Exploring Sleep Apnea

Obstructive sleep apnea is a potentially serious sleep disorder where breathing stops and starts repeatedly. Roughly a billion people worldwide suffer from sleep apnea. Another 80 to 90 percent of people with the condition are undiagnosed, according to Dr. Rhonda Elloway-Stephens, Doctor of Dental Surgery and Diplomate of the American Board of Dental Sleep Medicine.

Who is affected by OSA?

“OSA is a disease of any age or gender,” Elloway-Stephens says. “Newborn babies can have it as well as the very elderly, and all ages between. OSA continues to increase by 7 million annually, partially due to the continued rise in obesity, which is one of the highest risk factors for OSA.”

How is OSA diagnosed?

A diagnosis of OSA is made through an overnight sleep study. There are two types:

• Polysomnograms are comprehensive tests done in a hospital or sleep center. These tests involve being hooked up to complex equipment that measures multiple parameters such as heart rate, brain waves, respiration, oxygen levels, and leg and eye movements.
• Home sleep apnea tests are more basic and can be done at home with the patient in their own bed. These tests measure oxygen levels, breathing and airflow, heart rate, and sometimes body position and snoring levels.

Both types of tests must be analyzed by a sleep-specialist physician who will render a diagnosis, in part, by calculating the number of breathing pauses someone experiences per hour of sleep, called the apnea-hypopnea index, or AHI.

According to Elloway-Stephens, the current standard of diagnosis for OSA is classified by the number of breathing disruptions per hour of sleep:

• Mild: 5 to 15
• Moderate: 15 to 30
• Severe: 30+

Why is diagnosing OSA important?

“Sleep is one of the cornerstones of health, as it impacts almost every body system,” Elloway-Stephens says. “Good-quality, restorative sleep helps clean the brain of toxins, gives the body physical restoration, allows the brain to process and memorize information, regulates the mood, and strengthens the immune system.”

Studies have indicated that up to 80 percent of people with OSA also have other conditions such as cardiovascular diseases, respiratory diseases, and metabolic disorders. Also identified were disorders like peptic ulcer, gastroesophageal reflux, chronic liver disease, anxiety, insomnia, and depression.

“OSA is also correlated with headaches, irritability, chronic daytime sleepiness, poor concentration, early onset dementia, poor cell oxygenation, dietary cravings, automobile accidents, workplace accidents, and bed-partner problems,” Elloway-Stephens says.

How is OSA treated?

The most effective treatment for OSA is a continuous positive airway pressure machine, or CPAP. The device delivers continuous pressurized air through tubing into a mask that you wear while you sleep.

“The problem with CPAP is that it is not well tolerated or accepted by many people, with over 65 percent of users being non-compliant and abandoning treatment after attempting to use the therapy,” Elloway-Stephens says.

The second-most effective treatment is oral appliance therapy, which is a custom-fit precision mouth guard that is fabricated and monitored by a dental sleep specialist. These devices work by positioning the lower jaw slightly forward and bringing the tongue and surrounding tissue forward and out of the airway at the back of the throat.

Elloway-Stephens says oral appliances don’t work for everyone and are also a little less effective than CPAP. The compliance is typically much higher, though, and patients stay on this therapy in much higher numbers since it’s more convenient and easier to wear and sleep with. “The most important thing to focus on is finding a therapy that you can use nightly,” she says.

But, as Elloway-Stephens emphasizes, “Awareness and screening are so important. The only way to know if you have it is to be tested.”

This article was originally published in the November 2024 issue of alive magazine.