Snoring can cause a lot of grief for the person snoring and their bed partner. Relationships and health can suffer as a result of untreated snoring.
Snoring is often a symptom of a more serious sleep disorder known as obstructive sleep apnea (OSA). Left untreated or treated inadequately, apnea can lead to severe health problems and a lowered quality of life.
It’s important to note that many individuals with apnea, even severe apnea, barely experience any quality of life symptoms and feel there is nothing “wrong” during their sleep. Others may experience one or more of the conditions listed below.
Both snoring and obstructive sleep apnea can be treated with professional oral devices, but it will be important to first get medically evaluated before treatment.
During normal sleep breathing, the airway remains open and unobstructed. Although the jaw and base of the tongue drop back slightly, air freely flows through the throat and into the lungs.
Understanding Obstructive Sleep Apnea (OSA)
- Muscles and soft tissue in the back of the throat relax narrowing the airway.
- While a breath is being taken, air is forced through the narrowed passage causing vibrations of the soft tissues known as snoring.
- Chronic snoring can often be a sign of a more serious condition called Obstructive Sleep Apnea (OSA).
- Some individuals who snore but do not have apnea may develop symptoms that strongly affect their quality of life. These symptoms may include poor sleep quality, un-refreshed sleep, and excessive daytime sleepiness. Individuals that encounter sleep disruptions but technically aren’t diagnosed with apnea may be diagnosed with Upper Airway Resistance Syndrome or UARS. With an increase in weight or age, UARS patients often develop obstructive sleep apnea, discussed below.
- Many individuals who snore but are not “classified” as having apnea after testing are often neglected by a lack of medical direction. These individuals, who often would benefit greatly from oral appliance therapy, are often told to avoid sleeping on their back or that they do not need treatment.
- During sleep, the muscles in the throat relax. The jaw also relaxes and drifts back causing the back of the tongue also to fall back blocking the airway.
- The airway is either partially or completely blocked, air and oxygen struggle to reach the lungs.
- Eventually, oxygen-starved blood in the brain tells the body to awaken so that the airway can get wider and unobstructed. The person can breathe again for a moment until the next episode. Sometimes there are gasps or snorts witnessed at this time.
- The awakenings are so brief; most people are not aware of them.
- Loud snoring mixed with periods of silence is typical but not always present especially in children.
Obstructive sleep apnea disrupts sleep and results in lower oxygen levels in the blood and brain. Oxygen deprivation can trigger a negative impact in many areas of one’s health and well-being.
- High blood pressure
- Pulmonary hypertension
- Cerebrovascular Disease
- Cardiac Arrhythmia
- Myocardial Ischemia
- Higher incidence of strokes
- Erectile Dysfunction
- Gastro-esophageal reflux disease (GERD)
Quality of Life:
- Snoring disturbances
- Sleepiness during wake hours (Excessive Daytime Sleepiness- EDS)
- Family and relationship problems
- Morning headaches
- Poor job performance
- An increase in trips to the bathroom during sleep (nocturia)
- Sleepiness during driving
- Increase in work-related accidents
- Decreased sex drive
- Overall decreased quality of life
- Quality of life of a bed partner can also be severely affected
- Irritability and personality changes
Insomnia –like symptoms, difficulty staying asleep or falling asleep
- Memory problems
- Weight gain
- Tossing and turning during sleep, fragmented sleep
- Feeling unrefreshed upon awakening
After a thorough medical consultation of your snoring symptoms and any other potential symptoms, a referral for a “sleep test” or a referral to a certified sleep physician is usually your next step. To understand better what kind of medical provider to seek out see What Kind of Physician Should I Seek to Find Out if I Have Apnea?
Sleep tests are the only way to give you a thorough diagnosis whether you have apnea, or ’benign’ snoring without apnea events.
- There are several types of sleep-snoring evaluation processes to test if you have apnea:
- An overnight stay at a sleep testing facility. This type of study is usually performed at a facility within a room that looks like a hotel room. A polysomnogram uses sensors to various parts of your body recording brain waves, heartbeat, breathing, and movements. It is considered the gold standard of sleep diagnosis.
- A home sleep test unit used on sight in your home. Although not as detailed as a sleep lab test, this type of testing is being prescribed more commonly than in the past years.
- Which test is prescribed may be determined by:
- What other medical symptoms or conditions you may have
- The preference/knowledge of the medical provider
- Access to care
- Insurance guidelines
If you made it as far as being evaluated and tested, here are the most commonly prescribed treatment options (by trained sleep specialist physicians) should you be diagnosed with snoring (without apnea), or obstructive sleep apnea.
There are approximately 80 other sleep disorders classified, beyond the scope of this website. Also important to note, there are a few types of apnea: obstructive, central and mixed (also known as complex apnea).
Oral appliance therapy, the main focus of this educational website, is a choice of treatment for ‘benign’ snoring and obstructive sleep apnea. A combination of therapies may be involved with mixed or complex apnea (which includes central and obstructive events.)
- Weight loss
- Surgery– several types
- Professional Custom Oral Appliances
- Positional Therapy (See our Resource Page for Positional Sleep Devices and Equipment)
- “No treatment needed”
- Evaluation of other medical conditions or medication side effects
Which OSA treatment that is prescribed by the sleep physician depends on several factors including apnea severity, other medical conditions the patient may have, and patient lifestyle considerations (traveling, other).
- Weight loss
- CPAP (Continuous Positive Airway Pressure Device) or a similar device –administered by sleep technicians in conjunction with sleep physicians
- Professional Custom Oral Appliances- The use of dental device prescribed by the sleep physician and ordered or fabricated through a sleep trained dentist
- Positional Therapy (See our Patient Resources page for Positional Sleep Devices and Equipment)
- Surgery – several types
If the individual is diagnosed with obstructive sleep apnea, he/she is often shuffled through a process assuming the patient will be getting a CPAP (Continuous Airway Positive Pressure Device) or a similar device without ever being discussed ALL treatment options for apnea.
CPAP therapy is a great tool for treating apnea. However, many patients find it very difficult to ‘live with’ and many simply ‘give up’ with treatment. Most recent research and MEDICAL GUIDELINES have clearly stated that oral appliance therapy is a possible treatment option for many apnea sufferers.
Knowing all treatment options for oral appliance therapy before going in for a sleep evaluation can often save a patient many months, and even years of difficult efforts with the CPAP device.
Oral appliance therapy(OAT) has decades of research behind its effectiveness for many apnea sufferers. Additionally, research has concluded that although OAT may not be as effective as CPAP therapy, it is typically far better tolerated and the overall clinical impact between the 2 therapies is closer than most realize. For more on the overall therapeutic differences between these therapies see Efficacy versus Effectiveness in the Treatment of Obstructive Sleep Apnea: CPAP and Oral Appliances.