Expert in orthodontics, the renowned dentist Marina Población has more than 30 years of experience. She has been director of the Pre- and Post-surgical Orthodontic Service of Maxillofacial Surgery at the Hospital de la Princesa and is an honorary professor at the Universidad Autónoma de Madrid. In the following article she explains everything you need to know about sleep apnea.
How to diagnose sleep apnea?
In 1989 appeared the polysomnograph, which has been a huge step forward in the history of medicine, as it has allowed objectively diagnose sleep apnea. Until then, only the signs and symptoms were the only thing that the professional had to make a diagnosis, with a high error rate.
Today we can accurately state whether a patient has sleep apnea, although there is a problem: the evolution of the airway (VA). It decreases with age; it increases until the age of 20 and begins to decrease slightly until the age of 50. After that age, it decreases dramatically.
Fortunately, nowadays CBCT offers us a 3D image in which we can see where the VA is diminished and we can predict, if it is not diminished at the time of the test, the chances of having it after the age of 50 (given the measurements we can make of the most diminished areas and the place where they are).
Risk factors for sleep apnea
- Alteration in the craniofacial growth, which consists of a deficiency in the sagittal plane of the face, either only of the jaw or maxillomandibular, that is, those people who have the chin and, therefore, the jaw much smaller than it corresponds in relation to the rest of the face, or also the middle third of the face. This small deficit of forward growth of the facial bones prevents the growth of the VA to normal size.
- Obesity, mainly in women; to the generalized overweight is added the increased weight of their breasts over the ribs, making it difficult for the pectoral musculature to fully expand the ribs to allow maximum air intake.
- The wide neck above 42 cm, which is usually also linked to obesity, although not always.
- In children the main cause is tonsil hypertrophy and vegetations.
If a compression of the maxilla is added to this pathology, a very frequent situation, the symptoms multiply exponentially.
Symptoms of sleep apnea in children
- Poor school performance
- Sluggishness, drowsiness at school misunderstood as laziness.
- Breathing through the mouth
- Hyperactivity
- Not wanting to go to bed It can be said that the brain “deprives them of sleep” because it knows that sleeping stops the necessary amount of O2 from entering their organism.
- Unusual sleeping positions, such as sleeping on hands and knees, or with the neck hyperextended.
- Very unmade beds in the morning
- Falling asleep in the car ride home from school.
- Learning and behavior disorders
- Waking up at night even for an instant, the brain wakes them up to change posture
- Getting up to pee for the same reason
Symptoms of sleep apnea in adults
- Snoring
- Restless, unrefreshing sleep; nightmares, insomnia
- Waking up to go to the bathroom, choking sensation
- Night sweats
- Drowsiness, irritability, forgetfulness
- Dry mouth
- Lack of attention during the day
- Depression
- Sexual dysfunction
- Headaches
- Muscle and joint aches and pains that are mistaken for fibromyalgia
Consequences of sleep apnea
- Accidents, whether they involve cars, boats, trains, etc. According to some surveys, apnea is behind 60% of car accidents, because the driver falls asleep. Roads and cars are getting better and better, i.e. more and more monotonous and drowsiness-inducing. In fact, there are several countries in which for the renewal of the driving license it is necessary to present a medical certificate of a polysomnography, showing that one has apnea.
- Apnea is behind myocardial infarction and stroke. If we think for a moment how many young people have died suddenly from a heart attack or stroke without apparent cause, completely healthy, it is now being shown that behind it was a sleep apnea.
- Alterations in family relationships with a decrease in quantity and quality since these people have symptoms of depression and fatigue, to which are added muscular and joint pains that reduce their relationship life to a minimum, isolating them progressively with repercussions also in their life as a couple.
- The risk of diabetes and metabolic alterations are greater.
In children…
During the day the brain directs our life and takes advantage of the night to manufacture the hormones that we use during the day. The lack of O2 during the night in children prevents them from growing normally. Growth hormone is no longer produced in normal amounts, so it is almost of “vital” importance to diagnose and treat these children urgently.
The sad consequences they have to endure as a lazy, apathetic, non-sporty person, with no relationship with their friends….. A sad childhood! Because of a lack of diagnosis.
Often because of a blindfold in the eyes of parents who do not perform the necessary tests. They do not see it opportune since the child wakes up earlier, is not sleepy at bedtime, they do not believe that they are sick just because they fall asleep on the bus home from school, move in bed, sweat…… Until they reach higher grades that teachers warn of their “laziness” they do not start up having prevented for years the proper synthesis of growth hormone with its irreversible consequences.
Treatment of sleep apnea
In children, the orthodontist treats mandibular reduction and maxillary compression, for which early diagnosis is essential. Maxillary expansion appliances and/or functional appliances stimulate mandibular sagittal growth.
Recently we have been using mandibular distractors which, after a small surgery, are placed for approximately one month and stimulate mandibular growth until normal size is achieved.
On the other hand, the otolaryngologist removes or reduces the size of tonsils and vegetations as an essential treatment if there is an obstructive hypertrophy.
In adults the treatments are different since the factors that produce them are different:
- Orthognathic surgery is the only thing that cures sleep apnea. It is performed as a team with the orthodontist and the maxillofacial surgeon. This surgery increases the VA restoring the normal size or even larger and preventing the physiological decrease from the age of 50 years. It offers a normal life without any of the following appliances and allows to forget about the problem and the disease, which none of the following treatments achieve, they are only palliative.
Although you have to wear orthodontic treatment and overcome the fear or respect of accepting a surgical treatment, given the very good results, the number of patients who decide to undergo it increases considerably every year.
- A CPAP is a device that injects pressurized air through a mask, restoring the lack of air that stops entering the lungs due to the nocturnal decrease in VA. It is being of great help to these patients and there are millions of people in the world who use them daily. It is getting quieter and quieter, but the first models did not let the spouse sleep. Another big problem is for people who have to travel frequently for work and have to carry something quite bulky.
- The SAM or mandibular advancement system is an appliance made by the orthodontist that prevents the jaw from dropping backwards while sleeping, thus not only maintaining the same size of the VA as when you are awake, but day by day the appliance can be advanced to achieve a larger size than when awake and standing up. It is small and quiet so it is usually an excellent solution for not very severe apneas and for use in travel.
- As a home remedy would be to hang a small bag with a tennis ball on the back of your pajamas. This little gadget prevents sleeping on the back, a situation where the decrease in VA is greater.
- Treating obesity, avoiding alcohol and daily exercise is the best prevention.