Everyone jokes about snoring, but it’s not so funny if it’s happening in your bed — even less so now that we know there are potentially serious health problems, including depression and heart disease, linked with obstructive sleep apnea (OSA). The good news is that two treatment options — a retainer-like mouthpiece called the mandibular advancement device and a routine of tongue and throat exercises — may help keep the upper airway open without the discomfort or risk associated with other treatments.
Currently, the most successful conventional treatment is continuous positive airway pressure (CPAP), which is a machine that blows air into the throat through a mask placed over part of the face. But it’s a clunky piece of equipment and treatment can cause irritated skin, a dry or stuffy nose, headaches and eye irritation — while some people do well with it, many don’t want to live with the device for the rest of their lives, I was told by Steven Y. Park, MD, clinical assistant professor of otolaryngology at New York Medical College and author of Sleep, Interrupted. Surgery is another possible treatment, but it is a last resort and a controversial one because it carries its own risks and dangers.
A South Korean study of 50 patients with mild to severe OSA found that using a mandibular advancement device, which moves the lower jaw (mandible) forward to prevent airway obstruction, resulted in a 74% success rate, decreasing the number of breathing disturbances per hour from 37 to 12 after treatment. Snoring incidence, the duration of apnea episodes and sleep quality also improved. The findings were published in the May 2009 issue of Archives of Otolaryngology – Head and Neck Surgery.
The mandibular advancement device fits into the bottom of your mouth, with a piece that slides out to reposition the lower jaw. It is worn while sleeping. Once you’re satisfied with the results, a sleep study can determine if you no longer have sleep apnea but, you’ll still need to continue wearing the device.
“This is a good option for some people with mild to moderate obstructive sleep apnea,” says Dr. Park. But he notes, you’ll need to continue regular follow-ups with your sleep medicine doctor and dentist. He advises working with a dentist specializing in sleep breathing problems — start your search by logging onto the Web site of the American Academy of Dental Sleep Medicine (http://www.aadsm.org).
One caveat: If you have nasal obstruction, that problem should be addressed first, since you have to breathe well through your nose for this therapy to work. Check with your otolaryngologist or sleep doctor on this question.
From another part of the world, Brazilian researchers who studied 31 patients showed that tongue and throat exercises may reduce symptoms of mild to moderate OSA. After doing the exercises 30 minutes a day for three months, patients had significant improvements in blood oxygen levels, daytime sleepiness, snoring and quality of sleep. Patients in a control group, who underwent sham treatment consisting of deep breathing through the nose and nasal lavage, experienced no improvement. The findings were published in the May 15, 2009, issue of the American Journal of Respiratory and Critical Care Medicine.
The exercises patients performed included:
According to Dr. Park, there’s certainly no downside to trying these exercises on your own, but adds that not everyone will benefit. He suggests considering such an exercise program as an adjunct to other, more formal treatments. If you’d like to learn more about how to do these and other exercises, he suggests looking online at IJustWantToSleep.com.
An editorial accompanying the Brazilian study asserts that nasal inhalation and balloon inflation can generate sufficient air pressure to actually strengthen the throat muscles. And indeed, research presented at the Associated Professional Sleep Societies 2009 annual meeting reported that musicians who play high-resistance woodwind instruments, such as an oboe or bassoon or high-resistance brass instruments (trumpet, horn), for 15 hours a week have a lower risk of OSA. If you’re a musician — or have dreamed of being a musician — start practicing. Dr. Park agrees, an exercise program won’t hurt and might help.
