Sleep

For adults and children, alike, adequate, uninterrupted sleep is essential for leading a normal productive life.

What is sleep apnea?

Sleep apnea is a brief cessation of breathing during sleep. The most common form of apnea is obstructive sleep apnea (OSA). OSA is caused by obstruction of the airway, which could involve the nose, mouth and tongue, or the throat. These obstructions result in the stoppage of breathing. If breathing stops for more than 10 seconds, it is referred to as an apneic event. If you have more than 5 events occur per hour, you are considered to have apnea.
What is sleep disordered breathing?

One does not have to have apnea to have a sleep / airway problem. Sleep disordered breathing (SDB) refers to all conditions that are a result of altered breathing during sleep.
What are other types of sleep disordered breathing?

Some of the conditions that fall under SDB are snoring, upper airway resistance, frequent arousals, restless leg syndrome, periodic limb movement, parasomnias (night terrors, sleep walking, sleep paralysis, etc.) and others.
What are the symptoms of SDB?

There is a range of symptoms. A bed partner easily recognizes snoring and apnea. Snoring is terribly annoying and can lead partners to sleep in separate rooms. Apneic events, including choking, gasping and long pauses without breathing, can frighten any witness. The person suffering these events may not even be aware they are occurring. They may feel tired in the morning; fall asleep while sitting in a theatre or even while driving. (Take the Epworth Sleep Test). It is important to note that SDB has been shown to a factor in heart disease, high blood pressure, cardiac arrhythmias, diabetes, stroke, sexual performance, and other chronic health issues.
What treatments are available?

Accepted treatments are: CPAP, oral appliances and surgery.
When can I use a dental appliance or a CPAP? Can I use both?

CPAP treatment can be used for all apnea cases. Oral appliances are recommended only for mild and moderated apnea. In some cases, a combination of treatments produce the best results.
What treatments are available to restore the airway structure?

Treatments for apnea deal with managing the apnea. For those opposed to having to wear an appliance or CPAP for the rest of their lives, there is hope. The AAPMD advocates multidisciplinary evaluation for SDB. A team approach employing ENT, allergy, orthodontic, myo-functional and airway-restorative dentistry, along with weight loss and dietary changes, can reduce or eliminate SDB. A very specialized jaw surgery is available for extreme cases.
What prevention action is available?

The AAPMD believes that increased awareness and early childhood intervention can optimize growth and development, and protect, maintain and restore the airway.

Acknowledgement to The American Academy of Physiologic Medicine and Dentistry for this informatio

You may not know it, but the growth and development of your child can often be vastly improved by making subtle lifestyle changes, or correcting hidden physical problems. Take a look at these common issues…

 

What is the difference between sleep apnea in children and in adults?

Children are not just small adults. The thereshold for sleep disordered breathing (SDB) in children is much lower than adults. In adults, episodes where breathing stops or is reduced must last 10 or more seconds before being considered an apnea or hypopnea. Even healthy adults have some degree of sleep-related disordered breathing. There is an apnea index to differentiate normal from pathologic apnea. The apnea index is an average of the number of apneas occurring per hour during sleep. Apnea indices of fewer than 5 events per hour and hypopnea indices of fewer than 5 events per hour are generally considered to be within normal limits by adult standards.

Healthy children have fewer episodes of sleep disordered breathing than adults, and adult criteria is inadequate for diagnosing OSA in children. Most pediatric sleep centers view apneas or hypopneas that occur more than once per hour as abnormal. Other diagnostic factors are should be considered. It is not cute if your child snores – it is dangerous.
Does your child have to have apnea to have his growth and development affected?

Current research suggests that snoring, even without measurable apneas, is associated with cognitive, behavioral, and psychosocial problems. Children who snore have been shown to have lower scores on learning and memory tests including some types of intelligence quotient (IQ) tests. Sleep disordered breathing is believed to cause changes in the production of growth hormone and is also associated with impaired physical growth development.
What sleep signs and symptoms should I look for?

There are many indications that your child may be affected by SDB (sleep disordered breathing). If your child snores or gasp while sleeping, breathes through the mouth, has nasal obstruction, enlarged tonsils or adenoid, bed wets, exhibits hyperactivity and daytime sleepiness, they should be evaluated for a sleep related issue.
What growth and development signs should I watch for?

If there are any signs of growth and development, hyperactivity, attention deficit, tendency toward obesity a sleep evaluation should be considered. It is important to know that there is a critical period of brain development that determines how a child will perform in school. SDB problems can start at birth and awareness, diagnosis and treatment as early as possible are essential.
What should I do if I suspect a problem?

Share your concerns with your pediatrician. There is growing concern and awareness of this epidemic problem among our children. In 2012 the American Academy of Pediatrics published new guidelines for childhood sleep disorders. They recommend, “all children or adolescents who snore regularly be screened for OSAS. Additional symptoms can include labored breathing during sleep, disturbed sleep with frequent gasps, snorts or pauses, and daytime learning problems. It is important for children exhibiting signs of OSAS to get a comprehensive diagnosis by having an overnight, in-laboratory sleep study done. If left untreated, OSAS can result in problems such as behavioral issues, cardiovascular problems, poor growth and developmental delays.