Sleep Apnea Treatment: Does Sleep Apnea Wear Down Your Brain?
Sleep Apnea Treatment: Does Sleep Apnea Wear Down Your Brain? CPAP and Oral Appliances Save Lives! Nasal Obstruction is a Significant Factor in Sleep Apnea. Is There a Major Flaw in Sleep Research? Is ADHD Preventable?
GURNEE, IL, January 27, 2009 /24-7PressRelease/ – The current study from Yale was published in the December 2008 issue of the Journal of Aplied Physiology. A previous study from the same group of Yale researchers found that people with sleep apnea are three times more likely to have a stroke or die than people of similar health who don’t have the breathing disorder. It is estimated that there are over 18 million Americans suffering from untreated sleep apnea.
Patients with sleep apnea had lower cerebral blood flow velocity and notably lower blood oxygen levels during sleep than did apnea free controls. Apnea patients required longer times to recover from drops in blood pressure and longer times to re-establish normal blood flow to the brain. This is indicative of problems with cerebral autoregulation — the process in which the brain regulates blood flow to meet its needs. The repetitive surges and drops in blood pressure and blood flow in the brain seen with apnea leads to people with sleep apnea being more prone to having a strokes and dying in their sleep.
Sleep Apnea treatment with CPAP, Surgery and Dental Oral Appliances are all excellent patient choices. CPAP has long been considered the Gold Standard of treatment for sleep apnea but the majority of patients prescribed CPAP do not use it and even patients who use their CPAP average only 4-5 hours a night leaving the surges in blood pressure and blood flow present when the CPAP is not used. Oral appliances are considered a first line treatment for mild to moderate apnea and an alternative treatment for severe apnea when patients do not tolerate CPAP. Studies have shown that patients offered a choice between CPAP and Comfortable Oral Appliances overwhelmingly prefer the oral appliances.
CPAP and Oral Appliances are considered the first line treatments for adult patients with sleep apnea. Surgery has been considered a second line treatment and surgery to the soft palate appears ineffective as a cure for most adult sleep apnea patients. Maxillomandibular advancement, tongue reduction and genioglossus advancement are the most successful surgical procedures. A new study published in “Snoring, daytime sleepiness, and nasal obstruction with or without allergic rhinitis” published in Arch Otolaryngol Head Neck Surg. 2008 Dec; 134(12): 1254-7 may serve to move surgical removal of nasal obstruction as a first-line adjunctive treatment of sleep apnea. The study showed that nasal obstruction was a cause of snoring and excessive daytime sleepiness whether allergic rhinitis was present or not. In the absence of nasal obstruction allergic rhinitis was not a risk factor.
Children with sleep apnea have different treatment protocols. It is estimated that as many as 80% of ADHD cases are tied to sleep apnea and snoring and changes in brain development are known to occur in the presence of sleep apnea. There is no cases where snoring or mild apnea should be ignored. Correction of sleep apnea in children is usually accomplished with removal of tonsils and adenoids if obstructive or by rapid maxillary expansion (RME) with an orthodontic device. Time is of the essence and the younger patients are treated the better. In most patients both RME and removal of obstructions are indicated. A presentation at the American Academy of Dental Sleep Medicine meeting in Baltimore suggested that RME should precede surgical treatment because of ease and speed of RME treatment but that surgical removal of obstructive tonsils and adenoids should still accomplished.
Dental literature, especially the work Egil Harvold has shown orthodontic changes are a result of nasal obstruction. Dr Jim Garry a visionary dentist actually produced a flow chart showing how allergies and not being breastfed led to structural changes that are found in sleep apnea patients and TMJ patients. Over 40 years ago Dr Garry was discussing the developmental aspects leading to ADD, ADHD and learning disabilities. The medical community ignored this vitally important work for years but new research is showing that Dr Garry was exactly right.
There is still a major flaw that in most research into obstructive sleep apnea that this author had discussed with Jim Garry before his death. During sleep there is a Nasal Cycle that occurs repetitively every 60 to 90 minutes. The tissues in the nose expand on one side of the nose and contract on the other side. Most sleep studies do not differentiate between air movement from the right and left nostril and rarely differentiate between oral and nasal breathing. The neglect of this vital information makes many conclusions of sleep researchers incomplete or wrong. If patients have significantly different AHI during different phases of the nasal cycle it can lead to over-titration of CPAP part of the night and under titration at other times during the night. Over-titration of CPAP can lead to Central Seep Apnea.
The study on nasal obstruction should serve as a wake-up call that differentiating structural nasal obstruction from allergic obstruction is important. Apparently the body can compensate for allergic blockage but not for structural obstruction. Randomized studies that ignore nasal obstruction and the nasal cycle may lead to misleading conclusions.
The work of Dr Jim Garry has been validated by a report by the NHLBI, “CARDIOVASCULAR AND SLEEP-RELATED CONSEQUENCES OF TEMPOROMANDIBULAR DISORDERS” that can be viewed at http://www.nhlbi.nih.gov/meetings/workshops/tmLwksp.pdf
Dr Garry was also a strong advocate of Neuromuscular dentistry and a founding member of ICCMO, the international College of CranioMandibular Orthopedics the organization representing Neuromuscular Dentistry. Many feel that Neuromuscular Dentistry is the future of TMJ treatment. Dr Garry felt that early treatment could prevent the development of sleep apnea, TMJ disorders and ADD / ADHD. Dr Garry was a pedodontist and was the original developer of the NUK exerciser that was designed to promote normal jaw development in children who were not being breast fed.
Dr Norman Thomas DDS, PhD is the current president of ICCMO and is the undisputed leading scientist in the world on the field of Neuromuscular Dentistry.
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