Obstructive sleep apnea (OSA)
What exactly is sleep apnea?
Sleep apnea is characterized by abnormal pauses in breathing, during the sleep, that usually last from 10 to 30 seconds. These pauses sometimes come back a hundred times in a night. At the end of each episode, the brain briefly awakes the person so that he / she starts breathing again, which involves a jerked sleep, and one of bad quality.
The most common category of sleep-disordered breathing is known as the obstructive sleep apnea (OSA). This is precisely this type of sleep apnea that specialized physiotherapy can treat now with temporomandibular and related regions (throat, neck and head) therapy. This form of apnea appears when the soft tissue at the back of the throat gets slack and blocks the air flow. That blocking may be caused by the slackening of the muscles of the throat or of the tongue, by a bad posture, a narrow airway, a nasal septum deviation, a large tongue, a dysfunction of diaphragmatic breathing or an excess of fatty tissues inside the throat.
The central sleep apnea is a rarer form of sleep apnea. It is characterized by the bad functioning of the part of the brain that regulates breathing, i.e., the cerebral trunk. In other circumstances, it appears in high altitude or can follow alcohol or other drugs abuse.
The syndrome of hypoventilation / hypoxia of the sleep is another rare form of disorder of breathing during the sleep. It can be described as an insufficient absorption of oxygen during the sleep. This syndrome generally appears in conjunction with a restrictive pulmonary disease, with an obstructive disease like the COPD (chronic obstructive pulmonary disease) or following a weakness of the respiratory muscles.
Let's treat now the obstructive sleep apnea (that we can treat in physiotherapy)
How does the obstructive sleep apnea affect your breathing?
The obstructive sleep apnea prevents you from breathing normally. If you suffer from obstructive sleep apnea, you probably repeat this cycle when you sleep:
First, you may be sleeping quietly and breathing normally, the air passing easily through your respiratory tracts and entering your lungs.
Then you start snoring extremely. It is a sign that your respiratory tracts are partially blocked. The air quantity that can get to your lungs is smaller and your oxygen rate decreases.
At the end, your respiratory tracts are completely closed. There is no more air reaching your lungs. Your brain gives you a signal to breathe normally, but you can't breathe because your respiratory tracts are closed. This situation is called an “apnea”. After a 10 to 30 seconds pause, or more, your brain notes that you did not breathe, then it awakes you rather brutally so that you can breathe. You take a long inspiration, then you start breathing again.
This cycle may go on all night. Most people suffering from sleep apnea have tens or hundreds of apneas in a night. With sleep apnea, you can't get the restorative sleep that you need to be healthy and to do your every day work.
Prevalence
The Wisconsin Sleep Cohort Study, a bench mark exploratory study based on a population, used polysomnography (an evaluation of the sleep quality and of the air flow from the nose to the mouth during the sleep) to evaluate an average age random sample of employees of the State. 4% of the men and 2% of the women showed moderate or severe signs of obstructive Sleep apnea. According to population studies, the respiratory disorders of the sleep are at least as prevalent in Canada as in other industrialized countries.
The obstructive Sleep apnea risk factors
- The top of the body obesity: it causes an accumulation of greases around the air tracts and around the surrounding soft tissues, like those of the rib cage.
- Hormonal factors and the menopause influence the top of the body obesity.
- Getting older (more than 40 years) can bring narrower and possibly more slackened higher air tracts.
- Individual variations of the size and of the position of the jaw, the tongue and the soft palate contribute to a reduction of the size of the higher air tracts.
- Being a smoker.
- A wide neck (more than 17 inches of circumference for the man; more than 16 for the woman).
- The family antecedents.
- Being a man.
- Having a retruded chin in retrognathia or class 2 (congenitally, following a bad posture due to muscular and vertebral compensations, following a cervical or jaw problem).
- For a child, the sleep apnea risk is higher if its adenoids and tonsils are big. The tonsils and the adenoids are tissues that are at the back of the throat.
Clinical demonstrations of the obstructive sleep apnea during the state of awakening.
- Somnolence during the day is caused by a disorganization of the sleep and by the disappearance of the phases of the deep sleep. It often appears after the meals or at the time of absence of stimulation (during a meeting, while driving a car, while reading, etc)
- A non restorative sleep.
- Accidents (domestic, professional, on the public highway).
- The depressive syndrome.
- Automatic behaviors.
- Disorders of the memory.
- Impotence, disorders of the libido.
- Behavioral problems: irritability and aggressiveness, depression, cognitive troubles, morning headaches.
Clinical demonstrations of the obstructive Sleep apnea during the sleep
- The often intense snorings, interrupted by apneas (silence) with an "explosive" recovery. But there are OSA without snorings (important respiratory failure, patients recovering from a surgery).
- The apneas (They are not always conscious, but are a source of constant concern for the spouse. They are responsible for sudden awakenings with a feeling of suffocation.).
- The body movements.
- The sudden awakenings.
- The nycturia (the fact of getting up too frequently at night to urinate by probable Atrial Natriuretic secretion caused by the apneas and the thoracic lowering.).
- The hypersalivation.
- Involuntary micturitions.
- Night sweats.
- Sleepwalking.
The results for health
- Sleep apnea, without intervention, tends to get worse with time.
- The chronic diseases (diabetes, arterial hypertension or cardiovascular diseases) We cannot be sure if those are the causes or the consequences of sleep apnea.
- There is a measurable mortality increase, primarily cardiovascular, for the patients suffering from sleep apnea.
- The hypoxia has long-term consequences, but diurnal somnolence has immediate consequences, in particular on the cognitive functions, mood and the behavior (irritability, aggressiveness, depression) and increases the risk of road accidents.
The diagnostic instrument: polysomnography
Your doctor or lung specialist can have you pass a polysomnography test in order to diagnose a possible sleep apnea. The polysomnography is a recording during one night sleep (or even during a nap), for tracking, and aiming at quantifying the respiratory events (apneas, hypopneas) and at correlating them with variables that are:
- the level of sleep and short awakenings
- the position of the subject
- the respiratory efforts
- the saturation in percutaneous oxymetry
- the heart rate
Main available treatments (other than physiotherapy)
- The therapy of spontaneous ventilation in positive conventional pressure at fixed voltage (C-PAP – CONTINUOUS POSITIVE AIRWAY PRESSURE) is the main treatment for the patients suffering from obstructive sleep apnea. The reference treatment is still ventilation in continuous positive pressure. It maintains the higher air tracts opened at all the stages of the respiratory cycle. The apparatus weighs from 1 to 2 Kg, its noise varies from 25 to 30 dB. The types of masks are highly variable, made out of silicone or gel with holding fixture (strap, harness, etc). Their efficiency depends on the compliance of the patient. Approximately 70 to 80% of people are able to use these apparatus for variable periods. The effective minimal duration is 5 hours per night.
- Oral devices, sometimes called dental devices, can prove to be an appropriate therapeutic choice among patients suffering from obstructive sleep apnea from weak to average and showing minor symptoms during the day. These devices aim at treating the apnea ahead by maintaining the air tracts opened by pushing forward the lower jaw and/or by preventing the tongue from folding back and from blocking the air tracts.
- We can also choose a corrective surgery of the higher air tracts for certain patients suffering form obstructive sleep apnea for whom the therapy of spontaneous ventilation in positive pressure or the oral dental devices were not a success.
- Means like the loss of weight, the stop of alcohol consumption or sedatives have an incomplete and transitory effectiveness. Weight reduction is effective as well in moderate apneas as in severe ones. The demonstration of the effectiveness of a slimming program however remains to be made in the long run.
Exclusion criteria for the treatment of the obstructive sleep apnea in temporomandibular physiotherapy:
- The central sleep apnea
- The hypoventilation / hypoxia syndrome of the sleep
- Extreme obesity
- A too important retrognathy (a mandible moved too far back: > 6 mm)
- Alcoholism and/or other drug abuse
- Cancer or other severe infectious diseases
- The presence of a Pacemaker
- The lack of motivation: this type of treatment absolutely implies a constancy in the execution of the exercises given to you by your physiotherapist in order to improve significantly your sleep apnea symptoms.
The temporomandibular and related regions (throat, neck and head) specialization can help you
If you want to adopt an approach that is new, natural, without any apparatus, any surgery, any risk and cheaper in your treatment, we offer you temporomandibular physiotherapy. Physiotherapy can now help you to greatly improve your symptoms due to the obstructive sleep apnea. The international studies support the fact that physiotherapy is a privileged instrument to treat the obstructive sleep apnea. Temporomandibular physiotherapy is a speciality of this profession. It consists in evaluating and treating the articulation of the jaw as well as the body zones that are connected to it, i.e. the muscles and articulations of the neck, the muscles of the throat and of the tongue. The posture of the head, of the neck and the active respiratory muscles also have a great importance. Thus, everything is evaluated, analyzed and corrected.
The obstructive Sleep apnea is caused by a blocking of the air tract by the soft tissues that are slackened at the back of the throat during the sleep. That blocking can be caused by the slackening of the muscles of the throat, a narrow air tract, a large tongue or an excess of fatty tissues inside the throat.
In physiotherapy, we can thus work on those components. On the basis of the fact that the muscles and other structures blocking the passage of the air are sagging, they thus should be invigorated by specific exercises and by a very targeted neuromuscular electric stimulation of the atrophied muscles. When the tongue, that is made up of 17 muscles, is blocking the air tracts, it must also be invigorated in order to remain well positioned during the sleep. Other muscles also compensated for an inadequate respiratory mechanics, they retracted, adopted a state of spasm and changed the global posture of the individual. They thus should be relaxed using manual physiotherapy techniques, with gloves, in an intra-oral way. i.e. we induce a very targeted muscular relaxation of the hypertonic muscles.
With those interventions, we thus facilitate the passage of the air through the higher air tracts during your sleep and thus improve your oxygenation. It is this oxygenation which enables you to have a restorative sleep, days with much less tiredness and somnolence. Also, you decrease your risk of chronic diseases (arterial hypertension, diabetes and hypercholesterolemia).
In a word, you greatly improve your life quality and you can go back to your occupations and leisure that are so dear to you. All that, without any oral apparatus, any ventilation apparatus (C-PAP), in a natural way, without any danger and at a quite cheaper cost. If you think you suffer from obstructive sleep apnea, if your doctor or lung specialist diagnosed the obstructive sleep apnea to you, do not hesitate to consult us. Try a unique approach in physiotherapy, an innovative approach that could change your life forever!