Anyone who has any sort of commute to and from work has felt it: a groggy feeling descends out of nowhere and leaves you drifting off at the wheel - but hopefully not drifting off of the road. It’s only natural with the tedium of the roadways and traffic tie-ups. However, according to the National Sleep Foundation (NSF), even the most boring and menial of tasks shouldn’t be enough to put us to sleep.

Feeling active, aware, and awake is something everyone aspires towards, but a creeping epidemic of sleep deprivation has been steadily growing in the United States. The American Sleep Association (ASA) says lack of sleep affects moods and the ability to stay focused. One study found that people who are sleep-deprived have reaction times that are as slow as or slower than an individual who is under the influence of alcohol.

To some, the problem isn’t just staying up late to catch the end of the game or pulling an all-nighter to finish a project or meet a deadline. The problem could stem from a large number of sleeping disorders, one of the most common being Obstructive Sleep Apnea (OSA). According to the NSF, OSA affects some 18 million Americans, and it is estimated less than half are even aware they are losing sleep.

Usually, the first to notice that an individual suffers from OSA is the afflicted person’s bed partner. Even if the sufferer does not have a concerned and/or irritated significant other complaining about their constant snoring fits and periods of non-breathing, there are other ways for an individual to assess their sleep that can help determine if the problem stems from a disorder.

For example, do they wake up feeling tired? Do they experience daytime sleepiness? Anxiety? Difficulty staying focused? Irritability? These are all signs of an insufficient amount of sleep. If one can determine that the problem isn’t insomnia or just plain staying up too late, then OSA could be the culprit.

Reticence

Once a person has determined that something is definitely abnormal concerning their sleeping patterns, the next logical step should be to get tested. The most common and effective procedure for diagnosis is to undergo a polysomnography (PSG) test. However, some people are not comfortable with traditional laboratory testing.

Many reasons exist that could prevent a person from being clinically tested for a sleep disorder. Some may not want to spend the night in a test room, their insurance may not cover the cost of the test, or a sleep clinic may not be in close proximity to their home.

Regardless of patient anxieties, most doctors still insist that PSG testing is the best approach when it comes to the diagnosis phase of OSA. In fact, many professionals who deal strictly with the treatment of OSA recommend patients are diagnosed beforehand. For patients who are leery of laboratory testing, other options do exist.

Testing from Home

Home testing has recently become an affordable and viable option when evaluating sleeping disorders. This method has proven to be effective, but still nowhere near the levels of a traditional sleep clinic visit. The new methods of testing could eliminate some of the reticence patients have in going through the sleep clinic test. Also, home testing could encourage the patient to opt for clinic-based tests after an initial diagnosis is made by the home test.

Jonathan Parker, DDS a charter member of the American Academy of Dental Sleep Medicine, has been studying sleep disorders for more than 17 years. He has devoted his dental practice to the treatment of sleep-related disorders and is quick to point out that PSG “is still the gold standard in OSA diagnosis,” though more and more professionals are becoming open to the idea of home testing.


According to Parker, he and several other sleep medicine physicians in his community have developed what they call a protocol for the assessment of “snoring patients.” Using home-based, unattended sleep testing, they measure various factors including Body Mass Index (BMI), neck circumference, and frequency of apnea episodes to determine if a patient has OSA.

“This protocol has been an effective method of assessing patients with primary snoring and involves a cooperative effort from the dentist and physician in confirming the diagnosis and treatment plan. This process also makes it more efficient and beneficial for the patients,” explains Parker.

Choosing the Right Treatment

After the diagnosis is made, the next step is to discuss treatment options. The most reliable and effective treatment for OSA has been the Continuous Positive Airway Pressure (CPAP) device. While the device works wonders for a lot of patients, some have trouble adjusting and give up after only a few nights of use.

Many professionals insist that CPAP is the most effective therapy in the treatment of OSA. According to the ASA, compliance with regular and proper use of the CPAP device and therapy has been shown to effectively eliminate OSA. The problem is patient compliance.

Like PSG in the testing phase, CPAP is the therapy most doctors recommend and the therapy a lot of patients try to avoid. Patients who cannot tolerate CPAP therapy complain that the device is uncomfortable, causes dry nasal passages, and that they actually have trouble sleeping because they feel anxious while wearing the device.
Fortunately, many advances have been made in the treatment of OSA, so much so, that several reliable and effective alternatives to the traditional CPAP therapy exist.

Parker recommends the use of a dental appliance, a noninvasive treatment option, as one option that has proven effective for patients suffering from mild cases of OSA. Typically, a person who goes to a dental sleep center for the fitting of a dental appliance has already been diagnosed with sleep apnea, so the dentist is there strictly for treatment purposes.


According to Parker, “The compliance rates with oral appliances are about 70 to 90 percent in current research studies, whereas CPAP compliance is significantly less. Patients with primary snoring have a very high success rate, approximately 85 percent, with oral appliance therapy.”

Parker does point out that dental appliances are most effective with patients who suffer from mild OSA. For patients whose apnea is a bit more severe, dental appliances may not be enough to correct the disorder. If this is the case, then the next step would be to opt for a minimally invasive procedure.

At The Snoring Center in Dallas, founder and medical director Craig Schwimmer, MD, MPH, and his team have been performing procedures to help create permanent solutions to the problems associated with sleep apnea through the use of both noninvasive and minimally invasive procedures.

One of the simplest and quickest procedures The Snoring Center performs is the Pillar Procedure. During the treatment, a specialist will place four or five tiny, woven inserts in the back of the throat at the soft palate. These inserts help to reduce the vibrations caused by snoring and keep the soft palate from obstructing the passage of air. Over time, the tissues in the soft palate will conform to the inserts and create an almost natural correction of the soft palate’s structure.

“I view the Pillar Procedure as a reasonable alternative to traditional uvulopalatoplasty for many patients,” says Schwimmer. “It yields similar efficacy, but replaces an extremely invasive and painful surgical procedure with a minimally invasive, office-based procedure.”

While these options are effective for patients suffering with milder cases of OSA, for some, dental appliances and even minimally invasive surgery are not enough to alleviate the symptoms. The NSF recommends that people with mild cases of OSA take a few simple steps such as sleeping on the side of the body instead of the back, or losing weight for prevention.


For morbidly obese patients, a seemingly simple task such as shedding a few pounds is not an option. One answer that could help the quality of their sleep, as well as their overall health, is bariatric surgery. James J. Herdegen, MD, and his team at the University of Illinois at Chicago Center for Narcolepsy, Sleep, and Health Research regularly perform bariatric surgery, an invasive surgical procedure that is effectively weight-loss surgery.

According to the U.S. National Institutes of Health, bariatric surgery is recommended to patients that have a BMI of at least 35 and have other health-related issues, such as diabetes or OSA. Herdegen has researched the effects of the surgery on patients suffering from these symptoms and has found great success.

Not only will bariatric surgery usually help with issues pertaining to OSA by removing some of the excess tissue that may be blocking breathing passages during sleep, it also will help overall health issues that are commonly associated with morbidly obese individuals.

“Bariatric surgery is very effective at reducing or eliminating sleep apnea, but there are some patients who relapse after 4-5 years,” Herdegen warns.

The reasons for relapse are often associated with a way of living that has promoted weight gain over the years. According to Herdegen, “Behavioral interventions are often necessary for these patients to adapt a healthier, more active lifestyle.”

A Future Focused on Patient Care

Obstructive Sleep Apnea continues to be a silent predator for those suffering from its effects. It’s not so silent when those effects are overheard, however. Rather than endure the constant fatigue and restlessness, sufferers have choices in terms of how they can be tested and treated.

New options are becoming available, and with more alternatives to CPAP therapy being researched and expanded upon, patients have many choices when it comes to treatment. The goal is to work toward care that is comfortable for the patient and effective in treatment.

Herdegen is hopeful for what the future will bring, “I think the sleep industry will continue to move toward a more patient-friendly approach. Testing equipment will become smaller and more sophisticated, treatment will improve with better machine and mask design, and socially, I hope there will be a national effort for a more active culture with reduced caloric intake.”

— Richard Schupp is a freelance writer based in Allentown, Pa. Questions and comments can be directed to editorial@therapytimes.com.