Dr. Bennardo and his dedicated team members are constantly working to find better ways to provide the most comprehensive care and treatment for our patients. In order to do so, it is necessary to examine all aspects of a patient's daily life that may be contributing factors to other underlying conditions.
What is Sleep Apnea?
Sleep Disordered Breathing, or Sleep Apnea, is a disorder where there is intermittent loss of breath. This is most often caused by narrowing of the airway and/or airway collapse. When you stop breathing, your oxygen levels drop and your heart rate goes up. The decrease in oxygen and the increase in heart rate caused by the sudden awakenings put stress on the heart. This can happen hundreds of times per night and has been documented to cause blood pressure to rise which leads to hypertension as well as several other health related problems. Obstructive Sleep Apnea (OSA) occurs when the airway is temporarily compromised or collapsed causing you to stop breathing anywhere from 10 to 90 seconds.
Snoring and OSA are both breathing disorders that occur during sleep caused by partial or complete airway closure. OSA is a serious condition and in many cases it can result in excessive daytime sleepiness, high blood pressure, reflux, irregular heart beat and possibly heart attack or stroke.
Sleep Apnea Self Assessment
Even if you don't THINK you have a problem, take this quick self assessment.
Do you Snore?
Are you TIRED during the day?
Has anyone seen you CHOKING or GASPING when you sleep?
Have you been told you have HIGH BLOOD PRESSURE?
Do you have ACID REFLUX?
Do you have Atrial Fibrillation?
Do you have DIABETES?
Do you GRIND your teeth?
If you answered YES to more than TWO of the questions, give us a call or email us to inquire about home sleep testing.
Home Sleep Testing
Did you know that you can now take a sleep test in the comfort of your own home? Home Sleep Tests (HST) are becoming the standard method of testing for Medicare and most PPO medical insurance companies.
We work closely with and refer to a local home sleep testing company that will verify your insurance coverage, come to your home to show you how to use the equipment, and pick it up the following day. The out of pocket cost for a home sleep test is generally lower than the cost of an in-lab study.
In order to determine if a patient has sleep apnea, a home sleep study or an in-lab polysomnogram must be completed and interpreted by a Board Certified Sleep Physician.
Screen. Test. Results.
The Apnea Hypopnea Index (AHI)
What is an apnea?
• An Apnea is the total cessation of breath for 10 seconds or more and a 4% desaturation in the patient’s O2 levels.
What is a hypopnea?
•A Hypopnea is when there is a 30% or greater reduction in airflow lasting 10 seconds or longer and a 4% desaturation in the patient’s O2 levels.
•Diagnosis is made using the Apnea Hypopnea Index or AHI:
Total # of Apneas + Hypopneas
# of hours of sleep
We have no bias towards treatment options. We will guide you the appropriate treatment recommendation made by the American Academy of Sleep Medicine and also take into account patient preference. A successful treatment starts with what patient compliance.
Weight loss and exercise can help lower the severity of sleep apnea. However, most patients require Medical or Dental treatment. Treatment options available include:
Oral Appliance Therapy (OAT)
Continuous Positive Airway Pressure (CPAP)
Automatic Positive Airway Pressure (APAP)
Oral Appliance Therapy (OAT)
Oral Appliance Therapy is now the first line of treatment for mild to moderate sleep disordered breathing according to the American Academy of Sleep Medicine. It is achieved with a custom fabricated dental device that re-positions the lower jaw, tongue, soft palate and uvula to keep the airway open during sleep. It stabilizes the jaw and tongue and increases muscle tone of the tongue.
While documented studies have shown that oral appliances have substantially reduced the prevalence of sleep apnea, there is no guarantee that it will be successful for every patient. It is often a viable alternate to PAP therapy.
This treatment option is non-invasive and can be highly effective for both sleep apnea and snoring.
Although PAP therapy is the first line of therapy for severe OSA patients, if the patient is unwilling or unable to tolerate the machine, an oral appliance can be prescribed as an alternative.
Deciding upon the appropriate model and type of oral appliance will be decided upon between Dr. Bennardo and the patient. Dr. Bennardo will perform a thorough exam and diagnostic imaging to determine if you are a candidate for oral appliance therapy and which appliance best suits your needs.
Positive Airway Pressure
PAP therapy is provided by a bedside machine that delivers pressurized air through a tube that connects to a mask, covering the nose.
Automatic Positive Airway Pressure machines are set with a pressure range, for example 5-15, that will adjust to the patient's needs during the night.
Continuous Positive Airway Pressure machines are set to one pressure that is constant throughout the night. The pressure setting is determined during an over-night CPAP titration study in a lab.
Surgery is usually an option when other less invasive therapies have failed. Surgery can be an effective treatment option for OSA, however, long-term success with surgery has not been demonstrated.
There are several surgical options available. Additionally, it is imperative to work with an ENT, a Sleep Physician and occasionally an Oral Surgeon to determine if a surgical procedure is necessary and which one is indicated.
83% of people who are on multiple medications for high blood pressure have sleep apnea
50% of people with high blood pressure have sleep apnea
Almost 70% of people who have had a stroke have sleep apnea
58% of patients with Type 2 Diabetes have sleep apnea
77% of people who are obese (Body Mass Index of 30 more) have OSA
A person with sleep apnea is 7 times more likely to have a motor vehicle accident