Myth #: Oral Appliances Are Only For Mild Cases Of Osa
The position of the American Academy of Sleep Medicine states, All appliances are indicated for use in patients with mild to moderate OSA who prefer them to continuous positive airway pressure therapy, or who do not respond, or who are not appropriate candidates for, or who fail treatment attempts with CPAP. We have been treating patients with both moderate and severe degrees of obstructive sleep apneas. Studies prove that many of the moderate cases have completely resolved their sleep apnea and have used this as their only treatment modality. Some of the advanced cases of sleep apnea have also eliminated their sleep apnea. Other cases who are completely CPAP intolerant have had substantial reductions in their sleep apnea.
First Its Important You Do Everything You Can To Keep Your Sleep Apnea Under Control So Its Not Making Your Pain Worse
The options listed below are for people with the most common type of sleep apnea, obstructive sleep apnea. It happens when the muscles in the throat relax too much during sleep.
Some of the things that can help include:
Avoid alcohol in evening it can relax throat muscles and worsen symptoms
Avoid smoking it can aggravate and worsen inflammation in the airway
Weight loss about half of people with sleep apnea are overweight, even a small amount of weight loss can help improve symptoms
Watch your meds sedatives before bed can relax your throat muscles
Treatment Make sure you have a sleep apnea treatment thats doing the job. If you havent been diagnosed, get in and see a sleep specialist so you can get a treatment. If youve tried CPAP and struck out, dont give up! Theyre now plenty of alternatives you can try.
Central Sleep Apnea Happens When The Brain Is Involved
Central sleep apnea is less common than obstructive sleep apnea. It can also be trickier to diagnose and treat. Unlike obstructive sleep apnea, which is caused by a mechanical problem that blocks the airway, central sleep apnea occurs because the brain is not sending the proper messages to the muscles that control breathing. Central sleep apnea is caused by a neurological reason, explains Dr. Capasso.
While central and obstructive sleep apneas share many symptoms such as episodes of pauses in breathing, constant awakenings during the night, and extreme sleepiness during the day central sleep apnea often affects people who have underlying illnesses, too, such as a brain infection or other conditions that affect the brainstem. Common diseases associated with central sleep apnea include: severe obesity, Parkinsons disease, stroke, and chronic heart failure. Certain drugs, such as opioids or benzodiazepines, can also play a role in central sleep apnea. In patients who use opioids on a chronic basis, the breathing mechanisms can get numbed, Capasso explains.
Your doctor may refer you to a sleep specialist for a diagnosis if he or she suspects central sleep apnea, which may involve an overnight sleep test to rule out obstructive sleep apnea or other sleep disorders. The sleep specialist may also work with your cardiologist or order scans of your head and heart to rule out other contributing illnesses.
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Sleeping With Neck Pain
The fifth vertebra in your neck is often referred to as cervical. Cervical health has a direct connection to some sleep disorders.
The cervical spine affects how well a person sleeps. And when you dont get proper rest, disorders like sleep apnea develop.
Obstructive Sleep Apnea influences how you breathe while youre asleep. Some people have incessant snoring while others stop breathing on and off during the night.
OSA happens in the upper airway. The upper airway is in close proximity to the cervical spinethe neck. When the neck experiences injury, this may trigger symptomatic sleep or sleep-disordered breathing.
Thats why its of grave importance to pay attention to your sleep patterns after a neck injury. Consult with a physician right away if you have trouble sleeping through the night.
What Causes Pain After Sleep Apnea
Daytime pain after a night of sleep apnea symptoms is very common.
Chronic pain can lead to poor sleep and poor sleep can actually intensify chronic pain. Some of these reasons are straightforward. We all know the experience of an awkward position in sleep causing a few aches and pains the next day, and the fatigue that comes with often makes it feel worse.
But there is research that sleep apnea and pain are more deeply intertwined than that.
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How Sleep Apnea Is Diagnosed And Treated
A definitive diagnosis of sleep apnea can be made only with a sleep study , a non-invasive exam that records what happens in your brain and body while you sleep. Sleep studies are conducted during a visit to a sleep lab, usually overnight, or a home test performed with special equipment.
If youre diagnosed with OSA, chances are youll be advised by your doctor to use a continuous positive airway pressure machine to treat it. CPAP helps eliminate the pauses in breathing caused by OSA by delivering a stream of pressurized air. Once youre able to breathe freely, youre able to sleep through the night without waking up.
For people with RA, whose sleep disturbances lead to increased flare-ups, as well as depression, pain severity, and trouble performing normal daily functions, that will hopefully provide relief they only dream about.
Exactly What Is Sleep Apnea And Exactly What Are The Symptoms
Sleep Apnea Leg PainExactly what is sleep apnea? Apnea actually suggests no breath or stopping breathing.
Lots of people have rest apnea, however may not even know it.
In fact, rest apnea affects greater than 3 in 10 males and almost 2 in 10 ladies, so its more common than you could believe.
If you think you may have rest apnea, it is very important to identify a few of the typical symptoms and what you can do regarding it.
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The Link Between Rheumatoid Arthritis And Obstructive Sleep Apnea
With OSA, a persons airway becomes partially or completely obstructed during sleep, which interrupts their breathing for 10 to 30 seconds at a time and deprives them of oxygen until they wake up and start breathing again. These short stops in breathing can happen up to 400 times every night. Even if the periods of not breathing dont fully wake you up, the micro-interruptions in breathing can disturb your sleep.
If someone poked you with a stick every 10 minutes while you were asleep, youd feel pretty tired even if you slept eight hours, says Nitun Verma, MD, a sleep doctor in San Francisco and a spokesperson for the American Academy of Sleep Medicine.
Researchers arent sure why people with RA have a higher risk of OSA. Here are some possible explanations.
Kids Oral Appliances Are Available
Expanders and growth appliances will cure pediatric sleep apnea with proper attention to other conditions such as tongue tie and lip frenums. Appliances for children include Schwarz, ALF and Crozat. No one appliance is the best appliance. It depends on the growth needs of the child, what the child can tolerate and what appliance the dentist knows how to use.
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Sleep Apnea And Pain: Coincidence Or Not
A common old proverb most commonly attributed to athletic pursuits and doing things that are hard to do proclaims that pain is temporary and glory is forever. But what if pain is forever and glory is that day you had five years ago when you woke up, and for a single fleeting moment, didnt feel any chronic pain. Right now, over 100 million Americans suffer from persistent pain and billions of dollars are being spent to treat it. If you have been diagnosed with obstructive sleep apnea, chronic pain and the sleep disorder may be in cahoots to make your life a living hell.
What is the relationship between sleep apnea and chronic pain? First, it is important to know that there is no direct link between obstructive sleep apnea and pain and there is no proof that one causes the other. However, there is quantifiable and scientific proof that there are many differing causal links between the two. In so many words, if you have chronic pain, there is a strong chance that you also have sleep apnea. If you have sleep apnea, there is a high probability that you are also suffering from some kind of chronic pain.
So, what does this mean for chronic pain sufferers? You have two options:
The Connection Between Tmj And Sleep Apnea
TMJ disorders and sleep apnea are two very separate conditions. When you have sleep apnea, you will experience breathing issues throughout the night as your airway gets blocked.
If sleep apnea continues on a long-term basis without treatment, it can cause a range of complications such as high blood pressure, reflux, increased cortisol levels, digestive issues, and even death.
TMJ disorders are mainly a problem connected with the joint and often cause pain. Oftentimes doctors will treat the two separately.
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Other Side Effects Of Opioids
In 2017 , these results were further confirmed. Kirstie Anderson, BMedSci, MBBS, MRCP, DPhil, honorary senior lecturer at Newcastle University and consultant neurologist at Newcastle Hospitals NHS Foundation Trust, believes that overuse of opioids is not just about addiction its also about other potentially fatal side effects.
In a study of the effects on non-cancer patients taking opiates for pain management, the findings of increased risk of sleep apnea were conclusive. Anderson notes:
There has been recent concern about the addictive nature of opioids and a large number of side-effects, including worsening overnight breathing and therefore disturbing sleep. Few studies have looked at the impact of these drugs on metabolism. Our study is the largest of its kind to look at this group of drugs and show an association between obesity and poor sleep.
The study above also found an increase in:
- Body-mass index among 95% of participants
- High-risk waist circumference in 82%,
- Hypertension in 63%
All of these are primary indicators of an increased risk of sleep apnea, or worsening of symptoms in those already diagnosed.
Cpap And The Bodybuilder
No doubt you’re thinking how decidedly unsexy you’re going to look at night hooked up to a machine with a breathing tube. It may well be uncomfortable, make you feel claustrophobic, and even leave your mouth dry. You might also be embarrassed to wear it in front of others. Those are just a few of the reasons why the compliance rate for individuals who are diagnosed with OSA and have CPAP machines is so low.
Studies have shown the compliance rate of using CPAP machines at just 29-83 percent, depending on the study. Compliance rates in the limited number of studies have been all over the map, so it’s hard to even venture a guess as to how many people even use their CPAP. Many individuals never actually don the apparatus after purchasing one.
You could lose weight and try to remedy the underlying condition, and for the vast majority of people, that would be ideal. But some bodybuilders and powerlifters don’t want to get smaller, even when it’s clear that their size is causing OSA. Oftentimes a bodybuilder will find that when preparing for a competitionâwhen his bodyweight drops significantlyâhis nighttime breathing improves. It gets worse again when he goes back to an “offseason” weight.
Not surprisingly, then, many bodybuilders who don’t want to quit their vocation ultimately chose to use a CPAP device.
Cheung, now 35, overcame his initial fears and embarrassment about using a CPAP device. He lists a number of ways the machine has improved his quality of life.
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Implications For Osa And Tmd Patient Screening And Treatment
Clearly, with a large-scale study documenting a statistically relevant coexistence of OSA and TMD, the approach to screening and optimally treating both conditions needs to reflect this association. When a patient presents with one or the other, best practices should include screening for the both. If one is initially present but not the other after assessment and diagnosis, such as OSA without TMD, periodic screening checks for TMD should be conducted.
Chronic Insomnia And Psoriatic Arthritis
According to a review article that featured in Sleep Medicine Reviews, there is no clear evidence that people with psoriasis are more likely than other people to have insomnia. The authors also found no clear link between psoriatic arthritis and the risk of insomnia.
However, the authors did find evidence that getting treatment for psoriasis or psoriatic arthritis may help people who also have insomnia sleep better. In people who received treatment in the form of biologic medications, reduced joint pain had an association with decreased fatigue.
In addition to sleep disorders, several other factors may affect how well a person with psoriatic arthritis sleeps. These factors may include:
- extent of inflammation in the body
- presence of anxiety, depression, or other emotional distress
If the person has psoriasis, uncomfortable skin symptoms may also disrupt their sleep. For example, they might experience itching or burning sensations in their skin.
The persons sleep routine, bedroom environment, and other lifestyle factors may also affect how much high quality sleep they get.
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The Problems With Sleep Deprivation In General
Sleep deprivation, in general, is all too common in our fast-paced world today. Many of us just cant seem to get it all done and still fit in the recommended seven to eight hours of sleep each night. While simply getting less than the recommended hours of sleep at night may not necessarily fit the clinical definition of insomnia, sleep deprivation can also lead to big problems.
Sleep deprivation has also been associated with an increased vulnerability to pain, less mental focus, and depression. Sleep deprivation may also contribute to more sports injuries in teen athletes. In addition, disruptions in our normal circadian rhythm, the bodys biological day-night cycle clock, have even been shown to cause a reduction in the effectiveness of our stem cells to repair tissues and may also cause stem cells in our fat to multiply and make more fat, increasing the risk for weight gain and obesity.
So if you fall somewhere on the sleep deprivation scale, whether its not getting the recommended amount of sleep, or its full-blown severe chronic insomnia, or its any point in between, dont ignore it. Proper sleep is the ultimate rejuvenator and self-healer, so dont be resigned to allowing your body to skimp on it.
Chris Centeno, MD
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Fatigue: A Sneaky Symptom Of Ra And Sleep Apnea
The most common signs of sleep apnea are loud, persistent snoring and excessive sleepiness during the day. When fatigue is one of the most common symptoms of RA , it can be easy to miss the possibility that an RA patients fatigue may also be due to sleep apnea. But the medical community is becoming hip to the connection.
When RA patients are overly tired all the time, we may suggest they get a sleep study because of the high prevalence of sleep apnea, says Vinicius Domingues, MD, a rheumatologist in Daytona Beach, Florida, and medical advisor for CreakyJoints.
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Chronic Pain & Sleep Apnea: Is There A Link
Heres a shocking statistic put out by the National Academy of Sciencesthat 116 million Americans suffer from chronic pain. Thats more than diabetes, heart disease, and cancer combined. The article in the New York Times emphasizes the importance of more recognition of this condition by doctors. However, I doubt were ever going to make a significant dent in treating chronic pain unless we deal with their sleep issues.
Its easy to argue that chronic pain can negatively affect your sleep quality. However, you can also argue that poor sleep can predispose you to chronic pain, once you experience a trigger . Its been shown that poor sleep can lower your pain thresholds: Sleep deprived people were found to pull their fingers from a hot environment much quicker than people who had normal sleep. What this means is that the less quality or quantity of sleep you have, the more likely youll sense pain at very low levels.
If you think about the total number of people with obstructive sleep apnea , its probably about 1/4 to 1/3 of the population. Coincidence?
If youre truly committed to treating chronic pain patients, you have to simultaneously treat any underlying sleep-breathing problems. Giving sleeping pills just wont cut it.
Is Sleep Apnoea Seen In Rheumatic Disease Patients
Other rheumatic disease groups have also been investigated objectively by PSG. Solak et al. studied PSG recordings in a group of 31 AS patients. In that study, 22.6% of the total population met PSG criteria for OSA. It was observed that the frequency of OSA was 6.3% for those aged < 35 years and 40% for those aged > 35 years. Iaboni et al. studied PSG recordings in SLE patients with disabling fatigue. Of the 35 patients studied, 26% met criteria for sleep apnoea. May et al. performed PSG studies on newly diagnosed FM patients whose history was suggestive of a co-existing sleep disorder. This selection process resulted in 13 of 25 men and 4 of 92 women being included in the PSG study, of whom 11 men and 2 women had significant sleep apnoea.
Sleep-disordered breathing has been reported in children with JIA. Although there are both paediatric and adult PSG criteria for OSA, Accardo et al. recently applied both to an adolescent population, with comparable results.
A clinical association of gout with sleep apnoea has also been observed. Abrams has elaborated on pathogenic mechanisms in sleep apnoea that may contribute to hyperuricaemia and gout. With uric acid excretion dependent on renal function, it is interesting that Ahmed et al. have recently reported a link between nocturnal hypoxia in patients undergoing overnight PSG and accelerated renal function loss over the 2-year observation period.
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