The testing that is done for sleep apnea is through a test called a Polysomnogram. This entails hooking you up to a bunch of wires that will analyze sleep quality and snoring as well. It also measures how much desaturation of oxygen occurs and how often. The problem with the Polysomnogram (PSG) is this; let’s say you slow or stop breathing perhaps five times each hour of the night, yet that slowing, or cessation, lasts for several minutes, not just 20 or 30 seconds. Your apnea index will be the same, regardless of whether you stop breathing for 10 seconds or 10 minutes! In other words, you need to look at how long the breathing ceased or slowed to understand how serious the problem is.

When a person performs the PSG, a number called the Apnea Hypopnea Index (AHI), is generated. If that number is 0-5, it is considered mild apnea, and no treatment is indicated. If that number is 5-15, the apnea is moderate, and a CPAP is usually prescribed as the gold standard of treatment. If the apnea index is above 15, then the apnea is considered severe and most definitely the CPAP is required. In many cases, people who have a hard time wearing the CPAP can benefit greatly by wearing a dental appliance that opens and brings the jaw forward. Studies indicate that 93% of the people prefer this over the CPAP. It is easier to wear and much more portable. Carrying that bulky CPAP machine is hard to do when you travel.

Another interesting aspect of sleep apnea is that it often correlates with TMJ  disorder. When the jaw joint discs are slipped off, i.e. displaced, this creates chronic inflammation that can tighten up the throat and make the apnea worse. It is my belief that if you are going to go through all the trouble of the PSG and sleep analysis, you really should look at any underlying issues with the TM joints. As it turns out, most people with TMD (TMJ Disorder) also have underlying distortions to their cranial bones (the bones in the skull) and this can cause the neck to turn or twist. The twisting of the neck can then impede the airway. These are all the things we need to look at.

Just to add more to the mix, a critical aspect of sleep involves knowing what your Vitamin D₃ levels are. This is important because D₃ is actually not a vitamin, it is a hormone, and it controls aspects of your sleep. A simple blood test will reveal your D₃ levels. In most people, the D₃ is well below the bare bones minimum of  30 ng/ml. This is not healthy, and you simply will not sleep. Your D₃ needs to be around 60-80 ng/ml yet most doctors are not really aware of this.

As you can see, dealing with sleep apnea means we need to look at more than just what the PSG tells us. You need to talk to the doctor, then look at the numbers. The more information you gain, the more likely you can get improvements in sleep and overall health!

Getting Help

Dr. Jeffery Brown can help you with your sleep apnea symptoms.  Please call our team in Falls Church, Virginia to schedule your consultation. Please call 703-821-1103 today!

The post Breathing in the Night: Understanding Sleep Apnea and Its Fundamentals first appeared on Sleep & TMJ Therapy.

One of the best things, just for starters, is to consume enough water to keep your cells functioning as best as possible. The rule of thumb is that whatever your body weight is, cut that in half and that is how many ounces of water you need daily just to survive. For example: a 140-pound person needs at least 70 ounces of water per day. The water from your refrigerator filter is usually the best unless you can afford the fancy glass bottles at exorbitant rates.

Another factor in good sleep is getting enough Vitamin D3. You see, D3 is not a vitamin. It is actually a hormone that regulates your sleep. Vitamin D receptors, together with the activating enzymes (hydroxylase) control the activation and degradation (waste) being expressed during the sleep cycle. This is also an important item to help produce melatonin. This hormone is involved with the circadian rhythm, an important aspect of the sleep cycle. If your D is too low, you simply cannot sleep. The D level is determined by drawing blood and then the lab analysis is done. The results will tell you what level you have. Generally, 30 ng/ml is the bare bones minimum. Most people are either below or pretty close to that. If you are low then the recommendation is to take 5000 IUs of D-3 with K2 per day and then re-assess in three months.

Vitamin D3 and K2 are taken together for best absorption in the body. Vitamin K2 is generally not produced in sufficient amounts within our bodies. Achieving a healthy level of vitamin K2 will support our heart, blood circulation and bones. While vitamin D is well understood, the importance of K2 is not so known.

Sleep hygiene is a sort of new term that is in vogue these days. What this basically involves is your body’s ability to sleep efficiently. This involves your behavioral practices and environmental influences to obtain a healthy habit of falling asleep. Some sleep problems are caused by bad habits but to start the change a person needs to go to bed around the same time each day and wake up around the same time the next morning. If the bad habits have been reinforced over many years, then a better night’s sleep may take longer to be affected. Proper hygiene also means not drinking caffeine in the late afternoon and not consuming too much alcohol in the evening hours. A rule I tell my patients is to follow the 10,3,2,1 Rule:

-10 Hours Before Bed: No More Caffeine

-3 Hours Before Bed: No More Food or Alcohol

-2 Hours before Bed: No More Work

-1 Hour Before Bed: No More Screen Time (phones, TVs, Computers, etc)

As one leader of a campaign for sleep and mental well-being asserted, supported by the Mental Health Foundation, the author created the 5 principles of good sleep health: Value, Prioritize, Personalize, Trust and Protect one’s sleep.

In cases where the sleep apnea index (the AHI) is sky-high, the gold standard for treatment is the CPAP (Continuous Positive Airway Pressure). This is a device that forces the air down your throat and into the lungs to make sure you are breathing. It is quite effective in lowering the apnea index but can cause stomach bloating and even dry mouth or eyes. For most people, if they commit to wearing it, they can greatly benefit. For other folks, the CPAP is quite difficult to wear and since it really inhibits your movements at night, it can be a real bother.

A new device that just came on the market is the hypoglossal nerve stimulator. It basically involves a surgical procedure to embed a small shock wire into the hypoglossal muscle in your tongue and if and when the tongue falls back at night and closes your airway, it shocks the tongue into popping out of your mouth and thus opens the airway. Shocking, to say the least.

A much better approach to treating apnea is the Panthera device. It is made by a dentist and is an anti-snoring and opening airway device by bringing your chin forward (just like in doing CPR) to widen the breathing passage allowing for more air. This in turn reduces the potential of snoring. This appliance is customized to your mouth and is also adjustable. It is very effective and easy to wear. For most people, it does the job as well as a CPAP and, in some cases, even better.

There are many other ways to deal with apnea, and most of these are surgical, but the above ideas are simple and generally quite easy to implement for most people. If you would like to learn more about Sleep apnea and your oral health, please give our Sleep & TMJ Therapy team a call at 703-821-1103. Our dedicated dentist in Falls Church, Virginia, Dr. Jeffrey Brown, has been successfully helping patients with sleep apnea get a great night’s sleep!

The post What To Do About Lack of Sleep first appeared on Sleep & TMJ Therapy.