I picked up my sleep appliance two days ago, so I’ve had an opportunity to test it out for two nights now. But, before I talk about my experience with the appliance, it’s probably worth talking a bit about what Obstructive Sleep Apnea (OSA) is.
OSA is a sleep disorder in which a persons breathing pauses or stops for periods of time during sleep, usually somewhere around twenty (20) to forty (40) seconds. Breathing stops as a direct result of the persons airway becoming partially or completely obstructed. The obstruction can be caused by many different sources; the muscles or tissue in your jaw and/or neck, your tongue falling to the back of your throat, enlarged tonsils, or the structure and shape of your jaw or palate, to name just a few. The list of contributing factors is lengthy, and because Sleep Apnea often occurs as a result of a combination of these factors, it remains difficult to surgically correct the cause with a satisfactory success rate.
There is a separate type of sleep apnea called Central Sleep Apnea (CSA) or Central Sleep Apnea Syndrome (CSAS), in which a persons effort to breathe is neurologically diminished or absent for periods of time during sleep. CSA is much less common, and the vast majority of individuals who suffer from sleep apnea suffer from OSA. Because I personally have OSA I will only be speaking to this type of Apnea in this post.
A diagnosis for OSA can only be obtained through the use of a diagnostic overnight sleep study such as polysomnography (conducted in a clinical setting), or a home oximetry test. Polysomnography measures many physiological responses during sleep, including; brain, eye, and muscle activity, heart rate, oxygen and carbon dioxide levels, breathing effort and body movement. The home oximetry test measures a persons oxygen saturation levels, which indicates whether or not they are adequately taking in oxygen during sleep. Personally I was referred for polsomnography in a clinical setting. The study involved having well over fifty different leads and devices hooked up to every part of my body in order to measure what exactly my body was doing during sleep. Although not the most comfortable sleep I’ve experienced, the whole process is painless.
The study calculated how many times I completely ceased breathing for more than ten seconds, referred to as an apnea, as well as how many times my breathing rate or oxygen level decreased by greater than thirty percent (30%), or my body demonstrated an arousal from sleep, both referred to as a hypopnea. During my sleep study I averaged nineteen (19) apneas/hypopneas per hour (which believe it or not only pegs me at a moderate level of sleep apnea, some people experience upwards of thirty (30) per hour!).
The arousals, or awakenings, which are largely believed to be caused by the apnea/hypopnea events are also measured in a clinical sleep study. In my case, over 5 hours of total sleep I experienced twenty-seven (27) arousals from sleep that lasted longer than fifteen (15) seconds, and four hundred and sixty-nine (469) arousals from sleep that lasted less than fifteen (15) seconds. Do the math on those numbers…….my quality of sleep was being pretty negatively impacted!
It was once thought, and some doctors still believe, that an apnea is significantly more severe than a hypopnea. While true that it is much worse to completely stop breathing in terms of the immediate risk to the patient, many medical professionals now believe that the overall long-term effects caused by both apnea and hypopnea are nearly indistinguishable. Both cause your body to react with an arousal from sleep, causing fragmentation of your sleep. This sleep fragmentation means that a person is often unable to arrive at or remain in a deep sleep stage, which is the stage in which the body receives all of the positive and refreshing benefits of sleep.
Depending on the severity of the apnea/hypopnea, common effects are significant daytime fatigue, increased irritability, difficulty concentrating, headaches, emotional problems, and negative impacts on memory. Recent research using neuro-imaging has further shown that in twenty-five percent (25%) of OSA cases, the patient has suffered irreversible impacts to their cognitive function, working memory, and ability to mentally manipulate non-verbal information. Severe OSA can also result in high-blood pressure, cardiac disease, stroke, and a host of other medical implications if left untreated.
The bottom line being, if you have any symptoms of sleep apnea, talk to your doctor about it immediately. It’s worth getting tested, as leaving it untreated can truly have life or death consequences. An additional symptom which has only recently been recognized by leading experts in the treatment of Sleep Apnea, is that bruxism (grinding of the teeth) can often be an early red flag. Bruxism has long been believed to be a result of stress or anxiety, but it is also the bodies natural way of attempting to move your lower jaw forward in an effort to open up your airway. So, if your dentist has told you that you grind your teeth, talk to your medical doctor about having a sleep test conducted!
The two front line treatments for OSA are a continuous positive airway pressure machine (CPAP), and one of many oral appliances that manually align your jaw into a position that maintains your airway during sleep. As I mentioned in my post “January’s Intentions” I had trialed the CPAP for four months, but was determined to be intolerant to wearing it. As a result I was prescribed an oral appliance.
The oral appliance I ended up purchasing is the Narval CC made by ResMed. Although I’m certainly no expert in what oral appliances might be best, this appliance was relatively low profile, super lightweight, and easily adjusted by the patient to find the ideal jaw position. It also comes with a three-year warranty, which was significantly longer than the warranty offered by a lot of other companies in the oral appliance arena. And at a cost of $2500.00 per unit, it was worth having something that came with a solid warranty.
The first night after I picked up the appliance I was pleasantly surprised by the fact that I could still talk when I put it in. Although a bit cumbersome, I didn’t feel ridiculous wearing it, which was a nice bonus. I wore it for about six (6) hours that night, but woke up at four (4) in the morning with my bottom teeth aching and couldn’t get back to sleep. At about five (5) in the morning I finally gave up and took it out for the last two hours of my sleep. Not the greatest start, BUT, I was happy I was able to keep it in for at least six (6) hours.
Fast forward to last night and I was able to wear the appliance without difficulty for the entire night! I was very excited! I didn’t wake up feeling drastically different, but I had been cautioned that it can take up to three months to see significant results in daytime symptoms. After all, there is a massive sleep deficit accumulated for which your body now has to make up and repair.
When I checked my Fitbit sleep function I saw that I had achieved the best sleep results I’d ever had in two years of using the Fitbit. Although the Fitbit sleep function isn’t exactly precise, it does measure when you are restless in your sleep and provides me with a general sense of where my sleep quality is at. Despite being in bed for an average of eight (8) to nine (9) hours per night, I generally only sleep for about four (4) to five (5) of those hours in total. The remainder of the time is split up by an average of twenty-five (25) to thirty (30) incidents of restlessness/awakening culminating in about four (4) – five (5) hours of restlessness per night. Not ideal.
Night #2 with the oral appliance showed that I had actually obtained just over eight (8) hours of actual sleep, that was a number I had NEVER even been close to before. Additionally, my restless periods had gone down to fifteen (15), totalling just over two (2) hours of restlessness. My coloured sleep graph was showing much bigger chunks of the dark blue (sleep time) with fewer and shorter interruptions of light blue (restlessness) or even worse, red (awake).
The downside? Well, my jaw has been in a fair bit of pain today, but only when I chew or yawn! Hopefully I will adjust quickly to my jaw being in this new position all night long, but at least I was seeing some encouraging results quickly. It certainly made the discomfort of my jaw seem like a small price to pay! Now I can’t wait to see how things progress over the coming weeks!
If you would like to learn more about Sleep Apnea, or think you have symptoms, please visit the American Sleep Apnea Association’s website. Another excellent source of information on bruxism and it’s relation to sleep apnea is Dr. Mark Burhenne’s website.