Sleep Apnea

Intermittent pauses in breathing during sleep characterize sleep apnea. The breathing lapses can fragment sleep and reduce oxygen supply, leading to sleep and brain health consequences. Sleep apnea affects children and adults, men and women.

What we offer at Sleep and Brain

At Sleep and Brain, we conduct a detailed clinical history to detect the subtle symptoms of sleep-disordered breathing. We prudently search for clues during your sleep and wake period, as exampled below:

Sleep
- Snoring
- Bruxism
- Sweating
- Cold hands and feet
- Drooling
- Clenching
- Dry Mouth
- Nocturia

Wake
- Sleepiness
- Fatigue
- Impotence
- Anxiety
- Depression
- Irritability
- Forgetful
- Inattention

When you think of the term sleep apnea, you are likely considering obstructive sleep apnea. However, there are other types of sleep-disordered breathing. We discern the various types of sleep-disordered breathing, such as:

Snoring
- Respiratory noise typically occurring during inspiration
Obstructive sleep apnea
- Intermittent lapses in breathing due to a physical obstruction
Central sleep apnea
- Intermittent lapses in breathing due to faulty brain signals in the absence of a physical obstruction
Hypoventilation syndrome
- Insufficient sleep-related ventilation with high carbon dioxide levels
Hypoxemia syndrome
- Low sleep-related oxygen saturations

Following a thorough history, we conduct a specialized physical examination, as exampled below, to help determine the etiology of your sleep-disordered breathing:

Obstructive sleep apnea
- Facial dimensions
- Dental occlusion
- Tongue endurance and strength
- Nasal resistance
Central sleep apnea
- Peripheral edema
- Shortness of breath
Hypoventilation syndrome
- Obesity
- Muscular weakness

We give additional considerations to medical conditions that may increase the risk for sleep-related breathing disorders. Hormone conditions like hypothyroidism (low thyroid hormone) and acromegaly (high growth hormone) may increase OSA risk by causing airway tissue swelling and obesity. Stroke and brain tumors and infections can damage the brain stem and cause central sleep apnea. Heart failure can cause a special type of central sleep apnea called Cheyne-Stokes respiration. Obesity and opioids can reduce ventilation. Consequently, we may recommend laboratory tests, imaging, and echocardiograms.

The Sleep and Brain case images below illustrate an unmatched diagnostic precision and clinical expertise.

Enlarged Inferior Turbinates Touching and Obstructing the Posterior Nasal Passage

Concha Bullosa: Air Filled Medial Turbinate Causing Nasal Obstruction

Calcified Stylohyoid Ligaments Due To Tension from the Pharyngeal Dilator Muscles Attached to the Hyoid Bone: Indicates Chronic Efforts to Keep the Airway Open.

Severe Tranverse Maxillary Deficiency: The Maxilla Should be Approximately 9 mm Wider Than the Mandible at the First Molar Level.

Tonsil Stones Due to Chronic Mouth Breathing

Bi-Lateral Nasal Valve Collapse Exacerbated by a Left Nose Ring

Substantial Transverse Maxillary Deficiency of Approximately 7 mm.

Calcified Genial Tubercle: Tongue Muscle Overactivation to Open a Compromised Airway Causes Calcification of the Tendon Insertion at the Genial Tubercle.

Flaring Gonial Angle Flaring and Notching from decades of overactive jaw muscles trying to maintain an open airway.

Mucous Retention Cyst in Right Maxillary Sinus

Loss of Cervical Spine Lordosis Due to a Forward Head Posture Compensating a Restricted Airway

Oral Appliances May Not Improve Airway Volume and Could Cause Side-to-Side Narrowing With Mandible Advancement In a Narrow, Ovoid-Shaped Pharyngeal Airway.

Oral Appliances May Expand Airway Volume with Mandible Advancement in a Wide, Flat Pharyngeal Airway.

Excellent Transverse NasoMaxillary and Mandibular Width

Low Tongue Posture. Black Space Represents
Air Between the Tongue and Upper Palate. — Low Tongue Posture. Black Space Represents Air Between the Tongue and Upper Palate.

We typically begin with sensitive **home sleep testing** with peripheral arterial tonometry to quantify your sleep patterns and evaluate sleep-disordered breathing and sympathetic arousal frequency.

Nox A1 Child.jpg — **Laboratory sleep testing** with carbon dioxide monitoring, performed in your home, may be necessary to evaluate additional sleep-disordered breathing such as hypoventilation.

Fortunately, a plethora of therapeutic treatment options are available for sleep-disordered breathing. Unfortunately, many individuals are unsuccessful with standard therapy. We direct individualized treatment toward sleep-disordered breathing, depending upon your age, anatomy, and life experience, and as exampled below:

Obstructive Sleep Apnea
- Lifestyle modifications
  - Alcohol
  - Tobacco
  - Sedatives
- Weight loss
- Positional therapy
  - Philips NightBalance
  - Zzoma
- Positive airway pressure therapy
- Mandibular advancement splint
- Allergy evaluation
- Myofunctional therapy

**Myofunctional therapy** is a vital but often overlooked treatment for obstructive sleep apnea that can cut apnea severity by half, improve the lowest oxygen saturation, snoring, and sleepiness.

ExciteOSA neuromuscular stimulation device
iNAP

**Rhinomanometry** provides a quantitative measure of nasal airway resistance that can be used to investigate positive airway pressure intolerance and the indication for nasal surgery.

Nasal surgery

Orthodontic palate expansion
Anterior or posterior direct skeletal palate expansion
Maxillo-mandibular advancement
Inspire hypoglossal nerve stimulator implant

Central Sleep Apnea
- Positive airway pressure, including servo-ventilation
- Oxygen
- Altitude adjustment
- Medication adjustment and institution
Hypoventilation
- Weight loss
- Positive airway pressure, including Respironics AVAPS and ResMed IVAPS