How to deal with Obstructive sleep apnea

Obstructive sleep apnea is a phenomenon of sleep apnea caused by obstruction of the upper respiratory tract. The prevalence of this phenomenon is 2-4% in men, and in women only 1-2%.

The causes of the phenomenon are many: obesity that causes fat deposition in the walls of the pharynx and external pressure from fat tissue in the neck, obstruction of the upper airways by the base of the tongue, the structure of the lower jaw and its position in relation to the upper jaw (microgantia, In children), obstruction in the nasal airway (this subject is controversial, most researchers underestimate it), genetic factors, etc.

The potential damage to human health resulting from these respiratory pauses is great. The injury can result in a rise in blood pressure, a risk of developing various heart diseases or even a stroke. In addition to the significant harm to the quality of sleep, there has also been a decline in the quality of life of the person, which is manifested in great fatigue during the day, lack of concentration, excessive nervousness, decreased libido, etc. Another serious danger is excessive involvement in fatal road accidents due to falling asleep while driving. Snoring that is not accompanied by breathing breaks is not a medical problem, but a social problem that may harm a person’s relationship due to interference with the snoring partner.

The diagnosis is performed by a sleep laboratory test that determines the number of breath breaks, the level of oxygen saturation in the patient’s blood, the blood pressure during sleep and many other parameters. Severity of the disorder is determined by the super index of the number of full pauses (Apnoea) or partial (hypopnoea) during sleep (AHI or RDI). The accepted division is: Up to 4 breaks per hour (full or partial) is considered normal; 5-14 Easy hardware; 15 to 29 moderate hardware, while over 30 breaks in breathing at the disorder is considered serious.

The recommended treatment for mild to moderate cases is weight loss, changes in sleep positions, surgery performed by an ear-nose specialist, and oral devices performed by a dentist. The recommended treatment for severe cases is by using a propeller attached to the mask and injecting positive pressure air into the patient’s nose during sleep (C-PAP).

The indications for use of oral devices in sleep apnea syndrome are, as noted, in mild to moderate cases, as defined by the sleep laboratory test, in those difficult cases where other treatments (such as C-PAP) were not found to be appropriate. In cases where the problem is snoring only and not apnea, the device is the preferred treatment. It has been shown in many studies that the use of the device results in a significant improvement in the intensity and frequency of snoring, along with a reduction in the number of breath breaks and other sleep indicators. A recent study showed that the effectiveness of oral devices was no less than that of C-PAP in the mild and moderate cases of obstructive airway obstruction (More details can be found in the article by Hoekema and his colleagues published in 2008 which recommends this device). The efficiency of the oral devices is even more than the efficiency of certain surgeries (such as laser or radio surgery) to open the airways.

The oral contraceptive device for snoring and obstructive apnea is a removable device (similar to that of a tooth straightening) adapted to both human jaws. There are many types of devices: one-piece devices; Separate devices for each jaw and interconnected by special sophisticated mechanisms; Prepared devices that can be adjusted in the mouth by heating and biting them; And custom devices by an experienced dental technician. The vast majority of these devices promote the lower jaw, thereby pulling the tongue forward and opening the airways at the base of the tongue and pharynx and preventing the collapse of the pharynx walls. The device is used only during sleep.
Treatment with the dental devices has many advantages: The patient is not connected by a masked tube to a noisy machine (compressor), but the device is all in the mouth and can be moved (suitable for people sleeping outside the home). In addition, the treatment is non-invasive and reversible, which does not usually result in any permanent change in the teeth or jaws, so compliance with these devices is better than the response to the C-PAP device.

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