the upper airway
- Jaw surgery for moderate to severe obstructive sleep apnea
Mandibular Posture Appliance (MPA) for OSA
A mandibular posture appliance (MPA) is a type of night guard prescribed by our team and custom-made by our in-house laboratory so that it is comfortable and effective that is worn while sleeping. This device works by posturing the mandible (lower jaw) slightly forward while wearing it, which helps prevent the tongue from collapsing backward and also helps keep the airway open. Ask us to show you a video animation and actual appliance when you visit.
Most patients are surprised how comfortable these can be when custom made by our inhouse laboratory.
One advantage of MPAs is that they are small and portable, making them easy for patients to use at home. Patients generally report that these are relatively easy to wear.
The most effective custom-made MPAs are made by an orthodontist with extensive experience in sleep medicine in conjunction with a multidisciplinary team to ensure that they do not alter your bite and for maximum comfort and efficacy. They can be adjusted to fit your individual anatomy, using proprietary 3-D imaging and a clinical evaluation.
How many different types of mandibular posturing appliances are there?
There are more than 20 generic types of mandibular posturing appliances, each with unique designs and features. Generic appliances that are not custom made are not effective and can be deleterious.
Two common categories are mandibular advancement devices (MADs) and tongue-retaining devices (TRDs). MADs work by holding the lower jaw in a slightly forward position, while sleeping. TRDs are designed to hold the tongue in a forward position using a suction device.
The most effective appliances are custom-made specifically for your comfort, bite and type of airway obstruction.
Are online snore guards a bad idea?
Yes. These are very risky and hopelessly incomplete and inadequate. Online snore guards can also deleteriously create malocclusion, myofascial pain and TMJ dysfunction.
What is special about a custom-made MPA?
When prescribing an MPA, it is important to ensure it is custom-fitted and adjusted, different for each individual and their specific condition, anatomy, jaw, bite, stomatognathic function and degree of snoring and obstructive sleep apnea.
This involves a clinical examination, diagnostic records and tests, including a 3D image of your airway, jaw, mouth and teeth.
Expertly made custom mandibular posturing appliances can be a useful treatment option for patients with mild, moderate and occasionally severe OSA (including those who cannot tolerate other forms of treatment, including CPAP, that many patients complain vociferously about.)
Jaw Surgery for OSA
Jaw surgery, also known as maxillo-mandibular advancement (MMA), is an effective surgical treatment option for patients with moderate or severe obstructive sleep apnea (OSA).
MMA jaw surgery involves moving the upper and lower jaws forward to increase the size of the airway. This is typically done by cutting and repositioning the maxilla and/or mandible ( upper and/or lower jaw) and using small screws and plates to hold the jaws in their new position until they heal). The acute healing stage following jaw surgery is approximately 3 weeks. Please see Jaw Surgery Los Angeles.
Does jaw surgery improve my appearance (aesthetics) and function?
Jaw surgery can improve the appearance and function of the face and jaws.
Who is the best jaw surgeon for obstructive sleep apnea?
Jaw surgery is best planned by a multidisciplinary team of board-certified specialists, including a board-certified orthodontist, a board-certified ENT (ears, nose and throat specialist) and a team of surgeons with dual board certification in oral and maxillofacial surgery and plastic surgery and advanced training in sleep medicine and craniofacial surgery.
Who is the Chief of Surgery at Jaw Surgery Los Angeles?
David Dorfman, DDS, MD.
Dr. Schendel DDS MD (Professor Emeritus, now retired) and Dr. Jacobson recruited Dr. David Dorfman to be Chief of Surgery at Jaw Surgery Los Angeles approximately 10 years ago due to his extensive training and dual board certification in Maxillofacial Surgery and Plastic Surgery and his advanced training in Craniofacial Surgery from Stanford.
What are the risks of jaw surgery?
The potential risks and complications of jaw surgery include the following:
- Bleeding
- Infection
- Nerve damage
- Adverse reactions to anesthesia
Risks can be reduced with careful planning and surgical execution by a highly specialized multidisciplinary team, including experienced surgeons.
Do my teeth need to be wired shut following jaw surgery?
No. There was a time when all jaw surgery patients needed their jaws to be wired shut for three weeks. While patients complied, they did not enjoy being wired shut for three weeks and often lost five to 10 pounds due to an inability to eat normally.
Fortunately, wiring the teeth together is no longer necessary at Jaw Surgery Center Los Angeles (except in trauma cases and motor vehicle accidents and emergencies), thanks to protocols introduced at our onsite AAAHC-accredited Surgical Center by the founders of Jaw Surgery Los Angeles, Steven Schendel (Professor Emeritus and Chief of Surgery at Stanford Medical Center and Chief of Surgery at Jaw Surgery Los Angeles, now retired) and Dr. Richard Jacobson (Diplomate of the American Board of Orthodontics, with advanced training in jaw and bite disorders and TMJ dysfunction from UCLA).
How quick is the recovery from jaw surgery?
Patients’ recovery varies based on the surgery, age and health of the patient.
Jaw surgery and MMA’s performed by specialists at Jaw Surgery Los Angeles are generally done on a Friday so patients can recover over the weekend. Patients usually stay overnight at a recovery center for one night and can then go home. Patients return on the following Monday or Tuesday for their post-op appointment.
Does jaw surgery leave scars?
Since all the incisions are made inside the mouth, there are no visible scars.
Does jaw surgery hurt? What about pain?
Thanks to modern medicine and protocols prescribed at Jaw Surgery Los Angeles, pain can be well managed. Pain management is very effective based on the prescribed surgical procedure and an individual’s preference.
Is jaw surgery a permanent solution for obstructive sleep apnea?
One of the main advantages of MMA over other surgical treatments for OSA is that it can provide a permanent solution. Other surgeries, such as uvulopalatopharyngoplasty (UPPP), involve removing a little soft tissue from the upper airway, which can result in tissue scarring and tissue shrinkage over time. These types of surgeries may need to be repeated and may not be as effective as jaw surgery.
MMA, on the other hand, can provide long-term benefits by increasing the size of the airway, maintaining its patency.
Do patients with obstructive sleep apnea (OSA) sometimes have anatomically non-ideal jaw positions that contribute to obstructive sleep apnea (OSA)?
Yes. Many patients with obstructive sleep apnea (OSA) have abnormal jaw positions.
When the jaws are anatomically not in the correct position, this can also impact biting and chewing.
Some patients complain that their jaw and bite feels uncomfortable.
Many also complain that they don’t like the looks of their jaw. (eg. an overbite, a weak jaw, an asymmetric jaw or face, too prominent of a jaw, too long a jaw and face, too short a jaw and face, not enough teeth showing when they smile, too much gum showing when they smile, a concave profile, lip strain, with difficulty closing their mouth and mouth breathing during sleep).
Jaw surgery can correct these problems and improve the overall function of the jaws, facial esthetics, airway, breathing and sleep quality.
Obstructive Sleep Apnea FAQ
How do I know if I am not getting enough oxygen while sleeping?
Most people do not know they are not getting enough oxygen while sleeping. Diagnosis of OSA typically involves a combination of medical history, physical examination and diagnostic testing, such as a sleep study (Polysomnogram).
Can I do a medical grade, at-home sleep study?
Yes.
Board-certified specialists in ENT at Sinus Centre Los Angeles, Orthodontic Center Los Angeles and Jaw Surgery Los Angeles in Pacific Palisades can prescribe, send and assist you with a medical-grade overnight sleep test that you can use from the comfort of your own home to help measure your quality of sleep, and your oxygen saturation including how many arousals you have and the time you are in a deep peaceful rejuvenate REM sleep.
Is there any imaging that can measure my airway?
Yes.
Orthodontic Center Los Angeles, Sinus Center Los Angeles and Jaw Surgery Center Los Angeles share a state-of-the-art imaging center where specialists can take a 3D image in conjunction with a physical examination to help assess the anatomy of your airway, including your nasal turbinates, sinuses and airway leading into your lungs retro-glossary (behind the tongue).
Is snoring normal in children or adults?
No. Snoring is not normal in children or adults.
What is the problem with snoring in children or adults?
Snoring in children or adults can be disruptive and reduce the quality of your sleep. Most importantly, snoring indicates a breathing disruption and, thus, a lack of oxygen.
What are the symptoms of insufficient oxygen while sleeping?
A lack of oxygen from snoring or breathing difficulties or obstructive sleep apnea can cause a range of health disorders that usually get progressively worse over time, including:
- Feeling tired in the morning upon waking and/or at the end of the day
- Feelings of despondency, despair or depression
- Lack of concentration
- Attention deficit disorders in children and hyperactivity
- Cognitive impairment and/or memory loss
- Hypertension and/or heart disease
- Diabetes and metabolic disorders
- Deterioration of your health
Should my dentist make me a mandibular posturing appliance?
General dentists are generally NOT experts in jaw and bite disorders and malocclusions (bad bites) that can easily be caused by an MPA. General dentists are also not specialists in ear, nose, throat, sinus, or breathing disorders and OSA.