“Sleep, that deplorable curtailment of the joy of life,” author Virginia Woolf once wrote.
But for people who experience sleep apnea, it would be a joy to get a good night’s sleep.
Peg, who asked that her last name not be used, had put up with her husband’s snoring for years when she began snoring and waking up gasping for air. He had tried to use a CPAP, or continuous positive airway pressure, but the large face mask with air hose was difficult for him to use.
“I had seen him struggle with it,” she said about the CPAP, “and I didn’t want to have to go through that.”
Though he snored, Peg’s husband, as well as her son, began complaining about her snoring — something she was more concerned about than not breathing at intervals.
“My husband kicked me out of my bed because I snored so loud,” she said.
She tried using a mouth guard from Joe Stark, a dentist then in a Pink Hill practice, who has spent more than 20 years fitting oral appliances on people with sleep apnea. But the device didn’t work for her.
Dan Daniels, a Kinston native, had a different experience.
“I’ve always been told …I snore a lot,” the 43-year-old said. When in his mid-30s, he was told he would stop breathing when he was sleeping.
But the last couple of years, it began to affect the quality of his sleep.
“I would sleep eight hours,” Daniels said, “but I was more tired when I woke up than when I went to bed.”
Both Peg and Daniels tried to use a CPAP, but had problems using it. Peg continued to wear it at night for about a year because her son would wake her up and make her put it back on. She then tried a variety of other masks, but none of them worked well.
“I was always tired,” she said. “I needed to be in bed 10 hours to get enough rest to keep going.”
Daniels used it during a sleep study but refused to use it at home because he said it made him feel claustrophobic.
A tiring problem
An apnea occurs when a person stops breathing for at least 10 seconds.
“It occurs,” Stark said, “when the tongue and the soft palette collapse onto the back of the throat blocking the upper airway.”
Another disorder is hypoxia, an obstructive sleep apnea event where the oxygen saturation drops, he said.
The size of a person’s neck is a factor. It’s more likely for a man with a neck circumference of more than 17 inches and more than 15 inches for a woman, Stark said.
It’s a potentially life-threatening condition. Sleep apnea can increase the risk of congestive heart failure, stroke, high blood pressure and heart disease, as well as diabetes, obesity, depression and impotence, he said.
The CPAP machine forces air into the throat to keep it open.
“The problem with the CPAP is the compliance level is so low,” Stark said. “And after three months, it’s generally under 50 percent compliance. And so if the patients’ aren’t wearing them, it’s not doing any good.”
Reasons for not wearing it may be the comfort level, the pressure and noise of the mask or a patient who is claustrophobic, he said.
A fitting remedy
After Stark retired, he joined Harvey & Associates Family Dentistry on Plaza Boulevard part-time to fit sleep apnea patients with a fairly new oral device that is having an amazing success — so far, 100 percent satisfaction, Stark said.
The latest mandibular, or oral, appliances are custom-made to fit the upper and lower teeth. There is a tiny screw on each side that the dentist tightens to bring the lower jaw forward, forcing the air passageway to stay open.
There are 80 different FDA-approved types of oral appliances, and Stark said he and dentist Will Harvey use about 10 different models.
“Through the years,” Stark said, “they developed better appliances and now the ones that we use are very comfortable.”
But before they do so, the patients must have tried to use a CPAP without success. The patients then have to undergo an at-home sleep study. Harvey and Stark use a Watermark Medical ARES, or apnea risk evaluation system, home sleep test.
The device, which is worn for a night, fits like a headband and tracks all kinds of information about how a person sleeps.
“It will tell me how long you slept,” Stark said, “how long it takes you to go to sleep; whether you’re sleeping on your back, your right side, your left side; how many apnea events you’re having; how many hypothnea events you’re having; the action level.
“If you’re snoring, it will tell me how often and how loud you snore each time. It will tell me your beats per minute of your heart, your variance you have per hour. And so from that, we get all these charts and results.”
All the information is sent to a board-certified physician — as apnea is a medical disorder — for a diagnosis. Once the diagnosis is determined to be sleep apnea, a dentist can start oral appliance therapy. Medical insurance, not dental insurance, is used to cover the treatment, Stark said.
Adjustments as little as half a millimeter are made over a period of about 120 days and at-home testing is repeated. The device is mainly useful for people with mild to moderate sleep apnea, he said. But it also may help those with severe sleep apnea.
Stark knows from experience. He, like some of his patients, suffers from severe sleep apnea. He discovered that from his wife about 15 years ago. He tried a CPAP, which works well for some people, he said. But he said he just couldn’t wear it. He now uses the same device he fits on his patients.
Better bedfellows
Besides sleep apnea, Peg also has temporomandibular joint disorder, or TMJ. Still, she said the device is “working beautifully.”
“It’s not as uncomfortable as the CPAP for me,” she said. “… But the TMJ is probably as good as it ever will be since I’ve been wearing this.”
Peg said she still snores a little bit, but is no longer gasping for breath. Even her daughter will sleep with her now.
Both Peg and Daniels are still getting adjustments made on their oral devices.
Daniels filled out a questionnaire at Harvey’s dental office and Stark recommended he have a home sleep apnea test. He had moderate episodes of apnea.
“I could wake myself up sometimes,” he said, “and kind of feel like gasping.” He was also falling asleep during the day, even at meetings. He’s now undergone oral appliance therapy, and within a week of wearing the device, he could notice a difference.
“Now I can go home and sleep four hours,” he said, “and do better than I did sleeping eight hours without (the device).”
Daniel’s mother had been concerned about him not breathing during sleep.
“I don’t snore and have any apneas,” he said. “And I felt so good about it and what it’s doing for me that my dad’s got one.”
The oral appliance therapy has brought restful sleep to many couples and their families, Stark said.
“We’re bringing husbands and wives back in the same bedroom,” he said, “that haven’t been there for 15 years, and I’m getting Valentine cards from spouses. It’s really rewarding because we’re not only changing and trying to prevent the physical ailments that can happen from sleep apnea, but your quality of life goes way up if you’re getting a good night’s sleep.”
Margaret Fisher can be reached at 252-559-1082 or Margaret.Fisher@Kinston.com. Follow her on Twitter @MargaretFishr.
- About 24 percent of adult women and 40 percent of adult men experience habitual snoring, according to the International Classification for Sleep Disorders
- At least 12 to 18 million adults in the U.S. have obstructive sleep apnea
- Up to 50 percent of sleep apnea patients do not comply with or tolerate CPAP
- About 75 percent compliance is validated for patients using the oral appliance all night, seven nights a week
Source: AmericanAcademyof Dental Sleep Medicine