Our Approach to Diagnosing & Treating Sleep Apnea CHR
Watch this video to learn about Sleep Apnea.
Oral Appliance Testimonial CHR
By Colleen Doherty, MD | Reviewed by Timothy Morris, DDS
Updated February 04, 2018
Do you suffer from a headache when you wake up in the morning? Do you also find yourself dozing off multiple times throughout the day? Does your partner report episodes of snoring at night? You may be suffering from a medical condition called Obstructive Sleep Apnea (OSA).
Let’s review the basics of what OSA is and the morning “sleep apnea headache” that may accompany it.
What Is Obstructive Sleep Apnea (OSA)?
OSA is a medical condition characterized by frequent nighttime awakenings due to abnormal breathing during sleep. People with OSA have episodes throughout the night where they either stop breathing or breathe shallowly, causing low oxygen levels.
As a result of this disorder, people with OSA often report excessive daytime sleepiness, thinking problems, and morning headaches. The diagnosis of OSA is made by a sleep specialist after a patient undergoes an overnight sleep study.
What Is a Sleep Apnea Headache?
According to the classification criteria of the third edition of the International Classification of Headache Disorder (ICHD-III), a sleep apnea headache is a recurrent morning headache in a person who has been diagnosed with sleep apnea. A headache has one or more of the following features:
- Occurs more than 15 times a month.
- Occurs on both sides of the head, has a pressing quality, and is not associated with nausea, photophobia, or sensitivity to sound.
- A headache resolves within 4 hours
Before making the diagnosis, your doctor will take a thorough history and perform a careful physical examination to make sure there is not another cause for your headaches, especially since multiple medical conditions can cause morning headaches)
The precise “why” behind a sleep apnea headache is not fully understood. It may be due to the actual sleep disturbance. Or, the headache could be triggered by the low oxygen and high carbon dioxide levels that occur during the repetitive episodes of apnea.
Treatment of a sleep apnea headache entails treating the primary disorder, OSA. Sleep apnea is usually treated with a variety of interventions including weight loss, oral appliances, continuous positive airway pressure (CPAP), upper airway surgery, and treatment of nasal allergies.
What This Means for You
If you think you suffer from a sleep apnea headache, please speak with your doctor. The good news is that there are effective therapies out there for your sleep apnea and your morning headaches. Also, with treatment, you will likely find that you feel better and improve other health parameters, besides just your headaches.
At the Florida Snoring and Sleep Apnea Center, Dr. Morris and his dedicated staff 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 every aspect of a patients daily living.
Cardiovascular health and sleep are integrally related. Cardiovascular disease is common in people who have sleep disorders, and visa versa. Conditions like hypertension, heart failure, atrial fibrillation, stroke, even diabetes can be related to sleep disorders.
There are multiple physiologic events taking place when a patient has obstructed breathing in their sleep. During the obstruction, which can happen many times an hour, a person’s oxygen level will decrease. This decrease can be low enough, and long enough, to harm the muscles of the heart. It can also lead to plaque buildup in the arteries – the start of the cascade of events leading to a stroke.
It has been shown time and time again that untreated sleep disorders increase the risk of cardiovascular disease. More recently it has been shown that treatment of sleep disorders can clearly reduce the risk from cardiovascular disease. In addition, sleep disorders can contribute to daytime sleepiness and the danger of falling asleep at the wheel.
The first step is to find out if there are signs and symptoms that lead us to suspect the presence of a sleep disorder. Our main concern is obstructive sleep apnea. There are other conditions such as loud snoring and upper airway resistance syndrome that can also disturb sleep and lead to cardiovascular consequences.
We begin by asking you to take and fill out the Sleep Assessment Survey linked below. Based on the results we can determine if you should be further screened with a home sleep study, literally done in the privacy of your own home. This will confirm the presence and the severity of a sleep disorder.
We appreciate you taking a few minutes to complete the attached survey, and thereby help us to potentially reduce your risk from cardiovascular disease.
Dr. Morris and Staff.
Sleep matters. At no time in medical history has this been clearer. During the critical formative years, making sure that children get the restful, quality sleep they need is vital.
For children, the symptoms of sleep-disordered breathing — including OSA (Obstructive Sleep Apnea) and snoring — have been shown to negatively impact behavior and the ability to pay attention. Much was learned about this in the Avon Longitudinal Study of Parents and Children that examined the impact of mouth breathing, apnea and snoring on behavior in a group of more than 11,000 subjects spanning from infancy to age 7. This study uncovered a litany of connections between sleep-disordered breathing and heightened risk of attention deficit hyperactivity disorder, tendencies toward aggression, anxiety disorders, and behavior problems. The authors found that sleep-disordered breathing symptoms occurring before age 5 were associated with a 40% greater chance of special education needs by age 8.
Because their brains are still developing, screening for sleep disorders is paramount for children, as any hindrance in adequate oxygenation, and therefore parasympathetic sleep, can have an immediate and lasting effect.
Physically, evidence of sleep-disordered breathing presents in myriad forms, such as a long and narrow face, habitual open-mouth posture or venous pooling (dark circles under the eyes). Behavioral symptoms might include chronic mouth breathing, hyperactivity, snoring or bedwetting.
The seven common signs of sleep-disordered breathing include:
- High/narrow palatal vault
- Mouth breathing
- Clenching and grinding or tooth wear
- Enlarged tonsils and adenoids
- Allergic rhinitis or prevalence of allergy symptom
- Tongue tie and/or lip tie
- Maxillary and mandibular deficiency
If a clinician detects any of these symptoms, the next step would be to get the parents/caregivers involved. Key questions might include:
- Does the child snore, or make any noise while sleeping?
- Does he or she stop breathing for short periods during sleep?
- How rested does the child seem upon waking?
- Has he or she experienced behavior issues at home or school?
Assessing a child’s sleep habits can also help oral health professionals in treatment planning and educational efforts. Toward this end, the parent/caregiver should be asked not just how long a child sleeps, but also how well the child sleeps. Many adults will report their children sleep the whole night, which is usually a sign of adequate sleep quantity, but if the child shows signs of sleep-disordered breathing, the adult should be suspicious of possible poor sleep quality. Asking the parent/caregiver to spend 20 minutes watching the child sleep may help answer the first two question. How the clinician proceeds will vary based on relationships with other qualified health professionals, which, as previously noted, could include referrals to a pediatrician, ENT specialist, sleep physician, orthodontist, pediatric dentist or oral myofunctional therapist experienced in treating malocclusion that might be comorbid with sleep-disordered breathing and airway restriction. Utilizing a team approach will help optimize treatment for each patient.
Hi. My name is Dr. Tim Morris and years ago I began my training in sleep medicine when it was realized that an oral appliance could be a successful treatment for many sleep breathing conditions from simple snoring to yes, even severe sleep apnea.
It was clear to us from the beginning, to best diagnose and treat patients, a model that was patient centered needed to be created.
This process had to be easy, quick and simple.
It was also clear this model had to not only include medical sleep specialists, but had to coordinate care between the professions so that the best interest of the patient could be addressed. And that is exactly what we have done.
Once our patients have been screened with a simple questionnaire, the first step is for them to see a Florida sleep certified physician. We have made this a simple process. Our patients schedule their visit with our hand picked top notch physicians who are not only well versed in the science – but committed to including the patient in all decision making where appropriate.
Your first visit is scheduled at either our Merritt Island or Hibiscus office where our physician will see you via telemedicine.
If a sleep test is indicated, rather than being sent to a sleep lab to spend the night, a validated sleep test will be provided for you, and this simple test can be quickly done in your own home! You will be given instructions about the test equipment at your interview visit, but there is also a 24 hour hot line you can call with questions.
The results of that test will then be reviewed with you at a follow up telemedicine visit. At that visit treatment alternatives will be presented, and your preferences will be considered strongly. It is at this point our extensive training in oral appliance therapy for snoring and sleep apnea will play a major role in your treatment. If this treatment is indicated and something you would prefer after being given all the information concerning this treatment and others, then plans can be made to start the treatment and the appliance can be constructed and delivered efficiently.
All your questions will be answered at this follow up visit including your insurance coverage for whatever treatment is recommended.
We will file insurance for you, including Medicare.
We have made it easy to be seen by a sleep physician, and have assured that the sleep physician you see is patient oriented and not biased towards any treatment. We have made sure that whatever treatment is recommended, whether it is CPAP, an oral appliance, or anything else, you have a well-trained person guiding you through this process, to help answer your questions and address your concerns.
And, should an oral appliance be indicated, we can assure you that our high level of training will lead to the highest likelihood of long-term compliance and the highest possible efficiency.
We have created a patient centered alternative that helps assure you are properly and easily diagnosed and that the treatment is tailored uniquely for you. We look forward to seeing you in the near future.