Snoring is making the News everywhere as a growing problem

New figures published from research undertaken in Western Australia this week made the headlines on Channel 7 News, where it was announced that 70% of Australian men, and a growing number of women, now snore. The link between snoring and heart problems was strongly underlined. The coverage recommended various lifestyle improvements but emphasised first of all that a stop snoring mouthpiece is the key item that is needed to prevent this danger – because as they rightly say – Snoring Kills if it is ignored.

Snoring and heart conditions further evidence

According to NHS statistics published in the BBC publication The Radio Times this week, a quarter of the UK population snore but it is more prevalent in those aged 40-60, and twice as many men snore than women. Snoring noise is made by the soft palate and tissue in the mouth, nose or throat vibrating, and can disrupt quality sleep for both snorers and their bedfellows.

When breathing is partially obstructed in this way, snoring is the harsh sound that is created during sleep. It is a common condition that can affect any age group and could possibly be a sign of a more serious condition that’s causing it such as sleep apnoea.

The major outward signs of a snoring problem include drowsiness, irritability and a lack of focus. You should take immediate action if snoring is accompanied by symptoms of sleep apnoea such as daytime sleepiness, morning headaches or chest pain at night.

Untreated snoring caused by sleep apnoea can lead to greater risk of high blood pressure, type 2 diabetes, metabolic syndrome and liver problems, and recently, it was found that the vibrations caused by snoring damaged the carotid artery. This leads to heart attacks or stroke.

Mild snoring can be curbed with some simple habitual and lifestyle changes, although these obviously take time – particularly weight loss. There are lots of health benefits to keeping your weight in check, and combatting snoring is one of them. Excess weight around your neck can restrict your airwaves while sleeping, making you more prone to snore. However heavier snoring and sleep apnoea are very much a medical problem if left untreated.

Reuters also newly report that people who have had a procedure to open blocked heart arteries, untreated sleep-breathing problems like snoring or apnoea may raise the risk of a future heart attack or stroke, researchers say.

Patients who had artery-clearing procedures after experiencing chest pain or a heart attack were more than twice as likely to have heart failure, a heart attack or a stroke in the next five years if they also had any sleep-based breathing problems.

Intermittent low-oxygen periods during sleep may increase stress or activate inflammatory responses that damage the heart, said lead author Dr. Toru Mazaki of the department of cardiology at Kobe Central Hospital in Japan.

Sleep-disordered breathing has been associated with cardiovascular risks and symptoms like high blood pressure, elevated glucose and abnormal heart rhythms, said Dr. Nieca Goldberg of NYU Langone Medical Center in New York, who is also a spokesperson for the American Heart Association and was commenting on their behalf as he was not part of the new study.

It goes without saying that patients who are not sleeping well often become depressed. No one wants to spend their nights looking at the ceiling, or tossing and turning, trying to find a comfortable position in which to sleep. Patients with sleep apnoea often experience depression related to both their symptoms and the severity of their disease. Control of apnoea not only leads to improvement in physical health but can improve depression according to a new report. In a further Australian study Patients were screened for depression using the Public Health Questionnaire.

It’s important that we listen to the experts and take the right steps to preserve our health, so wearing a simple mouthpiece at night, and making a few lifestyle changes, will go a long way to making a remarkable difference to both life quality and longevity.

John Redfern


How much sleep do we need – when – and why?

 

Around a third of the population have trouble sleeping, including difficulties maintaining sleep throughout the night, particularly those who work unusual hours like shift workers. While night time awakenings are distressing for most sufferers, there is some evidence from our recent past that suggests that we had two periods of sleep each day and a period of wakefulness occurring between two separate sleep periods was the norm.

snoring and apnea

Segmented sleep is well documented across time, ranging from medical texts, to court records and diaries, and even mentioned in Charles Dickens’ book, Barnaby Rudge, which was written as late as1840.

References to the first and second sleep started to disappear during the late 17th century. This is thought to have started in the upper classes in Northern Europe and filtered down to the rest of Western society over the next 200 years and interestingly, the appearance of sleep maintenance insomnia in the literature in the late 19th century coincides with the period where these accounts of split sleep start to disappear.

Today’s society often doesn’t allow for this type of flexibility as we have to conform to today’s sleep/wake schedules, and it is generally thought that a continuous 7-9 hour unbroken sleep is probably best for feeling refreshed.

Some of the key advantages of a split sleep schedule include the flexibility it allows with work and family time, and some individuals in modern society have adopted this type of schedule as it provides two periods of increased activity, creativity and alertness across the day, rather than having a long period where tiredness builds up across the day and productivity wanes.

There are implications in this for shift workers and split sleep schedules have recently begun to emerge with some employers as a potential alternative to continuous night shift work. Some industries have introduced schedules with shorter, but more frequent shifts, so that the drive for sleep will be less with reduced time. While the challenges of night shift work cannot be fully eliminated, the advantage of some split shift schedules is that all workers get at least some opportunity to sleep at night and do not have to sustain alertness for longer than six to eight hours – much safer.

There is no tradition of an afternoon rest, like the Spanish siesta, in many countries. However some of the greatest statesmen, philosophers, writers and artists were habitual ‘nappers’ so perhaps there is a basis for it. Winston Churchill was devoted to his afternoon nap, which he called ‘that refreshment of blessed oblivion’. Henri Matisse napped after lunch, Thomas Mann for an hour before tea, and P.G. Wodehouse for an hour afterwards.

There are both mental and physical benefits to napping. A study last year published in the International Study of Behavioural Medicine, found that students who had a catnap of no longer than an hour had significantly lower blood pressure when faced with a complicated mathematical problem than those who had not slept. The study concluded that daytime napping may have a positive effect on cardiovascular health.

Another study last year, done in Germany, found that napping also helped with memory function. Participants had to learn lists of 90 single words and 120 unfamiliar word-pairs such as milk-taxi. Half were then allowed a 45–60 minute nap, while the other half watched a DVD. When it came to remembering the words, the nap group accurately remembered five times as many words and word-pairs as the DVD group. The study concluded that a short nap after a concentrated period of learning ‘plays an important role in memory consolidation’.

A NASA study of military pilots and astronauts, whose jobs are disrupted by their natural sleep cycles, worked out that the ideal length of a nap was 26 minutes and this improved performance by 34% and alertness by 54%.

On the other hand many people think they can teach themselves to need less sleep, but they are wrong, says Dr. Sigrid Veasey, a professor at the Centre

for Sleep and Circadian Neurobiology at the University of Pennsylvaniaʼs School of Medicine. “We might feel that we are getting by fine on less sleep, but we are deluding ourselves, largely because lack of sleep skews our self-awareness. The more you deprive yourself of sleep over long periods of time, the less accurate you are of judging your own sleep perception,” she said.

In support of this, Health issues like pain, sleep apnea or autoimmune disease can increase people’s need for sleep, said Andrea Meredith, of the University of Maryland School of Medicine.

 

John Redfern

 


What is the real cost to you of sleep apnoea – treated or untreated?

There are several ways in which this question can be interpreted but the answer is always the same one if you’re considering the possible health repercussions, and that answer is high, but if it’s a financial question then the cost can vary incredibly.

Apnea the true cost

There are estimated to be over 100 million OSA sufferers throughout the world where data is recorded, but the real number is likely to be much, much higher than this. Because so many cases of sleep apnoea go untreated – an estimated 90% – accurate figures aren’t really known.

The most recent official figures that have been published give the figures of known OSA patients as follows. The USA has 18 million apnoea patients, Australia has just about two million, and the UK approximately three million. However in all these countries the figures are increasing rapidly and this is mostly due to increasing obesity problems. They are also an understatement of the real number as many cases simply aren’t reported and go untreated.

The figures for snoring are of course much higher, and on the increase for both sexes, creating similar heath dangers if left to develop and deteriorate.

An overnight Sleep Test in one form or another is available at a price in order to fully evaluate the severity of the condition, but the starting point for most people is their partner, who through close observation will soon notice whether or not the key symptoms exist.

As a partner’s sleep is often disturbed this is rarely a problem, but they often need to convince their partner that the problem really exists, as it’s common for them to be in denial. Tests can be paid for, mostly in a specialist Sleep Clinic, but more Home Testing equipment is now becoming available, and some in app form for your Smartphone. However it’s a good start for you to start by recording their disturbed sleep and show it to them as a first step.

OSA occurs when the tongue and other soft tissues relax or narrow for one reason or another during sleep and block the airway. The brain senses a problem and wakes the body up just long enough to take a breath. This can happen hundreds of times in the night resulting in poor unprofitable sleep. The ‘choking’ awakenings are accompanied by gasping for breath, and then followed by a return to snoring, and these are clear to observe.

Scores of medical reports now clearly state that early recognition and treatment of sleep apnoea is important, as it may be associated with:

  • Irregular heartbeat
  • High blood pressure
  • Heart attack
  • Stroke
  • Daytime sleepiness
  • Increased risk of motor vehicle accidents

Historically, treatment has been the use of a pump-driven breathing device that forced air through a face mask, called CPAP, but this is now most often reserved for very severe cases only, as both the cost and the rejection rates are extremely high due to the many perceived disadvantages. New style, more expensive, oral appliances have taken its place, and these are ones that are laboratory made to fit the shape of the person’s dental profile.

They have been thoroughly tested by the UK’s leading NHS Sleep Clinic at the world-renowned Papworth Hospital and are now proposed by them in published documentation as the first recommendation for the prevention of both snoring and sleep apnoea, particularly the UK made SleepPro Custom, that clearly headed the league of all the appliances that were tested.

The cost of the SleepPro Custom was also found to be one that was equally beneficial as it was affordable to all – and this was deemed very important due to the widespread nature of OSA.

A similar Dentally recommended oral appliance in the USA could eventually cost well in excess of USD $3,000 including the sleep testing, and even new products that have recently been launched into the North American market from Australia state all-inclusive prices from USD $1.390 to USD $1,790.

The SleepPro Custom will be tailored to your own dental profile and made in a UK Dental laboratory for a price of £154.99 or USD $220. This is a very small price to pay for a medically proven solution that can not only improve your life but also extend it considerably.

John Redfern


Botox is now believed to damage your jawbone and cause tooth loss

In 2012 a review in the International Dental Journal stated botulinum toxin jabs, better known as Botox, were as effective as a mouth guard in reducing the problems of teeth clenching, grinding and the associated pain. That attitude has now reversed and it is even thought to cause tooth loss.

botox and night guard use

Evidence has recently emerged showing that Botox treatment may trigger a dramatic loss of bone density in the jaw, with parts of the jaw losing up to 40 per cent of bone volume after just one single treatment. What’s more, nobody knows when, or if, the weakened bone will fully regain its strength.

Botox jabs in the jaw are big business today. The paralysing effect is widely used to prevent tooth grinding, and also used by cosmetic doctors to slim the lower face. The treatment reduces the size of the masseter muscles, which are the large chewing muscles located on the jaw in front of the ears, and can cause dramatic cosmetic changes in a matter of weeks.

Teeth grinding, known as Bruxism, not only damages the teeth but can also cause headaches and facial pain, known as temporomandibular joint disorder (TMD) or temporomandibular joint pain (TMJ pain).

Injecting Botox into the masseter muscles means you’re unable to bite down with the same force but the evidence is emerging that the treatment may trigger loss of bone density

One of those leading research in the field is Dr Karen Raphael, professor of oral and maxillofacial pathology at New York University College of Dentistry who became concerned after reading animal studies that showed very dramatic losses in bone density after Botox for was used for these conditions – even after just one single injection of Botox. Researchers found that after only four weeks, the bone in the injected area was ‘severely decreased’. Three months later only half the lost bone had been restored.

Researchers said that in humans this significant degree of bone loss could be ‘a risk factor for fractures’. Normally, changes caused by Botox are assumed to be temporary, but even as early as 2004, doctors noticed that changes to the jaw were long lasting. Yet TMD and facial slimming patients are encouraged to repeat their treatments every 12 weeks.

So how might Botox be linked to bone loss? Our bones are constantly renewed. Old bone is dissolved while cells that are called osteoblasts are making new bone. They produce new bone in response to tugging by muscles and impact. But when masseter activity is reduced by Botox, it can’t push and pull the jaw as powerfully, reducing the amount of bone remodelling and thus bone density, explains Caroline Mills, consultant maxillofacial and facial plastic surgeon at Wexham Park Hospital, Berkshire.

‘A colleague recently saw a patient who had Botox in the masseter for ten years and has discovered her jaw joint is literally melting away.’ This loss of bone in the jaw is linked to an increased risk of loose or lost teeth.

She says the side effects of long-term Botox use in the jaw could include pain, increased risk of jaw fracture and even a need for joint replacement. She says doctors and dentists offer the treatment in good faith but may fail to warn patients of this risk because they themselves are unaware of it.

Six million people in the UK are thought to have Bruxism and should note that a mouth guard worn during sleep is a safer and more effective option to combat the problems and side effects of teeth grinding and clenching.

Allergan, the company that manufactures Botox have now said:

‘It’s important to note that Botox is not approved in the UK for the treatment of bruxism, temporomandibular muscle and joint disorder or for slimming of the lower face. While there are studies exploring the effects of muscle weakening on bone density, the clinical significance of these findings is as yet unclear.’

Allergan is conducting studies exploring the safety and efficacy of Botox when injected into the masseter muscle, the company added.

John Redfern