Airway & Sleep Apnea In Fullerton

Apnea, by definition, is the cessation of breathing and sleep apnea refers to the disruption of breathing on a daily basis during sleep. The two most common sleep-related breathing disorders are Central Sleep Apnea and Obstructive Sleep Apnea. Central sleep apnea (CSA) is characterized by the absence of airflow and the effort to breath is not present. Studies suggest that this disorder is related to a central nervous system dysfunction. It is relatively uncommon, but can be very dangerous to your health. This disorder is typically treated with a CPAP (continuous positive airway pressure) machine.

The more common type of sleep apnea is Obstructive Sleep Apnea (OSA). Obstructive sleep apnea is characterized by repetitive episodes of complete (apnea) or partial (hypopnea) obstruction of the upper airway during sleep. These episodes last for at least 10 seconds and are measured with a home sleep test (HST) or an in-lab polysomnography (PSG) test. These frequent interruptions in proper breathing result in poor blood oxygenation and can ultimately contribute to a wide range of adverse health consequences including hypertension, cardiovascular diseases, metabolic disorders (such as diabetes), gastric disorders (such as gastroesophageal reflux diseases), respiratory disorders (such as asthma), emotional and psychological disorders, and increased mortality rates.

Common symptoms of OSA include loud snoring, often accompanied by choking or gasping noises, poor quality sleep, abrupt awakenings in the middle of the night, and excessive daytime sleepiness. You may also notice issues like a sore or dry throat upon waking, morning headaches, or difficulty concentrating throughout the day. Without proper care, OSA can be a life-threatening condition.

Between 20 and 50% of the pediatric and adolescent population may have a sleep disorder. Unfortunately, these disorders are often not often recognized at an early stage and therefore go undiagnosed. Sleep disorders may lead to poor quality of sleep and have a direct impact on behavioral, physical, and mental growth and development.

Snoring is a very common complaint from parents and is believed to affect about 3-12%of children. Snoring is caused by the vibration of the soft palate and the pillars of the orpharyngeal inlet. Children who snore at night are typically suffering from some form of obstruction, mainly enlarged tonsils and adenoids. Screening of these anatomical structures can be done by Dr. Hang Pham and a proper referral can be made to an Ear Nose and Throat specialist for further evaluation and treatment, if needed.

There are a number of factors that contribute to OSA. In most patients, several of these factors are present and are the root cause of their sleep apnea. Hence a strong knowledge base is needed to fully understand the proper screening and treatment for this disease. 

Obesity has been linked to many patients suffering from sleep apnea. The increased girth of the waist and the extra soft tissue around the neck area increases the collapsibility of the airway. Weight loss through a controlled diet and exercise can help reduce the risk of OSA caused by obesity. Other causes of OSA include enlarged tonsils and adenoids, which can partially obstruct the airway. Some genetic anatomical features, such as narrow dental arches, large neck circumference, and deviations in nasal anatomy are associated with sleep apnea, and can contribute to OSA. 

Because of the nature of the complexity of sleep apnea, a broad range of specialist is needed to partake in an interdisciplinary treatment plan. Dr. Hang Pham understands the challenging role of being the quarterback but is confident that by doing so, she can have a huge impact on the patients in her community.
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Sleep apnea screenings are typically done by doctors or sleep specialists, often using a questionnaire such as STOP-BANG (Snoring, Tiredness, Observed apnea, bloodPressure, Body mass index, Age, Neck circumference, and Gender). You’ll simply answer a few questions about yourself and your sleeping habits, and your doctor can determine if you may have sleep apnea. In some cases, you may need a sleep study.

A sleep study will use specialized tools to gather information about your sleeping habits, and may record your breathing, heart rate, neurological activity, and other metrics to determine if you have apnea. Sleep studies are often administered overnight by sleep doctors at their clinics (polysomnography or PSG), but some sleep doctors can provide you with special equipment that you can use to conduct the sleep study at home (home sleep test orHST).

The most common therapy for sleep apnea is positive airway pressure (PAP). The PAP device produces a pressurized airflow that is delivered to the patient via a mask. The airflow subsequently creates a positive distension of the upper airway which allows for airway patency, or proper function and engagement of the muscles and tissues. There are several types of PAP modes but the most common one is continuous positive airway pressure (CPAP). While PAP machines have proven to be effective in treating sleep apnea, they can be inconvenient to use. As such, a significant challenge to both patients and health care practitioners is compliance to PAP therapy. 

For this reason, oral appliance (OA) therapy is becoming more prevalent for the management of sleep-related breathing disorder and is currently recognized by the American Academy of Sleep Medicine as a medical device option for treatment. OA is designed to reposition or advance the mandible to improve the upper airway patency. Because there are a lot of factors that must go into place when designing an appropriate appliance for each patient, proper screening and collaboration is needed between your dentist and the sleep physician.

Oral appliances are small, portable, require no power, and do not restrict your sleeping positions, so they are very versatile and a good option for patients with mild-to-moderate OSA. However, they are not usually recommended for patients with severeOSA, or central sleep apnea (CSA).