Articles - SNORING AND SLEEP APNOEA - IN KIDS AND ADULTS
Snoring Vs Sleep Apnoea
Snoring vs. Obstructive Sleep Apnoea
With Snoring, the tissue at the back of the mouth sags and enlarges and partially blocks the airway. The narrower the airway, the faster the air must move, and the more these soft tissues vibrate - leading to the sound of snoring.
Snoring is to obstructive sleep apnoea as thunder is to lightning. They may, but not always, appear together. One may be just an annoyance, but the other may be serious trouble.
With Obstructive Sleep Apnoea, breathing repeatedly stops and starts during sleep as the airway becomes obstructed. muscles of the soft palate at the base of the tongue and the uvula (the small, conical, fleshy tissue hanging from the soft palate) relax and sag, obstructing the airway, making breathing laboured and noisy. Collapse of the airway walls blocks breathing entirely. When breathing periodically stops, a listener hears the snoring broken by pauses. As pressure to breathe builds, muscles of the diaphragm work harder. Sleep is then temporarily interrupted, sometimes only for seconds, but it can be up to a minute ! This, in turn, activates throat muscles and “un-corks” the airway. A listener hears deep gasping as breathing starts. With each gasp, the sleeper awakens, but so briefly and incompletely that he does not remember doing so in the morning. Someone with obstructive sleep apnea may stop breathing dozens, even hundreds of times each night.
Each time breathing stops, the sleeper is now choking. Oxygen in the blood stream falls and the heart must work harder to circulate blood. Blood pressure rises and over time may stay elevated after breathing restarts. The heart sometimes beats irregularly and may even pause for several seconds. This may account for some deaths during sleep of people who went to bed in apparent good health.
With OSA, a sleeper triples his or her chances of having a Heart Attack or Stroke.
Snoring is associated with an increased risk of hypertension (High Blood Pressure) as well as an increased risk of both cardiovascular and cerebrovascular disease. Snoring, even without apnoea, can lead to numerous arousals from obstructed breathing. Arousals have been linked to sympathetic nervous system activation which may provide a link between snoring and hypertension.
- 24% of males and 18% of females suffer from snoring.
- 60%of males and 40% of females over the age of 60 snore (female snoring increases after menopause).
- Over long periods, sleep apnoea results in intellectual and memory deterioration.
Another form of Sleep Apnoea is Central Sleep Apnoea is when the body fails to breathe but is not caused by an airway blockage. An example is when sleeping at high altitude. Sudden Infant Death Syndrome may also be related.
Children with Sleep Apnoea
Overweight adults are the most likely group to suffer from OSA, however children and infants can also have the problem. Enlarged tonsils and adenoids are the most common cause and frequently need removal. Breathing through the mouth rather than the nose, and exposure to allergens is the usual cause.
The sleep disruptions impair the body's ability to reach the necessary deep restful phase of sleep. This is also when the most growth takes place. Often after tonsils and or adenoids are removed there is a catch-up growth spurt.
We can offer breathing training as well as expansion appliances to enlarge the airway, reduce middle ear infections, reduce bed-wetting, reduce tooth grinding, and some behaviour issues such as "ADHD", as well as develop the face and reduce dental crowding.
Taking a video of your child sleeping (perhaps with your phone) is very helpful for diagnosing the problem with an Ear, Nose and Throat specialist, to whom we can refer.
Signs of Sleep Apnoea:
Sleep Apnoea signs and symptoms can vary for every individual. It is not uncommon for people to experience one or more of the following:
* Excessive daytime sleepiness, - there are many examples of car and truck road accidents caused by falling asleep at the wheel
* Loud Snoring
* General Fatigue
* Observed episodes of breathing cessations during sleep
* Abrupt awakening accompanied by shortness of breath
* Grinding or clenching of the teeth at night
* Attention and behaviour issues such as ADHD inchildren
* Bed-wetting and numerous night-time toilet stops
* Morning Headaches
* Awakening with dry mouth or sore throat
* Weight gain - Lack of oxygenation slows the metabolism and a lack of energy to take exercise worsens the situation
Some very useful general measures that can be taken include : -
- Lose excess weight
- Get regular exercise
- Avoid sleeping on your back, perhaps attach something to your night wear to make you roll over off your back
- Avoid excessive alcohol, heavy meals and medications that make you drowsy
Controlled Positive Airway Pressure is a machine worn over the nose and or mouth that forces oxygen down the airway and into the lungs. It is only be prescribed after a Sleep Test by a Sleep Physician and is run with a motor and oxygen bottle.
Its major drawbacks are noise, comfort, cost, portability and effect on Carbon Dioxide to Oxygen ratio - however for some people it is a great solution to chronic tiredness.
Dental Appliance Therapy
Dental appliances are attached to the teeth in both the upper and lower jaws and use the upper jaw (Maxilla) to pull forward the lower jaw (Mandible) and with it the tongue. This has the effect of widening the airway behind the tongue and allowing much more air to pass to and from the lungs. As the airway is wider, the air does not need to move as fast, and less of a vacuum effect is created which means that the airway is less likely to be 'sucked shut'. The slower passage of air also means the soft tissue in the throat is less likely to vibrate - which means less snoring !
Custom fitted appliances adjusted to your requirements can help position the jaw during sleep so that the airway stays open and healthy night’s sleep is achieved.
Surgical Advancement of the Jaws
This sounds drastic but is becoming more common and can provide a permanent solution to a narrowed airway without machines or appliances.
Using both removable and fixed appliances can bring the teeth, the mandible, and therefore the tongue forward creating more airway space behind the tongue. This may well improve headaches, neckaches and TMJ problems apart from reducing snoring and the risk of Sleep Apnoea. It has the bonus of straightening your teeth too !
It is particularly helpful for reversing extractions with or without orthodontics, which used to be so prevalent in Australia. We know that this technique works as both Stuart and Deb Watkins have done it.
Epworth Sleepiness Scale
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The Epworth Sleepiness Scale is a questionnaire developed by Dr. Murray Johns of Melbourne to measure daytime sleepiness. You can use our interactive online form below, or Click Here to download a PDF version of the Form.
Using the rating scale below, rate each of the following statements as it best applies to you:
Result What your ESS result indicates Less than 10 You are most likely getting enough sleep
However, if you have noticed a change in your normal sleep routine, you may want to discuss this with your doctor.
10 - 16 Your may be suffering from excessive daytime sleepiness
You should see you Doctor to determine the cause of your sleepiness and possible treatment.
Your Doctor may refer you to Sleep Services Australia for a home-based sleep study to assist in your diagnosis.
16+ You are dangerously sleepy
It is imperative that you see your Doctor to determine the cause of your sleepiness, and to investigate treatment as soon as possible. Your Doctor can refer you to Sleep Services Australia for a sleep study to assist in your diagnosis.
* This scale should not be used to make your own diagnosis. It is intended as a tool to help you identify your own level of daytime sleepiness, which can often by a symptom of many sleep disorders.
Kids that snore and grind their teeth
Also see the section on Snoring Vs Sleep Anoea
Here are 4 important items : - 26 information slides, an artcile from reuters health, and 2 videos.
* A Brisbane Paediatric Ear Nose and Throat specialist on what happens to a childs brain when they snore
* Kids Who Snore May Have Poorer Grades in School
By Larry Hand
September 08, 2015 Reuters Health
Snoring and other breathing problems during sleep can put kids at risk for poorer performance in school, a new study confirms.
Parents, teachers, and health care professionals need to be aware of the potential effects of sleep-disordered breathing and be able to recognize the symptoms, Barbara Galland, who led the study, said in an email.
Galland, from the University of Otago, Dunedin, New Zealand, and her colleagues analysed data pooled from 16 studies done in 12 countries, each including an average of about 550 children ages 5 to 17.
The studies looked at symptoms of sleep-disordered breathing, such as habitual snoring and sleep apnea, as well as students' grades as reported by their school or their parents.
The combined academic scores overall of students with breathing problems during sleep were roughly 12% lower than scores of students without sleep-disordered breathing, the researchers reported online September 7 in the journal Pediatrics.
In particular, language arts scores were 12.3% lower, math scores were 13.1% lower, and science scores were 11.6% lower for the affected kids.
According to study published in 2009 in the journal Sleep, roughly one in every 100 elementary school children in the U.S. has sleep-disordered breathing.
"Although many studies find that the average achievement of children with sleep-disordered breathing remains in the range of typical children, children with sleep-disordered breathing may be more at risk for performing below this level," Galland said.
"That is, some children with sleep-disordered breathing may be performing less well on the tests. What we do not know is which children are more likely to do less well," she added.
The studies represented academic performance at one point in time, and "negative effects over time cannot be ruled out," the researchers wrote.
When sleep-disordered breathing is related to children's tonsils and adenoids, removing them might be helpful, the researchers said.
"For other children, jaw alignment may contribute and dental treatment is being developed to address this," Galland said. "Other health factors such as obesity can also contribute to sleep-disordered breathing, another reason for developing effective approaches to address this complex health issue."
More research is needed, she added, to understand which children are most at risk for academic difficulty associated with sleep disordered breathing and to figure out how they can be helped.
* The first video runs for 12 minutes featuring a Sydney Paediatric Respiratory physician
If your child snores, no matter how quietly, you may have a big problem on your hands.
* The 2nd is a 7 minute video concerning "Sleep disordered breathing" including snoring and sleep apnoea, and the increases in Attention Deficit Hyperactivity Disorder and many other adverse results.