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Snoring and sleep apnea - Snoring and sleep apnea

Snoring happens when the upper airway partially obstructs, and turbulent vibration of the upper airway flow occurs. Generally speaking when people get older it is often accompanied by partial loss of muscular and neurological of muscle tone of the upper airway. Snoring, when becoming severe (=loud) enough can have serious effects on general health conditions and can easily evolve into sleep apnea. Sleep apnea is a condition recognised by loud snoring and stoppage of breathing while the person is sleeping. Signs of obstructive sleep apnea (OSA) are often a combination of what follows.
Facial Sculpture Clinic - Dr Joël Defrancq - Jaw surgery and implant reconstructive surgery During sleep 

  • Loud snoring
  • Night-time sweating
  • Headaches

During the day

  • Tiredness during the daytime.
  • Dozing while driving.
  • Lack of concentration, constant tiredness.
  • Dropping of to sleep in seconds during the day.
  • Headaches.
Overweight is frequently involved, often a double chin with an obtuse jaw-neckline (what means continuous extra weight when you are laying down) is present and most often a receding lower jaw is present. High blood pressure becomes part of it. Finally and seriously the person is more prone to heart attack and strokes. 

OSA (Obstructive Sleep Apnea) is simply life threatening and serious enough to pay deserved attention to it. The following description is not to scare you, but written down a bit seriously… in your own interest. Realise always their is a cure (CPAP to start with, or Surgery).
The consequences of mechanical obstruction of the upper airway
A person falls asleep and the (tongue-airway) muscles get gradually in relaxation. The tongue feels deep in the throat and simply obstructs mechanically the airway. Breathing at that moment is impossible. In other words the patient is trying to breath, but fails because the airway is blocked. No breathing takes 15-20-30 seconds but can climb up to 120 seconds (two minutes).

This means the level of oxygen drops fast in the blood and body. The sleeper finally gets alarmed by his central nervous system. He weakens up partially, most often to a less deep sleep level. The breathing retakes for a while and the circle restarts. This partial but repetitive wakening-up events during the sleep prevents the sleeper from obtaining quality sleep. The sleeper has no time to reach the essential deep (REM) sleep cycle, since he wakens-up (partially) all the time, 50 times, 100 times, 250 times…Tiredness is what follows during the day.
But this is only part of the story
A normal living being has a normal blood saturation of 99-100%. It would be difficult, and without training impossible, if one could drop this number to 95% by breath-holding to the voluntary limit. 90% of oxygen saturation is worry some. Levels in the 80-85 % are quoted dangerous by the anaesthesiologist during a general anaesthesia. Realise now that for those sleepers it is not uncommon to display levels in the 40-70%!

So the rest of the story, next to the mentioned tiredness, is an accelerated rate of vascular diseases. It is that serious: in a given year a sleep apnea-person is roughly 5 x more likely to suffer a stroke or heart attack than a non-apnea-person. Mortality rates are roughly times 9 for a patient with serious apnea person versus non-apnea.

Again, this is not mentioned to scare you, but to let you realise: this is serious, since moreover you are empowered to solve this serious problem.
Postoperative instructions & frequently asked questions
How do I know I have sleep apnea?

It is likely you will start your investigation in a sleep lab unit. There they monitor and observe scientifically your sleep, the deepness and flow of your sleep, as well as your blood oxygen saturation and blood pressure.
Facial Sculpture Clinic - Dr Joël Defrancq - Jaw surgery and implant reconstructive surgery What is a CPAP?

It is often your start to treatment! CPAP means Continuous Positive Airway Pressure. The CPAP machine applies a constant low positive air pressure to the upper airway in an attempt to keep it open. It is a plastic mask, worn over the nose and mouth, and strapped onto the head at bedtime and worn during sleep. It is connected to a machine with an air hose. The CPAP pushes the airway open, allowing normal inhalation and exhalation. Up till now the CPAP Mask is considered the gold standard of conservative treatment The device is effective in 85% of cases, and asks from the patient discipline, some nightly adjustments, noises and further physical and psychological acceptances. Despite it’s effectiveness in most patients, research indicates that there is only 46% compliance after the first 3 months of treatment. 37% of those still using the CPAP soon abandon it completely. (Journal of Respiratory Therapy). It gives you moreover the time to relax, to stick on the CPAP, what is fine if it does not consume your quality of live, and slowly consider all your further surgical options and addresses.
Facial Sculpture Clinic - Dr Joël Defrancq - Jaw surgery and implant reconstructive surgery Are there other non surgical solutions?

Apart from the CPAP device, there are a number of dental devices, which all have in common the fact that they position the lower jaw forward. This positions the tongue forward and often helps to prevent snoring and, possibly, OSA. Evaluation and re-evaluation over time are certainly advisable with those devices. They hardly ever work 100% properly. The likelihood is, however, that you will seek further final advice and solutions at the end.
Are there other surgical treatments?

In the past ENT surgeons performed uvuloplasties in the back of the mouth. The aim was to shorten the soft (tissue) structures there. Those surgeries are painful and do not cure the OSA as they should. Furthermore, nothing happens to the tonus of the fine muscles in the area.
The surgical treatment
Is there a long lasting cure? Yes, there is. The cure is surgical and no less than 100%! Moreover, the surgery is most often aesthetically enhancing but at least acceptable. The reward of the surgery is simply a healthier and longer life. The only surgery known today that is documented to cure the OSA (short of a tracheostomy) is orthognathic surgery. As the muscles of the tongue base and throat attach themselves to the inner surface of the mandible, this surgery creates the necessary patent airway. The lower jaw needs to be advanced by at least 8 to 10mm. Since the lower jaw advancement has an effect on the bite, most often it is necessary to move the upper jaw forward as well to preserve the initial bite. The operation is known as MMA meaning Maxillo Mandibular Advancement. It permanently enlarges the airways by advancing and slightly rotating the upper and lower jaw as a unit and this in a anti-clockwise fashion. This way the upper jaw is relatively less advanced then the lower jaw, and that is often aesthetically positive. As a result, the tongue muscles are stretched forward and the upper airway opens. The procedure (MMA) is key to the definitive solution of this serious life threatening disorder. 

The bimaxillary osteotomy (MMA) is the cornerstone of orthognathic surgery, and as such Dr Defrancq is well placed to perform such surgery If you have a heavy fatty neck, this means extra weight at the back when you sleep. In this case a liposuction can be of great help. Furthermore, a weight loss is recommended in the case of obvious overweight, ideally before the surgery even.