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Sleep Disordered Breathing

The following are the show notes from Dr. Brian Fusilier

 

Sleep Disordered Breathing

1. What is sleep disordered breathing? Sleep disordered breathing is struggled breathing while an individual sleeps. Typically,
an individual with sleep disordered breathing is unaware of this struggle to breath.
2. Why should I be concerned about sleep disordered breathing? Sleep deprivation is associated with the development of
chronic pain, increased risk of stroke, increased risk of heart attack, increased risk of cancer, depression, and not to mention
death by falling asleep while driving.
3. What is one lost night‘s sleep like? One night of lost sleep is equivalent to driving impairment equal to an individual
consuming 4 beverages of alcohol. Two nights of lost sleep is equivalent to driving impairment equal to an individual
consuming 8 beverages of alcohol. Sleep Apnea patients typically go months and years without treatment. Sleep Apnea is
considered to be one the most under diagnosed or non diagnosed diseases today.
4. What is normal sleep? Normal sleep represents 7 to 9 hours of sleep per night linked to 4 to 6 ninety minute deep sleep
cycles. Sleep is divided into 2 categories, rapid eye movement sleep and non rapid eye movement sleep. Rapid eye
movement sleep is the dreaming stage of sleep. In normal sleep adults cycle into the deep sleep cycle on 4 to 6 occasions per
night and awakened refreshed the following morning. This deep stage of sleep is extremely important to maintain daytime
energy. This deep stage of sleep is our restorative sleep. Individuals who cannot enter into this deep sleep become
physically and mentally impaired. Inadequate deep sleep is the main reason why many people can sleep up to 12 hours a
day but remain mentally and physically drained.
5. Are there different types of sleep disordered breathing? Yes, sleep disordered breathing is profiled into a broad spectrum.
This broad spectrum of sleep disordered breathing begins with normal sleep and slowly advances to the different degrees of
sleep disordered breathing which is snoring, upper airway resistance, mild obstructive sleep apnea, moderate obstructive
sleep apnea, and lastly severe obstructive sleep apnea.
6. What causes sleep disordered breathing? The predominant thinking at present is that sleep disordered breathing is caused
by a mechanical failure. Sleep disordered breathing is caused by the tongue collapsing totally or partially into the throat
while sleeping in which the tongue is obstructing the airway.
7. What inside the mouth changed to take an individual from normal sleep to develop sleep disordered breathing? Presently
researchers and doctors believe that one of the tongue’s muscles that specifically holds the tongue in a forward position
becomes flaccid. This flaccidity in this specific muscle of the tongue develops due to lack of use allowing the tongue to drop
further and further towards the back of the throat. One other explanation is that the tongue enlarges as we age or it
enlarges if we gain weight. If the tongue enlargement is great enough it will no longer remain inside the mouth when the
tongue muscles relax. Relaxation of the tongue muscles become greatest when an individual enters into the deep stage of
sleep.
8. Can anything else create an obstruction inside the mouth? Yes, an obstruction in the region of our face behind our nose is
also fairly common. These nasal obstructions are usually diagnosed as deviated septums that may be associated with a bone
spur or enlarged turbinates. A CT/scan of the sinus is necessary to ascertain if this condition is present.
9. What causes snoring? It is presently believed that snoring begins in the early stages of sleep disordered breathing due to the
tongue either enlarging or slightly collapsing toward the back of the throat. This gradual rearward re-orientation of the
tongue allows the back of the tongue to contact the soft palate tissue. This contact of the back of the tongue to the soft
palatal tissue allows the soft palate to slap against the back of the tongue creating the snoring sound. As the tongue begins
to gradually move further and further towards the back of the throat the sleep disordered breathing advances to upper
airway resistance, mild obstructive sleep apnea, moderate obstructive sleep apnea, and ultimately severe obstructive sleep
apnea.
10. What is upper airway resistance? Upper airway resistance is when an individual stops breathing for less than 10 seconds and
is associated with an awakening event. It is presently believed that upper airway resistance is caused by the tongue partially

collapsing into the throat. This less than 10 second cessation of breathing causes a rise of carbon dioxide in our blood that
triggers an alarm in our brain which trips a switch for certain centers in our brain to release a specific chemical. This chemical
shifts our sleep from the much needed deep sleep to a lighter non-restorative sleep or it fully awakens us. Fortunately, this
chemical release truly saves our life by allowing us to breathe but at a price. Unfortunately, this chemical release deprives us
of the deep sleep which is our greatly needed restorative sleep.
11. What is apnea? Apnea is defined as temporary cessation of breathing associated with an awakening event.
12. What is an obstructive sleep apnea event? An obstructive sleep apnea event is the collapsing of the tongue into the throat
resulting in complete cessation of breathing during sleep for at least 10 seconds associated with an awakening event.
13. Are there different types of obstructive sleep apneas? Yes, there are 3 types of obstructive sleep apneas, mild, moderate,
and severe. All three types are associated with an awakening event. Mild obstructive sleep apnea is defined as an individual
experiencing 5 to15 obstructive sleep apnea events per hour of sleep, moderate obstructive sleep apnea is defined as an
individual experiencing 15 to 30 obstructive sleep apnea events per hour of sleep, and severe obstructive sleep apnea is
defined as an individual experiencing 30 or greater obstructive sleep apnea events per hour of sleep.
14. What should I do if I think that I may have sleep disordered breathing? If you feel that you may have sleep disordered
breathing please talk to your dentist and your physician about participating in a sleep study. This is your first step. The sleep
study can determine if you have a small problem such as only snoring or if you have a serious condition such as severe
obstructive sleep apnea which deprives you of your much needed deep sleep. Once the sleep study has identified a possible
problem with your sleep you can then decided which of the treatments outlined in this podcast that you prefer.
15. How is obstructive sleep apnea treated? Types of treatment for obstructive sleep apnea include a weight loss program,
sleep hygiene, physical therapy, the implementation of continuous positive airway pressure, to use an oral sleep apnea
medical device, or surgery. This podcast is on non-surgical treatment.
16. How will weight loss help sleep disordered breathing? Weight loss could remove the volume of the throat as well as the
tongue in which reduction of volume in either of these strctures could be beneficial in reducing throat obstruction.
17. What is sleep hygiene for sleep disordered breathing? Sleep hygiene for sleep disordered breathing is to sleep on your side
(sleeping on your side can be maintained by sewing a tennis ball to the back of your nightshirt), to remove all pets from your
bedroom, to turn off all electronic devices before going to bed, to set a bedtime reminder alarm 7 to 9 hours before
awakening, and to sleep inclined at approximately 3 to 5 degrees with your head elevated above your toes (this inclined
sleeping can be accomplished by placing a brick under each bedpost at the head of the bed).
18. What type of physical therapy can I participate in to minimize sleep disordered breathing? There is one exercise specifically
designed to increase the tonicity of the one tongue muscle that draws the tongue forward. This exercise program is called
“The Einstein Method.” It could save your life.
The Einstein Method is a daily tongue exercise program designed for people with sleep disordered breathing.
1. Gradually stick out your tongue keeping your upper and lower lips around your tongue. Do not open your mouth wide.
Extend your tongue out of your mouth only ½ inch for the first month, and a ½ inch further for each successive month,
reaching its greatest extension out of the mouth in 3 months.
2. Stick out your tongue for 30 seconds, then relax your tongue for 30 seconds
3. Repeat 5 times
4. Perform this exercise 3 times a day
This exercise may appear unusual even when performed alone. Therefore, perform this exercise during non-social occasions, such as
driving alone in your car or in the shower. As a beginner, do not perform this exercise when lying on your back. Strengthening this
tongue muscle is extremely important to help hold your tongue forward during sleep. As adults, we rarely fully use this muscle. Thus,
it is of utmost importance to make this exercise a part of your daily routine.

19. What is continuous positive airway pressure treatment? Continuous positive airway pressure treatment is the delivery of a
continuous stream of air into the nose or mouth, or both, specifically pressurized to displace the tongue away from the back
of the throat, thus eliminating sleep disordered breathing.
20. How does continuous positive airway pressure treatment work? Continuous positive airway pressure treatment, more
commonly known as CPAP therapy, works by delivering continuous pressurized air into the mouth or nose by a sealed face
mask. The face mask is tethered by a hose to the bedside air supply machine. The bedside air supply machine delivers a
constant flow of pressurized air. The pressurized air flow displaces the users collapsed tongue away from the back of the
throat allowing the user to breathe effortlessly.
21. What is oral sleep apnea medical device therapy? Oral sleep apnea medical device therapy is the use of an oral appliance
specifically designed to advance the users tongue away from the back of the throat.
22. How does an oral sleep apnea medical device therapy work? Oral sleep apnea medical device therapy uses the connection
of the tongue to the chin to advance the lower jaw while the user sleeps. This advanced repositioning of the lower jaw will
also advances the tongue to a forward position due to the ligamentous and muscular attachment of the tongue to the lower
jaw, thus oral sleep apnea medical device therapy works by advancing the user’s collapsed tongue away from the back of the
throat.

I hope that this pod cast on sleep disordered breathing has been helpful. If you feel that you may have this disorder please talk to
your dentist and your physician about participating in a sleep study. This is your first step. The sleep study can determine if you have
a small problem such as only snoring or if you have a serious condition known as severe obstructive sleep apnea. Once the sleep
study has identified a possible problem with your sleep you can then decided which of the treatments discussed in this podcast that
you would prefer to participate in.