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Oral & Maxillofacial Surgery
Sleep Apnea

Sleep apnea is a potentially life-threatening sleep disorder characterized by repeated pauses in breathing during sleep. The term sleep apnea is derived from the Greek etymology meaning “without breath”. Breathing pauses can last anywhere from several seconds to minutes, and happen as often as 30 times or more per hour. Ongoing disrupted breathing causes an imbalance between the carbon dioxide and oxygen levels in the bloodstream, as not enough carbon dioxide is exiting and not enough oxygen is entering the body.

Sensing this imbalance, the brain sends a message to the body, telling it to wake up to restart breathing the process. People with sleep apnea will partially awake as they struggle to breathe, and this is often accompanied by loud snoring or choking sensations. Because people with sleep apnea don’t always completely awake during the episodes, they are often unaware they have a sleeping disorder and it can remain undiagnosed.

There are two main types of this disorder; central sleep apnea which occurs when the brain fails to send important signals to the breathing muscles, and obstructive sleep apnea which occurs when air cannot flow through the nose or mouth even though the body is still trying to breathe. Obstructive sleep apnea is far more prevalent and treatable by your Oral and Maxillofacial Surgeron. This is often done in conjunction with a sleep medicine physcian and with the assistance of a sleep study or other diagnostic tests. 

Common signs of obstructive sleep apnea can include severe early morning headaches, sleepiness in the daytime, and insomnia. Fortunately, Dr. Gray is equipped with the necessary technology and expertise to treat sleep apnea in several different ways.

Reason for treating sleep apnea

It is very important to seek medical attention if sleep apnea is suspected. A sufferer can completely stop numerous times per hour, and this can lead to long term health complications. Obstructive sleep apnea occurs when the soft tissue lying at the back of the patient’s throat collapses into the airway. The tongue then falls towards the back of the throat which tightens the blockage and prevents oxygen from entering the lungs.

The problem worsens when the chest region, diaphragm, and abdomen fight for air. The efforts they make to obtain vital oxygen only cause a further tightening of the blockage. The patient must arouse from deep sleep to tense the tongue and remove the soft tissue from the airway.

Because sleep apnea causes carbon dioxide levels to skyrocket in the blood and oxygen levels to decrease, the heart has to pump harder and faster to compensate for the lack of oxygen. Sleep apnea has been linked to pulmonary hypertesnion and cardiovascular disease and should be investigated at the earliest opportunity.

What does obstructive sleep apnea(OSA) treatment involve?

Initially, a diagnosis must be established that indeed OSA. This is usually done in conjunction with a physcian who practices sleep medicine(often a pulmonologist) and with the assistance generally of a sleep study, and or other labs. Depending on the severity of the condition varying treatments may be employed . Dr. Gray has assisted many patients with their OSA. Here are some current theapies for OSA. 

            Occlusal repositioning orthotics-these are appliances that position the mandible and consequently the tongue anteriorly when one is sleeping to provide more airway patency.  Dental devices that gently tease the lower jaw forward are very effective in preventing the tongue from blocking the main air passage. These dental devices are gentle, easy to wear, and often help patients avoid unwanted surgeries.They are only worn at night and generally do not affect one's bite. Brand name of one device "Clearway appliance". Custom fitted to your dentition. This only requires office visits to do so. 

             CPAP(Continuous Positive Airway Pressure)-This is generally a mask that is worn at nights with sleep that provides a constant  slightly higher air pressure into your airway than the surrounding air pressure to "open" airway so obstruction does not occour or is lessened. This is effective for mild and moderate OSA but is not well tollerated by patients. It is not a natural sensation to wear. Requires cleaning daily. Most people who have OSA would likely benefit from it but will not or cannot tollerate it. 

               Adjunctive surgery(UPPP-Uvulopalatopharygoplasty)-part of the "stanford Protocol" for management of OSA. Involves removing reduntant upper airway soft tissue. Often very painful. Seems to improve mild to moderate sleep apnea but mixed results with obese patients. Typically performed by Otolaryngologist. 

             Maxillomandibular Advancement(MMA)-also part of the "Stanford Protocol". This is Truely orthognathic surgery to move the upper and lower jaw forward pull tongue forward and hypopharyngeal tissues anteriorly. Your Bite is kept the same or improved. This has been shown to improve and cure OSA in some patients. Generaly reserved for moderate to severe OSA. Dr. Gray performs this type of surgery in a hospital based setting. 

             Tracheostomy-this is generally reseved for severe OSA patients who have failed multiple or all therapies. A last resort. Obviously makes speaking very challenging and is not a cosmetic operation. Will cure OSA. 

            Dr. Gray can offer many different treatment options which depend largely on the exact diagnosis and the health of the patient. Often this may require patient to halt some habits that aggravate OSA such as smoking, alcohol consumption, and tranquilizer use.