Snoring & Sleep Apnoea Management

The severity and medical significance of your snoring is investigated by referral to a specialist physician for a sleep test. This test, known as polysomography or PSG, is non-invasive, and may be carried out in your home or in a sleep centre.

The test consists of attaching a series of leads, like an electro-cardiogram, to your head, body, arms and legs. This test will measure the various stages of your sleep and physiologic functions like breathing, heart rate, and oxygen content of your blood, leg movements, and eye movements.

A PSG will tell us about the quality of your sleep and just how much problem you may be having with sleep apnoea. The sleep test helps our office and your sleep physician determine what type of treatment would be best for your problem. Treatments range from things you can do to help yourself to use of devices to help maintain the size of your airway during sleep to surgery.

There are a number of things you can do to help yourself. These include :

• Weight loss If you are overweight, losing weight can help your snoring and sleep apnoea by reducing the size of the fat deposits around your soft palate, tongue and neck.
• Sleep Position Many people find that their snoring is worse if they sleep on their back. One way to train yourself not to sleep on your back is to place a tennis ball in a sock and sew it to the back of your pajama tops.
• Avoid drugs and alcohol Many people find that their snoring is worse if they sleep on their back. One way to train yourself not to sleep on your back is to place a tennis ball in a sock and sew it to the back of your pajama tops.

Devices Used to Control Snoring & Sleep Apnoea

Two main devices are available for the control of snoring and obstructive sleep apnoea. These devices must be worn every night to control your sleep problem.

CPAP (Continuous Positive Air Pressure) is a device that controls apnoea by providing a stream of air, under slight pressure, through a tube into your nasal passage. This positive air pressure acts as a splint holding the tissues in the back of your throat open to prevent collapse. Use of this device requires a sleep study to determine the proper pressure to use.

Oral Appliances – Oral appliances are devices very much like sports mouth guards or removable orthodontic appliances that hold the airway open by either holding the tongue or jaw in a forward position. Oral appliances are non-invasive and easy to use and as such they may be considered an early treatment option and may be the most appropriate treatment for your condition.

Surgery

The goal of any surgical procedure is to provide and maintain an open airway to prevent collapse during sleep. Surgical procedures are known as site-specific procedures because they treat a particular portion of the airway.

Surgery can be performed on the nasal passages to provide a clear passage for the flow of air by correcting a deviated septum, removing polyps and/or reducing the size of the bones in your nose known as turbinates.

Removal or reduction in size of the soft palate, uvula and back of tongue can be accomplished by a procedure known as:

Uvulopalatopharyngoplasty (UPPP) – which involves removal of the uvula, soft palate and redundant tissue in the back of the throat and requires hospitalization.

Surgical procedures may on occasion only provide a partial resolution to sleep apnoea and snoring and may need to be complimented with for example an oral appliance treatment to provide a more optimal outcome.

Oral Appliance Therapy for obstructive snoring & sleep apnoea 

Oral Appliance therapy involves the selection, design, fitting and use of a specially designed oral appliance that, when worn during sleep, maintains an opened, unobstructed airway in the throat. Oral appliances that treat snoring and obstructive sleep apnoea are customised devices made from impressions of the teeth. They are worn in the mouth while sleeping, dilating or enlarging the airway. When successful they have several advantages over other forms of therapy.

Oral appliances are comfortable and easy to wear and care for. They are small and convenient, making them easy to carry with you when you travel. Treatment with oral appliances is reversible and non-invasive.

Oral appliance therapy is recognised in the area of Sleep Medicine as an effective treatment option in the management of sleep breathing disorders. Medical and dental researchers have joined together to evaluate and improve the outcome of treatment with oral appliances.

Designs are constantly evolving and can be customised to individual dental configurations. In the case of individuals who have missing teeth or dentures for example, appliances can be modified and a suitable design provided. This could possibly include using dental implants, designed around these differing dental configurations, which can be used to help improve the fit of the oral sleep appliance and improve the effectiveness of the device.

Patients may have differing experiences following the need to wear a device while sleeping for either medical or noise reduction reasons. Customised appliances can accommodate individual tolerances and differences. Oral appliances may be used alone or in combination with other means of treating OSA, including general health and weight management, surgery or nasal continuous air pressure (CPAP). Oral appliances work in several ways:

• By repositioning the lower jaw, tongue, soft palate and uvula
• By stabilizing the lower jaw and tongue
• By increasing the muscle tone of the tongue

Oral appliance therapy can take from several weeks to several months to complete. Even after the initial phase of treatment is complete, we will continue to follow you to be sure that treatment remains successful and to evaluate the response of your teeth and jaws.

If a medical diagnosis of sleep apnoea has been made, as opposed for example to simple snoring / noise problem, a follow up sleep study with your sleep physician is required to evaluate the effectiveness of the contribution of wearing a customised oral appliance to the medical management of this condition. Necessary modifications and adjustments, called titrations, can be carried out if required following the results of this study.