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A Different Kind of Silencer, by K. in Illinois

Posted By James Wesley Rawles On In First Aid/Medical,Health and Fitness | Comments Disabled

The topic of obstructive sleep apnea and CPAP [1] machines has been mentioned regularly in SurvivalBlog. These references were mostly related to how an alternate power supply could be used to keep CPAP machines functioning. In a TEOTWAWKI [2] situation or lengthy grid down scenario persons suffering from sleep apnea, especially severe sleep apnea would worsen and probably die without an alternative power source or alternative type of treatment.

As a dentist who is a member of the American Academy of Dental Sleep Medicine and treating snoring and sleep apnea for almost 15 years I thought I would give the members some insight into the condition, its possible treatments and implications for long-term survival particularly in TEOTWAWKI. One of the recent blogs referred to a web site. If anything I say sounds similar to information on that site is because the developer is my dear friend, personal mentor and one of the foremost experts in the country.

Snoring
Snoring is the focus of humor in countless movies, jokes, videos and family stories. There are people whose snoring has decibel levels as loud as a steam locomotive. My own father could bring down the house, not just with his singing or jokes, but unfortunately with his snoring. Over the years he had developed severe obstructive sleep apnea. He was also the first sleep apnea patient that I treated.
All joking aside, snoring is no laughing matter. It’s the reason for many lost hours of sleep for bed partners, husbands and wives having separate bedrooms and sometimes even divorce.

What is Snoring?
Snoring is the sign of a breathing problem, in other words a blockage in your airway. The sound is typically caused by the tongue falling toward the back of your palate and throat. As your airway constricts it creates a negative pressure or pulling on your soft palate. This creates a vibration and sound like a reeded instrument, although much more annoying! If you snore loudly and often, you know the social implications of your problem. It’s bad enough when your spouse can’t sleep in the same room with you, but when your travel companions schedule a separate room because they can’t get a decent night’s sleep, it may be time for you to do something about it.

Even if you have become accustomed to sharp pain in your ribs at night (your spouse’s elbow), a lot of bad jokes, snoring is as serious as a heart attack or even worse a stroke. It is a signal that something is wrong with your breathing during sleep. It means that the airway is not fully open and the bad tunes you are playing could kill you. According to recent sleep studies, approximately 45% of the general population, 30% of men and women over age 30, 40% of the middle-aged population, and 6% of children snore on a regular basis. Studies show that 45% of normal adults snore at least occasionally, and 25 percent are habitual snorers. Sadly, these statistics are on the rise with rising obesity approaching epidemic proportions.

Problem snoring is more frequent in males and overweight persons. It usually grows worse with age. Although obesity is a major factor for snoring and sleep apnea people that are “as thin as a rail” can have these issues. Generally these are people that have narrow jaws, tall (high) palates and or deep bites and are more prone to having or developing airway issues.

Is Snoring Dangerous?
During the days of the Wild West a famous gunslinger shot a man in the same hotel for snoring too loudly. Ouch! It has also been shown that of males over the age of 45 almost 50% have some form of sleep apnea.  An Australian study found that the prevalence of blockage of the carotid artery (which can lead to strokes) was 20% for mild, 32% for moderate and 64% for heavy snorers. According to the Journal of American Medical Association (JAMA), snorers have three times as many motor vehicle accidents as non-snorers..

Snoring and Sleep Apnea

 According to the experts at www.ihatecpap.com [3], snoring can be a strong indicator of the condition known as sleep apnea. Sleep apnea patients that snore are actually lucky that the condition manifests vocally, so the condition can be treated early, before it becomes life threatening. Partners with concerns are often the ones to bring this problem to light and ask the snorer to seek sleep disorder/sleep apnea treatment [4]. Because of the intermittent periods of stopped breathing, patients do not get the amount of oxygen needed and health risks are increased. Recent studies have led many leading clinicians to state that they believe that snoring will lead to sleep apnea 100% of the time. Sleep apnea has been linked to cases of heart attack, stroke, hypertension, high blood pressure and other dangerous conditions. If you notice heavy snoring in your loved one, ask him or her to see a sleep apnea professional [5].

How Snoring Affects Others

According to a Mayo Clinic [6] sleep study, it is estimated that snorers cause their partners to lose an average of about an hour of sleep each night. For the average American that is almost 20% of your night’s sleep. Even if sleep apnea is not indicated, the disruption of the sleep cycles of family members can create a hazard. Bed partners of snorers also reports high levels of fatigue, sleepiness and possibly even hearing loss. Recent studies have indicated that repeated disruption of sleep patterns can cause sufferers to perform motor skills at or below the levels of individuals who are legally intoxicated! So even if your snoring is not a sign of sleep apnea, it is likely that your snoring could be a real threat to your loved ones because impaired reaction behind the wheel of an automobile can lead to disaster regardless of the cause. The whole family can suffer when any family member has a sleep problem.

What is Sleep Apnea?
Apnea is a Greek word that means shortness of breath. An apnea episode is the absence of breath for 10 seconds or more repeatedly during the normal seven hour sleep cycle. During an apnea event, the oxygen level in a person’s blood drops(while the carbon dioxide increases), the blood becomes” thicker” and more difficult for the heart to pump throughout the body. This puts a strain on the heart (which can show signs of enlargement) as well as the entire cardiovascular system. Coughing or choking sensations, which force you to wake up or get elbowed by your partner, are also common signs. Untreated sleep apnea (OSA) increases the risk of heart attack and stroke, shortens life, and diminishes your quality of life.
What are the common signs of Snoring and Apnea?
Sleep apnea can reveal its presence in a number of ways, and each patient may have a unique combination of symptoms. If you or a loved one experiences any of the following recurring symptoms, please speak with your family physician or a dentist that has experience with treating OSA.

Pediatric Apnea

Chronic breathing problems during a child’s sleep have been shown to affect children’s physical, intellectual and emotional growth. Heavy snoring in children may be a sign of pediatric apnea [7]. Pediatric apnea causes children to have paused breathing events during sleep and can be dangerous if left untreated. Children with untreated apnea may experience daytime sleepiness, or signs of ADD/ADHD such as lack of concentration and mental capacity, trouble in school, and hyperactivity. A thorough ear, nose, and throat exam are a priority. Any asthma and allergy concerns need to be diagnosed and controlled. Often a tonsillectomy and adenoidectomy may be needed to eliminate airflow obstructions.

Apnea and Childhood Development
Visit the web pages from sleep apnea dentist Dr. Brian Palmer [8]. He has given international, national and state presentations on the importance of breastfeeding for the proper development of the oral cavity, airway and facial form; infant caries; why tight frenulums need to be addressed; the signs and symptoms, cause and prevention, and treatment of snoring and obstructive sleep apnea; and basics of dentistry not taught in dental schools.

Sleep Apnea & Snoring Treatment

I will briefly list some of the treatments for sleep apnea, but will focus mainly on the most TEOTWAWKI pertinent answers.
First and foremost, your physician or dentist will examine your living habits and make recommendations for behavioral therapy, such as avoidance of alcohol or sedatives, or sleep positioning devices. Use of pillows to alter your nighttime breathing habits may also be suggested. Your sleep physician and dentist with appropriate training in sleep apnea will help you decide which dental sleep medicine treatment or combination of treatments will work best for you.

Depending on each patient’s diagnosis, sleep apnea treatment may be as simple as a lifestyle change such as weight loss or change in diet. Other patients may benefit from the help of a specially designed oral appliance, which prevents airway blockage. Some more severe cases of apnea may require surgical intervention to prevent upper airway obstruction. Jaw surgery, tongue surgery, palatal implants and removal of the soft palate (UPPP, LAUPP,) are among these techniques. Some work well (jaw surgery) and others not well at all (UPPP, LAUPP). 

Nasal Vents
ProVents are a new as a treatment option. The results from the initial studies are promising. They do have a significant impact on lowering the number of apnea events a patient experiences, but they are not adjustable. Any one that is prescribed these by the doctor should insist on a full night sleep study while wearing them to verify that they are working sufficiently. Just because you feel better after sleeping with them doesn’t mean you are getting the best results possible.

CPAP
Mechanical therapy in the form of a mechanical device called a CPAP, or Continuous Positive Airway Pressure, uses a mask with an air blower to force air through the patient’s upper airway, assuring constant inhalation of adequate amounts of oxygen. are positive air pressure machines with various types of masks and hoses designed to force air past the main obstruction in the airway which in the vast majority of patients is the tongue. It inflates the airway like a balloon and hose.

CPAP has been considered ” the gold standard” of OSA treatment for many years and is incredibly effective for alleviating symptoms, avoiding the health risks discussed earlier and achieving a restful sleep. These benefits can only be realized when the CPAP is actually worn and worn for the fully prescribed amount of time. Sadly, study shows that 2/3 to 3/4 of people given a CPAP cannot tolerate full compliance. The list of problems encountered by CPAP users is lengthy. Many of these can be overcome, but the ones most pertinent to us on this blog are loss of power and portability.

Alternate power sources can definitely be one solution when these are available and when OSA patients want to use them. The majority of OSA patients who cannot tolerate the CPAP or want a non-powered solution and oral appliance should be considered.

As Seen on TV
You’ve probably seen dental appliances advertised on television that claim to handle your snoring problem. These have a few problems. If you snore but have not been tested for apnea and you wear one of these devices you may not snore, but if you have sleep apnea it is still killing you. If you have been diagnosed with OSA these devices are not being adjusted (titrated) for optimal effect and they are not FDA approved to treat OSA. The principle is the same, but as they say: ” the devil is in the details”.

Dental Appliances
There are dozens of these devices with varying designs, patents and trade names, but they all work on the same principle, basically they move the lower jaw forward in order to open your airway. Since your tongue is attached to your lower jaw basically behind your chin, moving the jaw forward (mandibular advancement) moves his tongue forward, opens the airway front to back, as well as side to side and prevents the tongue from falling to the back of the throat.

The best devices are custom fit and extremely adjustable so that your airway is opened enough to drastically reduce the number of apneic events and ideally eliminate snoring. This adjustment or titration is done in close collaboration between you, the dentist and the sleep physician. When looking for a dentist, be sure they are a member of the American Academy of Dental Sleep Medicine and ideally one who is a diplomate of that academy. Unfortunately, over the years I have seen dentists treat patients for snoring without knowing whether the patients have obstructive sleep apnea and use devices that are not approved to treat OSA. I’ve also seen lack of knowledge and follow-up with patients both of which are extremely important for optimizing treatment and avoiding unwanted side effects.

Some physicians shy away from this treatment, but quite honestly in my opinion this is due to what they are taught or not taught in medical school. There is a great deal of research that shows the effectiveness of these” low-tech” devices in treating mild, moderate and even severe sleep apnea. As preppers and survivalists you should appreciate that they are generally very durable, relatively inexpensive and could be repaired without a lot of sophisticated equipment. They are easily cared for and stowable in a tac bag, glove compartment, briefcase and purse or bug out bag. I would suggest speaking to your dentist about making several appliances . . . for a discount (or barter) of course. Remember: one is none and two is one.

One point that I would like to emphasize is that it is extremely important for you or your loved ones to be evaluated and treated regardless of whether a TEOTWAWKI situation ever occurs. This is a life-threatening condition is often ignored or minimized. It is a silent or not so silent killer. For those of you that are trying to maximize your health and your families health as a part of preparedness is crucial to consider seeking treatment. Everyone will sleep and function much better.

For more information on snoring, obstructive sleep apnea and treatment you can visit www.ihateCPAP.com [9] and www.aadsm.org [10].