Obstructive Sleep Apnea

  • Obstructive Sleep Apnea, Sleep Health

    Best CPAP Alternatives

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    If you have sleep apnea, here’s what to know about dental devices, tongue trainers, mouth tape, and more.

    Consumer Reports | By Kevin Loria

    When you have obstructive sleep apnea, or OSA addressing it is key. Left untreated, OSA is linked to daytime sleepiness and an increased risk of anxiety, diabetes, hypertension, and stroke.

    With OSA, your breathing pauses during sleep because something blocks your airway, like your tongue or relaxed throat muscles, explains Richard Schwab, MD, chief of the division of sleep medicine at the University of Pennsylvania Perelman School of Medicine in Philadelphia. Losing weight, quitting smoking, and limiting alcohol can all help ease obstructive sleep apnea symptoms such as snoring, says Ana Krieger, MD, medical director of the Center for Sleep Medicine at Weill Cornell Medicine in New York City.

    CPAP Machine

    Sleep apnea’s severity is determined by something called your apnea-hypopnea index (AHI): the number of times per hour you fully or partially stop breathing for 10 seconds or longer. The primary treatment for people with moderate (15 to 29 AHI) or severe (30 AHI and higher) obstructive sleep apnea is a continuous positive airway pressure (CPAP) machine, which keeps your airway open by pumping air through a mask you wear over your mouth and/or nose when you sleep.

    Many people have difficulty tolerating CPAP and don’t stick with it, however. The good news is that CPAP machines have become smaller and quieter, with more comfortable options available. And for some people with mild (5 to 14 AHI) or even moderate OSA, less invasive alternatives to CPAP may be worth considering.

    A Common CPAP Alternative

    A dental device designed to move the jaw so that the tongue shifts toward the front of the mouth can help keep the airway open. It’s one of the primary alternatives to CPAP, Schwab says, and can also be used with CPAP to help make severe obstructive sleep apnea milder.

    A dentist who specializes in sleep medicine (find one at dentalsleep.org) will be able to customize its fit to help your breathing without causing harm to your bite or teeth, says Kevin Postol, DDS, president-elect of the American Academy of Dental Sleep Medicine. These custom-made oral appliances can cost between $2,000 and $4,000, according to Schwab, but may be covered by insurance.

    There are much cheaper options available online to treat snoring, but experts say these may not help with OSA, and could move teeth out of place or cause jaw issues if they’re not properly fitted.

    Other Sleep Apnea Treatments

    • Position therapy: For some, sleeping on the back can make obstructive sleep apnea dramatically worse. In these cases, switching to side sleeping—perhaps using pillows or a tennis ball attached to a shirt back—can sometimes get AHI into the mild range.
    • Tongue trainer: In 2021, the Food and Drug Administration approved a tongue-stimulating device for mild sleep apnea called eXciteOSA, which people wear for 20 minutes a day for six weeks and then 20 minutes a couple of times a week indefinitely. It costs $1,650 and is not covered by insurance. More research is still needed on its efficacy, Krieger says.
    • Mouth tape: While it’s a popular suggestion that may reduce snoring, taping the mouth shut is not an effective or safe option for people with obstructive sleep apnea, Schwab says.
    • Surgery: Some people who can’t tolerate CPAP have upper airway surgery to reduce the size of their soft palate or other tissue in their throat. But such options don’t always work, have serious potential complications, and cannot be reversed. So in general, they should not be first-line treatments, Schwab says. A newer option is a surgically implanted device called Inspire. Approved in 2014, it stimulates a nerve that moves your tongue to keep your airway open. Inspire can be removed if it is not tolerated, but it should also be tried only if someone is unable to use CPAP, and it is not an option for everyone.

    Could Weight Loss Meds Treat OSA?

    Because sleep apnea is an anatomic disorder, drugs typically have not been effective, Schwab says. But GLP-1 weight loss medications such as Wegovy may be used in the future, perhaps in concert with an oral appliance or airway surgery.

    That’s on the table because obesity is a primary risk factor for OSA: One 2022 study found that for every 7-pound drop in weight, there’s a roughly 7 percent drop in AHI. But more research on using these meds for obstructive sleep apnea is needed.

    Editor’s Note: This article also appeared in the April 2024 issue of Consumer Reports On Health.

  • Obstructive Sleep Apnea, Sleep Apnea Dentist, Sleep Health

    Sleep-disordered breathing tied to greater preeclampsia risk

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    Women with high-risk pregnancies who experience sleep-disordered breathing have an increased risk for preeclampsia, according to a study published in the American Journal of Obstetrics & Gynecology.

    The prospective observational cohort study involved women with high-risk singleton pregnancies, author Stella S. Daskalopoulou, MD, MSc, PhD, of the department of medicine’s division of internal medicine at McGill University Health Centre in Montreal, and colleagues reported in the study.

    Women with mid-gestation sleep disordered breathing have a 3.4 odds ratio for preeclampsia, and women with late-gestation sleep-disordered breathing have an 8.2 odds ratio for preeclampsia.
    Phan K, et al. Am J Obstet Gynecol. | Original Post

    High-risk factors included age of at least 35 years, BMI of at least 25 kg/m2, chronic hypertension, pre-existing diabetes or renal disease, conception via in vitro fertilization and personal or first-degree relative family history of preeclampsia.

    Of the 235 women recruited between 10 and 13 weeks of gestation at two tertiary obstetric clinics in Montreal, 181 women completed questionnaires about their sleep based on the Epworth Sleepiness Scale, Pittsburgh Sleep Quality Index and restless legs syndrome during each trimester.

    Women identified with sleep disordered breathing (SDB), defined as three or more incidences of loud snoring or witnessed apneas each week, in the first or second trimester were diagnosed with mid-gestation SDB. Women identified with SDB in the third trimester were diagnosed with late-gestation SDB.

    The researchers also conducted arterial stiffness, wave reflection and hemodynamic assessments between 10 and 13 weeks and again six more times at approximately 4-week intervals through the rest of the pregnancy.

    Carotid-femoral pulse wave velocity (cfPWV), which is considered the gold standard for predicting arterial stiffness and is predictive of preeclampsia, and carotid-radial PWV were calculated to determine aortic and peripheral arterial stiffness, respectively.

    According to the study, the 41 women (23%) who had SDB also had increased cfPWV across gestation independent of blood pressure and BMI (P = .042). Also, only women with SDB saw an association between excessive daytime sleepiness and increased cfPWV.

    After 20 weeks’ gestation, women who had BP of at least 140 mm Hg/90 mm Hg were diagnosed with preeclampsia.

    Women with mid-gestation SDB had an OR of 3.4 (95% CI, 0.9-12.9; P = .063) for preeclampsia, which increased to an OR of 5.7 (95% CI, 1.1-26; P = .028) for women who also experienced hypersomnolence. Women with late-gestation SDB had an OR of 8.2 (95% CI, 1.5-39.5; P = .009) for preeclampsia.

    Additionally, the researchers reported a positive association between excessive daytime sleepiness and central arterial stiffness in women with SDB but not in women who did not have SDB. Women who reported SDB and excessive daytime sleepiness appeared to have a greater risk for preeclampsia than women with SDB alone as well.

    However, women who had positive restless legs syndrome scores did not see increased odds for developing preeclampsia either in mid-gestation (OR = 1.23; 95% CI, 0.25-4.68) or late gestation (OR = 1.01; 95% CI, 0.21-3.75). The same held true for women who had positive Pittsburgh Sleep Quality Index scores in mid-gestation (OR = 2.11; 95% CI, 0.58-8.66) or late gestation (OR = 2.83; 95% CI, 0.65-19.81).

    Overall, the researchers said, there was an association between SDB in the first or second trimester and greater central arterial stiffness starting at 10 to 13 weeks’ gestation for women with high-risk pregnancies.

    Further, the researchers said, their results provide supporting evidence for arterial stiffness as an important mediator and promising surrogate endpoint for vascular dysfunction in preeclampsia, as well as for the need to screen for SDB throughout pregnancy.

  • Obstructive Sleep Apnea, Sleep Apnea, Sleep Health

    Frightening Things Sleep Loss Can Do to Your Body

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    Original Post by: Sara Middleton, staff writer | December 18, 2019

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    sleep-loss

    The sleep loss some people willingly subject themselves to is doing the exact opposite of helping them gain an academic “edge,” and is in no way beneficial for stress management (NaturalHealth365) Calling all students, board executives, parents with busy families, or any other hard-working individuals: pulling all-nighters is officially no longer something to brag about!

    Case in point? Research from institutions like Texas A&M College of Medicine and St. Lawrence University finds that consistently pulling all-nighters is associated with a lower grade point average – in addition to increased anxiety, impaired performance, and a myriad of other problems.

    Pulling all-nighters will lower your grade point average and increase the risk of weight gain

    Poor grades and a low-grade point average (GPA) can be big issues, but they’re certainly not the only ones caused by staying up all night. According to research, pulling all-nighters or consistently getting less than 6 hours of sleep per night increases the risk of other serious and undesirable health consequences, including:

    • Weight gain
    • Cancer
    • Heart disease
    • Accidents
    • Depression and anxiety (even just one sleepless night can raise anxiety levels by as much as 30%, according to a recent study from the University of California Berkeley published in Nature Human Behavior)

    Of course, we’d be remiss to just harp on the negatives. For example, the same UC Berkeley study we just mentioned also determined that deep non-rapid eye movement sleep (the non-dreaming stage) can literally rewire brain circuitry in such a way as to decrease anxiety, as well as lower blood pressure and heart rate.

    We also know that consistently getting a sufficient amount of sleep (that’s 7 to 9 hours per night for adults) increases our mood and productivity, reduce our risk for diabetes, helps us manage stress, and strengthens our immune system to help us avoid getting sick.

    Psst: teens need about 8 to 10 hours of sleep, and kids between the ages of 6 and 12 need about 9 to 12!

    Do NOT ignore the health dangers linked to toxic indoor air.  These chemicals – the ‘off-gassing’ of paints, mattresses, carpets and other home/office building materials – increase your risk of headaches, dementia, heart disease and cancer.

    Get the BEST indoor air purification system – at the LOWEST price, exclusively for NaturalHealth365 readers.  I, personally use this system in my home AND office.  Click HERE to order now – before the sale ends.

    Struggling with sleep apnea or insomnia? Here are three natural tips for combating sleep deprivation

    If you have a hard time falling and/or staying asleep, you’re in good (albeit tired) company. According to the Sleep Health Foundation, 1 out of 3 people have at least mild insomnia.

    But popping a sleeping pill – whether over-the-counter or prescription – doesn’t work long-term…and, of course, poses the risk of dependency and adverse side effects.

    So, how can you ease your mind and get to sleep better without becoming reliant on drugs? Previously, we’ve shared some helpful tips for improving your sleep naturally in our NaturalHealth365 podcast.  But, for a brief refresher, here are three simple strategies you can start implementing tonight:

    1. Turn down the temp. Sleep research indicates that an ideal bedroom temperature is between 60 and 68 degrees Fahrenheit (ca. 20 °C). Surprisingly cool, but it seems to be ideal for helping your body create melatonin, a major sleep-wake cycle hormone. Plus, we all know how hard it is to fall asleep on a hot summer’s night when the A/C breaks!
    2. Power down your devices. Dim your lights and avoid using televisions, cell phones, tablets, and laptops about an hour before bed. Hard to do? Sure. But if the trade-off is better sleep and better health, it definitely seems like a challenge worth taking on.
    3. Implement a relaxing bedtime routine. Instead of scrolling on social media, try kicking back with a book or journal, deep breathing in a hot shower, or testing out that new DIY facial mask you’ve been wanting to try. Practice regular self-soothing acts that help your body wind down.

    Sources for this article include:

    Livescience.com
    Sleephealthfoundation.org
    Sleepadvisor.org
    Sciencedaily.com
    Sciencedaily.com
    Berkeley.edu
    ADAA.org
    Washingtonpost.com
    Healthfinder.gov

  • Obstructive Sleep Apnea, Sleep Apnea

    7 Athletes and The Common Misconception About Obstructive Sleep Apnea

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    Original Post in CPAP.com | APRIL 12, 2019 7 MINS READ

    At Sleep Apnea Dentists of New England, we see many athletes of all skills and ages who are dealing with Obstructive Sleep Apnea. We stumbled upon this very useful article that directly addresses the current misconception of athletes and sleep apnea and found it shareworthy.

    Athletes and Sleep Apnea

    According to the American Sleep Apnea Association, as many as 22 million individuals1 in the U.S. struggle with obstructive sleep apnea (OSA) – men, women and children. And, 80 percent of moderate and severe OSA cases are undiagnosed. Researchers have also found you have a 46 percent higher risk of dying early when you have severe OSA, and this includes athletes with sleep apnea.

    Sleep Apnea Misconceptions

    Surrounding these statistics though are misconceptions about sleep apnea that keeps an individual from receiving a diagnosis ― and being treated.  A couple of common sleep apnea myths are:

    Sleep Apnea Only Affects People Who Are Overweight

    OSA is often viewed as being closely related to an above-average BMI. While many individuals with a diagnosis are overweight, there’s still many who are at an average weight. Anyone of any size or shape can get sleep apnea. Genetics can sometimes play a role.

    But, OSA does decrease how much restful sleep an individual gets each night and some studies do show a link between weight gain and insufficient sleep2.

    However, another study shows a link between CPAP therapy for sleep apnea and weight gain and that it can increase both weight and BMI (Body Mass Index). To experience CPAP and weight loss at the same time, you should combine your therapy with a healthy lifestyle that includes:

    • A healthy diet
    • Not smoking
    • Exercise
    • Quality sleep
    • Taking care of yourself

    Sleep Apnea Only Affects Men

    The common misconception is that sleep apnea only affects men. Sure, men do tend to receive more diagnoses of the condition than women, but women do get it too. Most women develop sleep apnea following menopause, with around six percent of them having it. And, female patients now make up 45 percent of sleep study referrals.

    Not only does sleep apnea affect both men and women, but celebrities with sleep apnea aren’t uncommon either. In fact, there are many famous athletes who have or had sleep apnea.

    7 Athletes With Sleep APnea

    1. Shaquille O’Neal, who goes by the nickname “Shaq” is a retired professional basketball player in the U.S. He raised sleep apnea awareness by featuring in the four-minute video, “Shaq attacks sleep apnea,” where it shows him interacting with sleep specialists from Harvard as they prep him for an overnight sleep study. He’s also the global ambassador of ZYPPAH — a solution to snoring3.

    Shaquille O’Neal tells Bill Littlefield about his academic struggles as a kid, his growth at LSU and his current work as a children’s book author. (Courtesy Turner Sports)

    2. Ryan Jensen, who is offensive lineman of the Baltimore Ravens told ABC news, “an obstructive sleep apnea diagnosis saved my career.” 4. He lost a lot of weight and strength and was cut from the team. After using a CPAP machine for several nights, it “changed everything.” His weight went up after one month of use, his strength returned, and he even returned to the team.

    3. Reggie White, a two-time NFL Defensive Player of the Year, died prematurely because of sleep apnea5. His widow, Sara, created the Reggie White Foundation, which helps to raise awareness of the condition.

    The new kid in town met some of the other kids in town for a Green Bay training camp tradition, July 1993. John Biever/Sports Illustrated

    4. Roy Green, a retired NFL wide receiver, has now started focusing on promoting awareness of sleep apnea6 all over the country to help improve both current and former professional athletes’ health. He’s teamed up with David Gergen, dental icon and the Pro Player Health Alliance to help hold free local community public awareness events all over the nation.

    5. Warren Sapp, Super Bowl champion, was prompted to seek treatment after the death of Reggie White, his friend and fellow football star. Through the Sleep Apnea Prevention Project7, he now helps raise sleep apnea awareness.

    Warren Sapp, a former defensive tackle for the Tampa Bay Buccaneers and the Oakland Raiders. Robert B. Stanton/NFLPhotoLibrary

    6. Percy Harvin, former NFL wide receiver, received a sleep apnea diagnosis in 2010 after collapsing at practice. He talked to reporters during an interview about how CPAP therapy made him immediately feel much better. In fact, he said “It’s a 100 percent difference.”8

    7. Josh James, a pitcher for the Houston Astros found his performance was lacking in between the 2016 and 2017 seasons. He sought help from a sleep specialist and was diagnosed with sleep apnea. After starting treatment, he saw his symptoms (and performance on the field) improve dramatically.

    Why Do Some Athletes Get Sleep Apnea?

    In recent years, Sleep-disordered breathing like OSA has gained notoriety within the athletic community. The prevalence of OSA in the NFL is around 14 to 19 percent and has a two to five percent estimated prevalence rate in the general U.S. population9.

    NFL players have a higher susceptibility of possibly developing OSA due to risk factors9 like having a large waist circumference and high prevalence of obesity.  NFL linemen could be especially susceptible because they usually have a higher BMI.

    Athletes, while often in great physical condition, have “thick” necks10 due to excessive weightlifting and having to carry around extra weight required for pushing others around the football field. This is another risk factor of sleep apnea.  The extra fat or muscle tissue on the neck can cause the wall of the windpipe to become thicker and make it more difficult to keep the airway open when the body’s in a relaxed state.

    Other muscular athletes, like football players, who carry extra weight11 have a risk for sleep apnea-related health concerns like stroke, high blood pressure, and other life-threatening problems.

    Today, we live in a culture that’s celebrity-obsessed. Because of this, professional athletes that have sleep apnea can help raise awareness of the condition, making a difference toward public education. When the public sees athletes with sleep apnea that are tackling it, it makes a great impression.

    David Repasky has been using CPAP treatment since 2017 and has first-hand experience with what it’s like to live with Sleep Apnea. He brings the patient’s perspective to the CPAP.com blog and has received formal training in CPAP machines, masks, and equipment.

    References

    1. American Sleep Apnea Association. Sleep Apnea Information for Clinicians Published on their official website. Accessed April 12, 2019.

    2. Harvard University Medical Center. Sleep and Health Published on their official website. Accessed April 12, 2019.

    3. Press Release. ZYPPAH® Signs Shaquille O’Neal as its Global Brand Ambassador Accessed April 12, 2019

    4. Thorbecke, Catherine, et al. NFL star Ryan Jensen says Sleep Apnea Diagnosis ‘Saved my Career’ ABC News. Accessed on April 12, 2019.

    5. Reggie White Foundation About Us. Accessed on April 12, 2019.

    6. Press Release. Arizona Cardinals’ Alumni Roy Green Joins Pro Player Health Alliance To Spread Awareness Of Sleep Apnea At An Event Hosted By Dr. Bradley Eli At Scripps Memorial Hospital Accessed on April 12, 2019.

    7. Zyppah, Inc. Warren Sapp – Sleep Apnea Prevention Project Video Segment 1 Published on YouTube. Accessed on April 12, 2019.

    8. Associated Press. With Sleep Apnea Diagnosis Percy Harvin Believes His Migrane Problems are in the Past. Published by Fox News. Accessed on April 12, 2019.

    9. Rogers, April J et al. “Obstructive Sleep Apnea among Players in the National Football League: A Scoping Review.” Journal of sleep disorders & therapy vol. 6,5 (2017): 278. doi:10.4172/2167-0277.1000278 Accessed on April 12, 2019.

    10. National Center on Sleep Disorders Research. “Problem Sleepiness in Your Patient” Published on their official website. Accessed on April 12, 2019.

    11. National Institute of Diabetes, Digestive, and Kidney Diseases. Health Risks of Being Overweight. Published on their official website. Accessed on April 12, 2019.