Snoring and sleep apnea for public presentation1

Snoring and Sleep Apnea

Dr. Allan GrossDirectorSleep Healthy Dental TherapySnoring and Sleep Apnea Sleep Better Live Better

Dr. Allan Gross

Slide 1: Title slideI am a member of this organization. We are a multidisciplinary Academy and we meet together every year with all types of practitioners who are involved in the identification and treatment of snoring and sleep apnea. The ACSDD is an educational and research Academy in the United States with members worldwide. Dentists, physicians, nurse practitioners, respiratory therapists, ENTs and others are all part of the organization.

1/9/2016 1:37 PM 2007 Microsoft Corporation. All rights reserved. Microsoft, Windows, Windows Vista and other product names are or may be registered trademarks and/or trademarks in the U.S. and/or other countries.The information herein is for informational purposes only and represents the current view of Microsoft Corporation as of the date of this presentation. Because Microsoft must respond to changing market conditions, it should not be interpreted to be a commitment on the part of Microsoft, and Microsoft cannot guarantee the accuracy of any information provided after the date of this presentation. MICROSOFT MAKES NO WARRANTIES, EXPRESS, IMPLIED OR STATUTORY, AS TO THE INFORMATION IN THIS PRESENTATION.

1

Apneic event video

Dr. Allan Gross

Slide 2: Video of apneic man

After the video is done playing) Does this sound or look like someone you know? Does it remind your bed partner of you? The estimated time between breaths in this video is about 10 seconds. Try holding your breath for 10 seconds. Now imagine doing that hundreds of times a night. Its called an apneic event, and it results from the airway collapsing in on itself as you sleep.

Why is that important? This puts a huge strain on your body and can contribute to heart attack and other medical problems including death.


2

Questions to ask yourself and your loved ones?Do you snore?Do you stop breathing while sleeping?Do you wake up tired?Are you overweight?

Dr. Allan Gross

Slide 3: Questions to ask yourself and your loved ones

Based on the statistics, chances are that many of you suffer from a sleep breathing disorder if you answered yes to more than two if these questions Snoring or apnea.Ask yourself and your loved ones these questions(presenter asks questions)Person who is presenting could sayI see some of you nodding your heads, you are going to find this presentation very interesting. 3

Agenda for TodaySleep Breathing DisordersAdultsSigns to look forMedical conditions and risk factorsChildrenStatisticsBed partnerTreatment

Dr. Allan Gross

Slide 4: AgendaThis is what well be talking about today. (This is where you set the ground rules for the discussionencourage people to ask questions, or to wait until the end. If you want to do some audience participation, let them know here that you will be asking for feedback and thoughts and experiences throughout the presentation.)

We will begin with Sleep breathing disorders, and then move into what these conditions look like in adults. I will give you some signs and symptoms to look for. Then we will talk about the medical conditions that often accompany snoring and sleep apnea, and associate risks. As for children, yes these conditions can occur in children as wellthe literature shows its pretty widespread. Your bed partner suffers as well. I will review the statistics with you, and then we will conclude by talking about treatment options.

4

Sleep Disordered BreathingObstructive Sleep Apnea

Normal Airway Healthwise, IncorporatedDr. Allan Gross

Slide 5: Sleep disordered breathing

(Presenter should point out tongue and airway obstruction and the difference between the two pictures)


5

A continuum of problemsDr. Allan Gross

Slide 6: A continuum of problems

This slide shows that if left untreated, it has been shown in the literature that snoring and apnea can get worse. And the literature shows that snoring is a sign that there could be a problem, or there already is a problem. Its not just funny or embarrassing, its dangerous. And in some cases, fatal. And the worse that snoring is, the worse the problem will be. Watch out for choking, gasping for breath, and/or stopping breathing.

What is apnea? It is when you stop breathing during sleep because you have an obstruction of the airway as I showed on the previous slide. These events can last for over a minute and most of us cant hold our breath for that long. You held your breath at the beginning of the presentation for 10 seconds howd you feel. It was difficult, right? Imagine doing that over and over and over while you sleepand those 10 seconds is a very minor event.

6

Snoring: Do you snore loudly?Tired: Do you often feel tired during the day?Observed: Has anyone observed that you stop breathing during sleep?Blood pressure: Do you have or have you been treated for high blood pressure?

STOP!

Dr. Allan Gross

Slide 7: STOP!

This is a screening tool called the Stop Quiz. S stands for Snoring, T stands for Tired, O stands for Observed, and P stands for Blood Pressure. Very easy to remember, and if you answer yes to two out of four of these questions, the literature shows that this is very predictive that you could likely have sleep apnea. It is so effective that practitioners are using this in emergency rooms across the country now.

Why is this important? There are so many other medical conditions associated with snoring and sleep apnea that ER physicians need to know who and what they are dealing with, and thats why its important to do the STOP quiz in the ER7

Medical conditions associated with snoring and sleep apneaCardiovascular disease, cardiac afibrillationDepressionDiabetesHeadachesHigh blood pressurePregnancy

Dr. Allan Gross

Slide 8: Medical conditions

And here are some of those associated medical problems

The research has shown that if you have one of these conditions with sleep apnea, the condition is worsened. The good news is, if you have one of these conditions along with sleep apnea, when you treat the sleep apnea the condition will likely improve. In cases such as pregnancy, treating the sleep breathing disorder is important because the mother and baby both suffer from lack of oxygen that occurs during apneic events. The baby could even have a lower APGAR test result. The APGAR test monitors pulse rate, reflex, activity and respiratory effortand is a research-based indication of a newborns health immediately following birth.8

3-4 x increased risk for premature heart attack and strokeBlood sugar controlDaytime fatigueDrowsy driving 8x greater risk of motor vehicle accident deathDepressionCognitive thinking problems / Dementia

Risk FactorsDecreased Life ExpectancyDr. Allan Gross

Slide 9: Risk factors(each bullet appears one by one in this slide, and then at the end, decreased life expectancy pops up.)3.4x increased risk of premature heart attack and strokesnoring and sleep apnea have been frequently associated with cardiovascular disease. The amount of stress put on the heart and vascular system of a snorer or apneic patient during the night is extraordinaryand can result in the systems being taxed so much that they simply give up, the result is a heart attack or a fatal stroke.Blood sugar controldid you know that snoring and sleep apnea have also been linked to diabetes and metabolic disorders, which can negatively influence a persons energy level and contribute to weight gain? Daytime fatiguethis one is simple, if youre not sleeping at night, youre tired during the day.Drowsy drivingif you stay awake over 24 hours, the cognitive impairment is equivalent to far above-the-legal-limit alcohol consumption. Depressionsnoring and sleep apnea has been linked to depressionboth in those who have the condition and those who share the bed or house with those individuals.Cognitive problems/dementiasleep breathing disorders are also associated with damage to the brain that can result in Alzheimers disease and other cognitive disorders. The link lies somewhere in the lack of oxygen making it to the brain through the blood streamthis damages the gray matter of the brain and can result in cognitive impairment.And yes, its scary but true---decreased life expectancy by 10-20 years. The question that most practitioners ask, however, is when did that 10-20 years start?

9

Increased neck circumference is a risk factor for sleep disordered breathing:Men 17 inchesWomen 16 inchesFor every inch gained, the risk factor is increased 9 times

Weight

Neck Circumference MeasurementNeck Circumference: Risk FactorDr. Allan Gross

Slide 10: WeightObese adolescents and children are not exempt from this risk.Why neck circumference? The neck size is important because the larger it is, the more chance for the fatty deposits to collapse the airway while the individual is asleep.Studies are also showing now that waist circumference is a risk factor.10

AD/HD-like symptomsSwollen tonsils and/or adenoidsGrowth deficienciesMouth breathing

What about your children?Dr. Allan Gross

Slide 11: What about your children?The lack of sleep for adults makes them tired, children are exactly the oppositethey tend to be hyper. Here are what to look for:Does your child or grand child make snoring or funny breathing noises during the night?Does your child or grand child have large tonsils?Does your child breathe through their nose or mouth when asleep? Enlarged tonsils can lead to Mouth breathing, which leads to increased orthodontic problems, a longer-looking face, and a smaller child when full grownDoes your child walk or talk during their sleep? Does your child have allergic shiners (deep circles under their eyes)?Under size for their age/Growth deficiencies?

11

Child with apnea

Dr. Allan Gross

Slide 12: Video of an apneic child

Note the movement of the rib cage and the breathing pattern. This is an apneic event in a small child.

12

Signs to look forPoor growth and developmentOrthodontic problemsMouth-breathingSwollen tonsils and/or adenoidsChildren with sleep breathing disorders are 20-100% more likely to have behavioral problems resembling ADHD

Dr. Allan Gross

Slide 13: Signs to look for

Again, be sure to look for poor growth, orthodontic problems, mouth breathing, and swollen tonsils/adenoids in children.And, if you think your child has AD/HD, be sure to have them assessed for a snoring or apnea problem.

13

In childrenIQ score, attention span, and memory indices in children are adversely affected by snoring.(Citations: Bonuch et al., 2012; Fitzgerald et al., 1997)(Citations: Kennedy et al., 2004; Franklin, 2000) Dr. Allan Gross

Slide 14: In children

Snoring at ANY AGE is not normal and should be looked into. It can affect IQ levels. If caught early enough, the damage can be reversed.

14

~1 in 5 adults has mild OSA~1 in 15 adults has moderate or severe OSA~5-10% of the pediatric population is at risk50% of the population over the age of 50 has some degree of a sleep breathing disorder80-90% of sleep breathing disorders remain undiagnosed

StatisticsDr. Allan Gross

Slide 15: StatisticsMild is when you have some breathing issues5-15 episodes per hour.Moderate is 15-30 breathing issues an houra lotone episode every couple minutesSevere is over 30many episodesThis is such a new field, that only 10 years ago they spent only an hour on it in medical school. Can you imagine? AN hour? And now were seeing it so widespread with so many different populations suffering. Thats why were here todayto learn and help keep each other alert regarding these very dangerous health problems.In other words, less than 10% of those suffering from sleep breathing disorders have been diagnosed. This is a real problem.

15

Likelihood of dying from cancer is 4.8 times higher in people with severe apnea at night than those who have no issues.Moderate apnea doubles the risk of premature heart attack and strokeSevere apnea increases the risk of premature heart attack and stroke by more than 8 times


Slide 16: Statistics

Again, having other problems along with the sleep problem makes everything worse. In other words, snoring, through sleep apnea, is connected to cancer, heart attack, and stroke.

16

Women who snore regularly are at twice the risk of heart attack and stroke compared to women who never snore.Carotid artery atherosclerosis associated with snoring.What is it? Plaque buildup: the leading cause of heart attack and strokeSnoring is a risk factor for plaque deposits


Slide 17: StatisticsWomen are not exempt. Snoring and sleep apnea are no longer seen as an old mans disease. Snoring and apnea have been linked to heart attack, stroke, and cancerIts also connected to plaque deposits in the arteries, not to mentionkeeping your bed partner awake, which we will discus on the next slide.

17

Mayo Clinic in Arizona found that when spouses were treated for chronic snoring, both bed partners quality of life improved significantly within 6 weeks of treatment.Bed partners of those who snore have also been found to have higher levels of musculoskeletal pain and fibromyalgia-like symptoms.

Bed PartnerDr. Allan Gross

Slide 18: Bed partnerYouve heard of second-hand smoke and the problems associated with it in people who dont smoke but are exposed to it, now we have second hand snoringa similar situation.The Mayo study is important because it demonstrates that snoring and sleep apnea adversely affect quality of life not only for the individual who is suffering, but also those who share the house with him or her. The good news is that these problems can be reversed when the conditions are treatedfor both the individual suffering and the bed partner.It has also been shown that bed partners of people who snore have poorer work performance. And snoring and sleep apnea often leads to bed partners sleeping in separate beds, which leads to stress on relationships.

18

Ultimate objective is to find the treatment that works for youOptions (or a combination of them) include:

Surgery Lifestyle changes Continuous Positive Airway Pressure (CPAP) Oral appliances Treatment is crucialDr. Allan Gross

Slide 19: Treatment is crucialIm here in my capacity as a dentist treating snoring and sleep apnea, which I will talk about in a moment. But the real lesson here is that there are many ways to treat these conditions, and treatment is crucial.

19

Surgery

BeforeAfter

Uvulopalatopharyngoplasty (UPPP) is a procedure that removes excess tissue in the throat to make the airway wider. This sometimes can allow air to move through the throat more easily when you breathe, reducing the severity of obstructive sleep apnea

Slide 20: SurgeryMost surgical procedures for treatment of sleep breathing disorders have been shown to be not very effective, painful, and initial improvement can lapse back and scar tissue and problems return.They cut away all the structures in the back of the throat that are thought to be obstructing the airway Its very painful and it can relapse.The problem is, those structures may not be whats calling the blockage.

20

Lifestyle

Dr. Allan Gross

Slide 21: LifestyleIf an individual with mild OSA gains 10% more body weight, they will have:Six times increased chance of having higher severity apnea If you weight 150 and your weight goes up to 165, you have a much greater chance of worsening apnea.Fortunately this can be resolved with:DietExerciseBetter sleep habits such as keeping the room dark at night and cooler and no noise in the bedroom and importantlytrying to go to bed at the same time each night and waking up at the same time each day.These have been shown to improve some of the symptoms of sleep apnea.

21

CPAP

Dr. Allan Gross

Slide 22: CPAPEveryone has heard of CPAPit pushes air down the nose and mouth to keep the airway open while youre sleeping.Successful treatmentCPAP is very effective IF you can use itMay be the best option for severe OSA

22

Oral Appliance

Dr. Allan Gross

Slide 23: Oral applianceThe oral appliance gently moves the jaw forward, which moves the tongue forward, to keep the airway open. Only worn at night keeps the tongue from falling back and blocking the airway.(Presenter can animate on him/herself how the appliance lifts the jaw and tongue to showand comment on how this would open the airway. Move jaw forward)23

Comparison

Dr. Allan Gross

Slide 24: ComparisonNote the differences between the two optionsWith the oral appliance theres no mask, and with the CPAP there is. With the oral appliance, theres no air being pushed down the nose or throat like the CPAP does.

24

Looks like an athletic mouth guardIs custom-made to fit the patients mouthHolds the jaw gently in position where the airway can remain open and airflow occursIs only worn at nightIs completely non-invasive and non-pharmacologicIs proven in the scientific literature to be efficacious in helping patients who suffer from Sleep Disordered BreathingIs FDA-approved

What is an oral applianceDr. Allan Gross

Slide 25: What is an oral appliance?(Presenter can show the appliance and how it workspass it around, but make sure you get it back!)

25

Airline travelCampingNo electricity neededSmall and discrete

ConvenienceDr. Allan Gross

Slide 26: convenienceTraveling, fishing, hunting, campingrequires no electricity and travels light.Discrete and convenient(Presenter can show again how small it is and light.)

26

Save your lifeEnhance your marriageIncrease your quality of lifeExperience less physical pain, lower levels of depression

Treat your sleep apneaDr. Allan Gross

Slide 27: Treat your sleep apnea(Presenter can summarize a bit.) I hope this presentation has shown you that snoring and sleep apnea are very serious conditions. They are connected to many medical problems, and they can adversely affect your quality of life and be fatal.

27

Snoring: Do you snore loudly?Tired: Do you often feel tired during the day?Observed: Has anyone observed that you stop breathing during sleep?Blood pressure: Do you have or have you been treated for high blood pressure?

Remember to STOP!

Dr. Allan Gross

Slide 28: Remember, STOP!And soremember to Stop!Do you have these symptoms or do you know someone who has?Two out of fourhave it looked at. Talk to a dentist such as myself who is trained in this field and I can help you get on the road to getting better.Ask yourself these questions

28

Questions?If you snore, we can helpDr. Allan Gross

Slide 29: Questions?Talk to us today, your life or the life of your loved one may depend on it.For your familys sake and for your saketreat your condition as soon as possible, because as I mentioned earlierwe dont know when that 10-20 years of decreased life expectancy started for you.29

Education

Snoring and sleep apnea for public presentation1