and global conscious mental processes (cognitive functioning).
Another study supports the theory that disordered breathing accelerates memory loss.51
A study with a group of 2500 Alzheimer patients, aged between 55 and 90 years, showed interesting results. Memory declined 10 years earlier among those who had breathing problems such as snoring or sleep apnea.
How bad was the memory loss? Was it enough to prevent daily routine activities?
Albeit noticeable to their surroundings, fortunately, the loss was only mild.
It translated into forgetting recent events for instance.
Those who had been treated by CPAP instead behaved like those without breathing problems.
Their mental decline was as the same as the group non-affected by breathing disorders.
Also, Alzheimer development occurred 5 years earlier amongst untreated patients with breathing problems.
Lower oxygen is not the only factor that can explain these observations.
Lack of sleep could also cause an earlier onset of Alzheimer disease.
By preventing the brain from eliminating toxins.
This is a process, which can only occur during deep sleep.
Since we talked about Alzheimer, let’s now look at its relationship with OSA.
How are OSA syndrome and Alzheimer disease related?
Did you know that Alzheimer and OSA show considerable overlap in the population?
What this means is that:
if you suffer from one of the two,
then you are more likely to also suffer from the other.
Although some suggest a link between the two, the mechanism is not understood.52
An article reviewing many published studies (meta-analysis) reports some interesting facts. It reveals a potential mechanism.53
Let’s analyze the facts.
The review shows that if you are a patient with Alzheimer disease, then you will be five times more likely …
Yes, you understood correctly,
… five times, more likely of presenting OSA than individuals of similar age with normal mental functions.
By mental functions we mean:
The authors highlight that approximately half of the patients “have experienced OSA at some point after their initial diagnosis.”
They conclude by saying that if you are an Alzheimer patient, changes in:
sleep quality and structure,
cerebral blood flow,
the presence of unstable molecules that damage cells (oxidative stress/free radicals),
may contribute to a decline in your mental functions worsening your disease.
If you have found this article interesting, or if you want to learn more, then ….
Let's now look at the rather long list of risk factors. These may interfere with the smooth functioning of your upper respiratory tract:
If you are overweight or obese, your chances of presenting OSA will increase.
Why is that you may wonder?
Because the deposits of fat down the back of your throat, around the neck or chin.
These increase if you are obese, and they will tend to obstruct your breathing.
Obesity is considered the most important risk factor.
Even a modest weight loss can improve the quality of your sleep.1011
If you are obese or overweight, you have 50% chances of suffering from sleep apnea.
But there also many thin people presenting this syndrome, because they may have other risk factors – see below.
Gender: if you are a male, your chances of presenting OSA are also higher. And even more so if you are older than 40.
If you are a woman instead, the risk of suffering from sleep apnea will be half that of a man.
Now, what happens with age?
Well, this difference will decrease.
During menopause the ratio will be almost the same: "Disordered breathing during sleep is more common among postmenopausal women than among their premenopausal counterparts. ... This is possibly due to the decline of levels of estrogen and progesterone."12
As we have just seen, Age is also a factor irrespective of your gender. OSA is much more frequent in a population aged between 45 and 64 years.
The risk further increases as you get older.
A family history of OSA or snoring will also increase your risk of suffering from the same syndrome.
Yes, there is a hereditary component for OSA!Unique genetic features determine the size and position of:
For instance, an undersized lower jaw (versus the upper jaw) is a risk factor that may lead to OSA.
A small lower jaw will remain in a posterior position, and the upper respiratory airway will be narrower.1314
Your ethnic group will also play a role. Asians and Afro-Americans have a higher risk of sleep apnea15
It is obvious that obstructions can also have an impact. These can be due to:
diseases of ear, nose, and throat (otorhinolaryngologic disease),
All this leads to small airways and increased risk of OSA.
For instance, a study showed that if you suffer from allergic rhinitis, then this will influence your OSA.
OSAs will be longer and more frequent during a period of significant nasal obstruction than when symptoms are absent.16
Results suggest that a high nasal resistance may influence the development of OSA (pathogenesis of OSA).
Sleeping with the mouth open is a sign.
Are you surprised? Well, you should not.
It is a sign of obstruction of the nasal airway.
Nasal obstruction causes the jaw to drop. This reduces the diameter of your pharyngeal airway. As a result, your likelihood of presenting OSA will increase.
Take this piece of advice: check with your family or bed partner if you are a sleeping mouth breather.
You may indeed be suffering from OSA.
Substances causing relaxation of your throat's muscles, such as:
These exacerbate sleep breathing issues and worsen your OSA symptoms.
They will also increase the frequency and length of OSA events you may experience.
Smoking If you are a smoker and you ascribe your OSA to be due to something else, then think twice! Because smoking also plays a role.
You will be at higher risk for sleep-disordered breathing than if you do not smoke or if you have quit.17
Smoking increases your likelihood to suffer from OSA by a factor of 2.5 or 3 versus non-smokers.18
This may be due to an inflammation of the airways as well as fluid retention. They lead to a reduction of the volume available for smooth flow through the airways.
You suffer from diabetes type 2 you are at risk for OSA.
But if you expect a clear explanation, then you will be disappointed.
The reasons are not well understood yet, but obesity most likely plays a role.
Last but not least, enlarged tonsils and adenoids are also a risk factor for OSA.... And, you may have already guessed the reason ... decreased airways passage.
This leads us nicely onto the next section.
What are the risk factors of developing OSA for your children?
Enlarged tonsils or adenoids are the most frequent causes in a pediatric population.
As their size increases, the flow through the respiratory airways becomes more difficult.
But the good news for your children is that airflow can resume after removal of these tissues.
It is the best option to solve the problem, and the surgical procedure is quite standard.
Other risk factors for your children include:
obesity or being overweight,
a narrow face shape.
We have looked at the risk factors for OSA, but what about symptoms and signs?
You just need to read on to find out.
What are the symptoms and signs of OSA in adults?
Surely, you should be able to tell with ease if you have OSA … right?
Your relatives or your bed partner are usually the ones who can help you do so.
You will probably not realize you have breathing difficulties during your sleep unless you identify the symptoms.
The same goes for gauging how severe your sleep apnea is.
And, when it comes to symptoms, you can divide them into 2 groups: major and minor.
The main one is frequent and loud snoring.
It is the most common symptom occurring in 70% to 95% of patients. 1920
You may stop breathing during sleep. These pauses may interrupt your snoring. After the pauses, you may be panting or gasping for air.
When you sleep on your back, the pressure on your respiratory airways will be more important than if you sleep on your side.
Hence, sleeping in a fetal position (on the side) will make your snoring less loud.
But, it cannot end your snoring if this was initially loud.
Will you snore every night?
Nope. Though it is likely that, with time, your snoring will gradually worsen and increase both in frequency and intensity (louder).
Another major sign of OSA is fatigue and feeling sleepy during your daily activities (work, travelling, etc.).
You will also find yourself struggling to avoid falling asleep during quiet times of the day.
Drowsiness will permeate and increase during the day while taking a nap will usually be of no relief.
You may even wake up more tired after a nap if apneic events interrupt it.
Minor signs and symptoms include:
a morning headache,
memory or learning problems,
struggling to concentrate,
frequent nocturnal awakenings to urinate,
(as you wake up) sore-throat or dry mouth,
drowsiness and uncontrolled daytime sleepiness when you work or drive.
Let's now see what the symptoms are in a younger population.
What are the symptoms and signs of OSA in children?
Little patients have somewhat different symptoms than adults.
Unlike them, they do not show sleepiness. Instead, they display restlessness and overactive reflexes.
As a parent you will also observe behavioral disorders that characterize a "real problem child" like:
hostile or angry behavior,
sudden mood change,
a tendency to cry easily.
Other issues will be present like:
Lack of attention at school, and poor school performance,
a tendency to breathe through their mouths (instead of their noses) during the day,
struggling to remember things they learned at school.
On the good side though, you will not have to worry about:
cardiovascular complications such as high blood pressure,
and excessive weight gain.
Since we broached the subject of health effects, let's now see how OSA can impact your health.
(Note: this is not just another page of annotated resources - available on the web - about sleep apnea. It is somewhat special because we have added some extra data and information. Are you curious? ... Then continue reading to discover our secrets.)
Sleep apnea: a brief introduction
They say that life in a couple falls into two categories: delights or annoyances.
If your partner suffers from sleep apnea, then sleeping together …. well you know into which category it falls.
Sleep apnea is also called sleep-disordered breathing.
And that is for a reason since this disease is characterized by repeated shallow breaths or interruptions.
The most frequent type is called obstructive sleep apnea (OSA) where your upper airways collapse or become obstructed during sleep. This slows down or interrupts your breathing.
If your partner suffers from OSA, he will tend to snore and make choking sounds as he will try to breathe through the reduced or obstructed airways passage.
But if you or your partner snore, you do not necessarily suffer from OSA.
OSA is characterized by breathing pauses that can last between a few seconds and few minutes, and that can be quite frequent, up to 30/hour. After which, breathing usually resumes normally but is accompanied by loud snoring.
Guess how will all this affect your sleep's quality?
It will plummet as you move out of deep sleep into light sleep throughout the night.
No wonder you will feel so tired during day hours.
Sleep apnea is one of the major causes of daytime drowsiness.
As a result, you will be at a higher risk for car crashes, work-related, accidents and a number of associated diseases:
Sleep apnea is underdiagnosed because it is not possible to diagnose it via a medical check-up or with blood tests.
Besides your physical exam, your medical and family history, your doctor will also use data collected during a sleep study for a proper diagnosis.
What are the risk factors?
Well, if you are obese, overweight, male and if you have a family history of small airways then your risks will increase. Likewise, your children will be at a greater risk if they have enlarged tonsils or adenoids.
But, after this long list of worrisome information, here are some good news…. yes sleep apnea can be treated in different ways:
The text shows an expandable/collapsible menu with some main topics. Clicking on each topic will lead to several subtopics. For instance, clicking on “Causes” will show “Obesity”, “Large tonsils”, “Endocrine disorders” ….
Heart or kidney failure
Unhealthy lifestyle habits
Family history and genetics
Race or ethnicity
Screening and Prevention
Screening for sleep apnea
Healthy lifestyle changes to prevent sleep apnea
Signs, Symptoms, and Complications
Signs and symptoms
Ruling out other medical reasons or conditions
Healthy lifestyle changes
Therapy for mouth and facial muscles
Using and caring for your breathing device or mouthpiece
You can either read the 230 words long abstract, or the full 4000 words article.
Discover our opinion and explanations.
Our advice: this article requires solid medical knowledge and the non-initiated will find it difficult to understand.
In a nutshell it talks about Percutaneous Coronary Intervention (PCI) in patients with OSA.
PCI is a non-surgical procedure that uses a thin, flexible plastic tubing to position a small device called a stent. It is used to open blood vessels that have narrowed as a result of plaque formation (atherosclerosis).
This review article concludes saying that if patients already suffer from OSA and undergo PCI, then they will have significantly increased incidence of:
all-cause death (4 studies),
cardiovascular death (4 studies),
and repeat PCI (7 studies).
So, patients with OSA are at greater risk of subsequent cardiovascular events after PCI.
Find a Behavioral Sleep Specialist with a search by last name https://my.absm.org/listing.aspx. But our team has also found a page where you can look at a list of individuals who have earned certification in behavioral sleep medicine.
and they can also reduce the risks of suffering from these diseases.
Let’s now look at what you can do.
What lifestyle changes can you implement to treat mild sleep apnea?
If you suffer from mild forms of sleep apnea, then it may be possible to treat it merely with some lifestyle changes:
If you are obese or overweight, your risks of suffering from sleep apnea increase. Even a mere 10% weight loss can be beneficial and relieve your symptoms
Experts believe that excess body weight may contribute significantly to sleep apnea.1
Studies have shown that if you are obese or overweight, going on a diet (and losing weight) will be beneficial since:
your apnea frequencies will decrease;
your Apnoea–Hypopnoea Index (AHI) will improve compared to controls.2
If you are a smoker, you also need to quit tobacco consumption. Smoking irritates your throat and makes you cough at night.
Avoid alcohol, sleeping pills or painkiller drugs. They make it harder for your throat to stay open while you sleep since they relax throat muscles.
Sleep on your side instead of your back. This may reduce sleep apnea symptoms.
Sleeping on your back in fact stretches your throat and neck’s tissues thus narrowing or blocking your upper airways.
You can learn to sleep on the side by placing a pillow so that it may support you (on the side).
You could also use the ‘tennis ball trick’: sew a pocket onto the back of your pajama top and put a tennis ball in it.
The pressure from the ball will make you roll back to your side.3
Practice sports regularly.
Also, try to have regular sleep patterns by going to bed and waking up more or less at the same time.
This will improve the quality of your sleep.
Do you have a runny or stuffed-up nose, because of an allergy or a cold?
If so then consider using some nasal sprays or allergy medicine.
Check with your treating physician what is the best treatment for you
We will now look at the use of medical devices that can help your OSA.
Are dental appliances behavioral treatments
You can consider mouthpieces, also called dental appliances, as behavioral treatments.
Because they have to be worn regularly to re-align the oral cavity. Hence, they lead to a change in your behavior.
The American Academy of Sleep Medicine (AASM) recommends them as:
A first choice therapy in mild or moderate forms of sleep apnea.
Severe forms when CPAP has failed or where patients prefer alternative therapies. But they are not the first choice for severe forms because they may not be enough for a challenging airway4
They are also used:
Concomitantly with CPAP to lower the air pressure levels, if you do not tolerate higher pressures.So there is hope if you struggle with CPAP!With the help of a dental appliance, your airway will present less resistance. Your CPAP machine will, therefore, blow air with lower pressure and more timely;
if you have refused or failed surgery (such as tonsillectomy, adenoidectomy, …).
Your doctor may recommend them if you snore loudly, even if you do not have sleep apnea.
But that comes with other types of costs because prefabricated oral appliances:
May fall out at night and your snoring will continue.
Have to fit different anatomies and tend to be bulky.
To understand how they work, let’s see how you wear them.What a paradox! A bulky dental appliance in a small airway!Indeed, it will be challenging to improve your snoring and sleep apnea.
May mislead you, or rather, their results may mislead you.If you are successful at eliminating snoring symptoms and think that your sleep apnea has been cured….you may suffer from the complications of an untreated sleep apnea later on.
And OSA is no laughing matter since it is a life-threatening disease.
Also, your jaw position may actually be worse and increase occlusion of the airway without you realizing it.
may force you to clench to keep the dental device in place.
But a sleep medicine trained dentist will immediately identify these issues, and help you avoid them.
The ease with which you can buy OTC appliances may fool you into thinking that:
you can diagnose your sleep apnea,
and manage its side effects on your own.
Fortunately, some of the above issues, namely lack of comfort (and even pain), limit their use somewhat.
And this despite that they have been around for approximately 20 years.
One of the paradoxes of their lack of effectiveness and discomfort is that …..
………they discourage patients who would otherwise be excellent candidates for custom-fitted appliances.
Let’s see how you can use them, to better understand some of the issues.
OTC dental appliances: less than optimal fit
Many of these OTC appliances are crudely made with thermoplastic polymer materials.
When you buy them, you often need to boil them.
No! No sauce needed 😉 (we are easily amused with simple jokes here at SPDA).
They are softened by boiling so that they mold and adapt to your oral anatomy when you bite the softened material.
You will do this with a somewhat advanced jaw position.
No wonder these appliances are also called “boil and bite.”
The appliance is then placed in a bowl of cold water to “set up.”
The end result is a device that may somehow fit, but it is not always a very good fit.
Now let’s analyze how an optimal fit is ensured when a qualified dentist gets involved:
he will take an impression and send it to a lab;
once the oral appliance is received, your dentist will make the necessary, delicate adjustments to achieve an optimal fit;
these adjustments will depend on your OSA symptoms and oral condition.
These are all chair-side steps which need time and engender costs.
It is important to note that, in New York, a dentist has to:
and receive training
to make custom appliances for sleep apnea and snoring.
Doctors have to follow with rigorous standards ensuring good success rates.
It is thus preferable to contact your dentist to have a dental appliance really adapted to your anatomy (teeth and gums).
Let’s now study what happens as you get older.
Poor to no adjustability of OTC dental appliances
How will your sleep apnea evolve as you age?
It is likely not be shocking if I tell your that your sleep apnea will get worse.
That happens because muscles lose their tone, and tend to occlude your airways.
Though it is true that you may compensate for this process by losing weight, for instance.
Is there a difference in durability of a prefabricated dental appliance versus a custom made one?
The answer is a definite yes, and the difference is significant:
The former lasts only a year approximately,
the latter has a lifespan of 2-5 years. The time depends on whether you clench and grind your teeth during your sleep.
Finally, the AASM and the AADSM guidelines also advise that:
…… “a qualified dentist uses a custom, titratable appliance over non-custom oral devices.”6
This means that an adjustable (titratable) oral device should be used.
Can I use Medicare approved OTC dental appliances?
Do you definitely want to try an OTC dental appliance instead of one made ad-hoc for you? If so, then go for a Medicare-approved one.
They have been tested clinically and also stand the test of time.
It will be a safe choice that may protect you from some of the issues explained above.
What are the advantages of dental appliances versus CPAP masks?
Amongst the pros …..
Dental appliances can significantly reduce sleep apnea, if used over an extended period.
And, you will show better adherence to treatment because mouthpieces are more comfortable to use than CPAP masks.
Unlike CPAP masks, they:
are portable hence you can travel with them;
allow you to talk and drink water.
You will not have any dry, itchy nose issues due to air pressure from a CPAP mask.
Oral appliances are less cumbersome to use than CPAP equipment:
If you move a lot in your sleep, there no risk of getting entangled with the tubing because there is none;
a dental appliance will stay in place until the end of your sleep. That is unlike CPAP masks which you may unintentionally remove;
finally, a dental appliance does not need a machine.
Let’s now take a look at the cons of oral devices.
What are the disadvantages of dental appliances used to treat OSA?
To begin with … These can be permanent or transient.
I know what you are thinking!
You would prefer the side effects of oral appliance therapy to be transient only and not permanent.
But do not worry.
The benefits of oral appliance therapy outweigh the adverse effects.
Let’s look at some examples of oral health issues.
Dental health problems to consider before using a dental appliance for OSA.
Just like taxation is a certainty in life, some dental health issues will invariably affect your use of dental appliances.
Let’s look at these dental health concerns.
It is associated with sleep apnea.
If you are an edentulous patient, you will be more likely to suffer from sleep apnea17. A study found that if you were a patient aged 25-65, your risk of developing OSA would increase by 2% for each additionally lost tooth18.
So, your dentist will have to carefully consider restoring your missing teeth, before an appliance is made.
This will create a more balanced occlusion.
Likewise, use of dentures is associated with a higher apnea-hypopnea index (AHI>15)19.