Next time you have a group of people together, to a quick poll.  Ask “How many of you snore, or know some one who does?”

You will find that virtually everyone’s hand goes up.  That’s because sleep disordered breathing (SDB) affects 1 in 3 adults … which in turn means everyone either IS a snorer, or knows someone who is.

Of course, the problem is that snoring is the ‘thin end of the wedge’.  In many cases, the snoring is actually a symptom of a much more serious condition, such as obstructive sleep apnoea, where the patient actually stops breathing while they’re asleep.  This can happen 20 or 30 times per hour, and last for a minute or more each time.

No wonder the sufferer wakes feeling tired.  They didn’t really get 8 hours of uninterrupted sleep.  Instead, they were briefly and unconsciously woken ever few minutes to make sure they started breathing again.

That said, not all snorers are apnoea sufferers.  But it’s only a matter of degree. 

Think about it.  If you saw someone during they day who was breathing the way a snorer breathes while they’re snoring … you’d be concerned for them.  Snoring is a loud clear signal that a person’s airway is impaired or obstructed.

The problem is it’s such a common condition, people have come to think of it as ‘normal’.  It’s not uncommon for people to actually laugh when they hear a friend or family member starting to snore. 

But ‘common’ isn’t the same as ‘normal’.  A normal, healthy airway is unimpaired.  The person breathes without restriction throughout the night.  Their body does not fight to drag air into the lungs and keep the body oxygenated.

Lesson:  snoring is common but not normal.  If you see or hear someone labouring to breathe while they’re asleep, get them to seek treatment urgently.

The truth is, there’s absolutely NOTHING wrong with dental treatments for sleep disordered breathing conditions.  PROVIDED THAT the correct form of dental treatment or ‘oral appliance therapy’ is being used AND PROVIDED THAT the patient’s condition is one which has been professionally assessed as one which can be properly treated with OAT.

Professional assessment of a sleep disordered breathing condition involves an overnight diagnostic sleep study, or ‘polysomnogram’.  These studies record brain activity, heart activity, blood oxygen levels, breathing patterns, sleep posititions and much more, all while the patient is asleep.  The study is often performed overnight in a hospital-type environment, but leading edge technology means the study can now often be done in the comfort and privacy of the patients’s home.

In either case, the recordings will be reviewed by the a sleep scientist and specialist sleep physician to diagnose the exact nature of the condition and the appropriate form of treatment.

This is where the problem sometimes starts.  Unfortunately, some dental practices have recently begun promoting their ability to provide treatments for snoring and sleep apnoea.  They can IF they are working closely with a specialist sleep physician.  If they are simply treating patients ‘off the street’ without a preliminary polysomnogram, they are NOT delivering a proper standard of care.

If you are considering gettting treatment for your snoring or sleep apnoea, ask to be treated by a treatment provider who does not provide only one form of treatment.  For instance, most dentists provide only oral appliance therapy.  Most CPAP merchants provide only CPAP.  Most ENT surgeons provide only surgical options. 

You’ll get a better result by dealing with an organisation which is able to offer or arrange ALL of these forms of treatment.  That way you’ll know you really are getting the best form of treatment for your situation – rather than  just the treatment the business person wants to sell you.

On behalf of all the team at The Sleep Therapy Clinic, thank you to all of our past and existing patients who voted for us in the recent Business Achiever Awards.

It is a privilege and pleasure to report that The Sleep Therapy Clinic was chosen as winner of the ‘Professional Services’ category. 

Rest assured we’ll be working even harder in future to meet and exceed your expectations.  Thank you!

Which treatment is best?  CPAP (Constant Positive Airway Pressurisation) or OAT (Oral Appliance Therapy)? 

The answer, of course, is “That depends.” 

And it depends on a whole range of things.  According to the guidelines laid down by The Academy of Sleep Medicine, CPAP is the appropriate form of treatment for severe obstructive sleep apnoea.  OAT is proposed as the first line treatment for snoring and mild to moderate sleep apnoea.

But these guidelines are not absolutes.  For instance, some patients with only a mild condition (who would normally be prescribed OAT) might not have the necessary dental structures.  That is, they might not have the necessary number of strong teeth needed to support an oral appliance.  Or the structure, shape or condition of their oral cavity, teeth or gums might make OAT uncomfortable.  In these cases, the patient might get better results from CPAP.

On the other hand, a patient with a severe condition (who would normally be prescribed CPAP) might find they can’t tolerate some aspects of the treatment.  They might not be able to get a good fit, or good mask seal.  They might be claustrophobic and experience distress while wearing the mask.  They might be concerned about the impact it might have on their ability to start a new relationship.  Or they might simply have concerns about the logistical issues associated with CPAP (such as transporting the system and finding a power supply to run it).

In many cases these problems and issues can be worked around … but on other occasions, it might be that the patient would be better off using OAT.  Generally speaking, in severe cases of apnoea a patient will not get as good a result with OAT as they would get from CPAP – but it is obviously to have some treatment rather than none at all. 

For instance, we recently treated a patient who had an AHI of 80 (in other words, an average of 80 breathing stoppages per hour while asleep).  Anything higher than an AHI (Apnoea Hypopnoea Index)  score of 30 is considered ’severe’, so this patient was initially prescribed CPAP.  According to the downloaded data taken from the machine during regular review appointments, the CPAP was highly effective at treating the patient’s apnoea, reducing it to just 11 events per hour.   The problem was the patient could not wear the mask for more than an hour or so per night.  Despite repeated and prolonged efforts to resolve this, the patient ultimately refused to continue using CPAP and so OAT was arranged as an alternative.

A post treatment sleep study was done while the patient was wearing their appliance, and their AHI was measured at 22 events per hour.  This is clearly not as good a result as the CPAP achieved … but it is vastly better than the untreated condition, and importantly the patient was wearing their appliance all night. 

The ‘bottom line’ is that OAT and CPAP are both excellent treatments for snoring and sleep apnoea.  The choice of treatment will depend on a wide range of conditions, issues and factors — which is why it’s necessary to get advice and treatment from a treatment provider who specialises in the field, rather than attempting to do it as a sideline to a standard medical or dental practice. 

It also pays to deal with a treatment provider who can provide both forms of treatment, so you can be confident of getting the treatment which really is best for you – rather than the treatment the provider wants to ’sell’ you.

For more information on treatments for snoring and apnoea, call The Sleep Therapy Clinic on 07 3263 4655.

CPAP (Constant Positive Airway Pressurisation) is the ‘gold standard’ treatment for severe sleep disordered breathing conditions.   This is the form of treatment recommended by The Academy of Sleep Medicine and all leading sleep physicians when patients suffer from conditions such as severe obstructive sleep apnoea (OSA). 

CPAP works by pushing air into the patient’s airway.  This is achieved by a small and very quiet air pump, connected to a comfortable mask which the patient wears while asleep.   Contrary to common perception, the CPAP system does not ‘breathe’ for the patient.  Instead, the pressurised air simply acts as an ‘air splint’.  That is, the pressurised air is sufficient to gently ‘inflate’ the soft tissue of the upper airway, thus keeping the walls of the airway apart.  It’s a bit like blowing enough air into a long balloon to make the balloon stand erect.  While the walls are held apart, air can move in and out without obstruction.  Without the air pressure holding the walls apart, you can imagine how difficult it would be to inhale through the collapsed walls of the balloon.  This is effectively what happens with OSA.  The soft issue of the upper airway collapses onto itself, blocking the flow of air. 

CPAP resolves this problem by maintaining enough pressure in the upper airway to hold the soft tissues apart.  In general terms it is 100% effective … yet the treatment is NOT always successful. 

That’s because of the ‘compliance’ issue.  In other words, CPAP treatment will only work if the patient uses it, and some patients simply cannot or will not comply with or tolerate the treatment.  They find the mask too uncomfortable, or intrusive, or indiscreet, or claustrophobic … or something else.  For whatever reason, a significant proportion of patients do not continue with this highly effective form of treatment, and so do not experience and enjoy the profound benefits of successful treatment.

According to some studies, the ‘compliance rate’ is as low as 40% — which obviously means 6 out of every 10 patients are left untreated.  Worse still, many of these patients have invested in a CPAP machine, which then does nothing more than gather dust.

At The Sleep Therapy Clinic we’ve done a few things to resolve this problem.

First, we don’t simply ‘fill a prescription’.  In other words, unlike mere CPAP merchants, we don’t simply sell a CPAP machine and the relevant fittings to patients when they come in with their prescription from the sleep lab / sleep physician.

Instead, we walk and talk each patient through an extended period of trialling and adjusting to ensure the optimum choice of machine and accessories, and to ensure the patient is fully comfortable with the treatment.  As with most things, CPAP takes a little while to get used to.  (Even a new pillow or mattress feels uncomfortable and unnatural for the first little while.) 

But with one of our CPAP Therapists holding your hand through this early period and helping you choose the best type of mask, strapping, CPAP machine, humidification system, tubing, etc, etc, etc … it becomes much more likely (in fact almost certain) you’ll become fully familiar and comfortable with the treatment by the end of the trial period.

In fact, patients of The Sleep Therapy Clinic have a 91% compliance rate — which has been recognised as the best result in all of Queensland. 

The OTHER thing we do to ensure patients get effective treatment for their sleep disordered breathing … is offer a range of treatments.   Unlike other organisations which treat SDB as a ’sideline’ to a standard medical or dental practice, our clinic focuses exclusively on the treatment of these conditions.  That means we can offer alternatives (such as oral appliance therapy or even surgery) if CPAP is not successful or appropriate.  (Less severe sleep disordered breathing conditions such as snoring and mild to moderate sleep apnoea can often be successfully treated with these other forms of treatment.)

Our range of treatments also means you can be confident of getting the best treatment – because we don’t have a vested interest in promoting one form of treatment over the other.  Our objective is simply to achieve the best possible result for you, so we’ll use whichever form of treatment delivers that result.

If you’d like more information about how The Sleep Therapy Clinic can treat your snoring or sleep apnoea with CPAP, oral appliance therapy or surgical intervention, visit www.SleepTherapyClinic.com or call 07 3263 9455. 

(The Sleep Therapy Clinic is located in Aspley, on the North side of Brisbane in Queensland.  We also have a visiting schedule for various regional centres and plan to open more clinics in the near future.  Call for information about your area.)

One of the challenges associated with the treatment of sleep disordered breathing (SDB) conditions is the fact that the sufferer usually does not know they’re a sufferer.  And the main reason for that … is because they’re asleep while it’s happening!

Anybody in the vicinity of the snoring / apnoea sufferer will know only too well that the person is experiencing a seriously disturbed airflow … which is NEVER a good thing … but the sufferer themselves will be oblivious to the matter.

This is despite the fact that the sufferer is waking many dozens of times per night.  Polysomnograms (diagnostic sleep studies) show that people with severe cases may wake 30 or more times PER HOURthroughout the night!  No wonder their sleep is disturbed and they wake feeling tired.

Yet if you asked the sufferer, they wouldn’t even know they’d woken.  That’s because most or all of the awakenings are ‘micro arousals’.  These brief awakenings bring the sleeper to a level of consciousness just sufficient to get them breathing properly again — but this is not normally a level which the person becomes consciously aware of. 

So … people will wake feeling tired, but thinking “I’ve just had 8 hours sleep.”  The reality is often they had a hundred or more short naps.  You can imagine the impact that has on the quality of sleep, and the body’s ability to get into the deeper levels of sleep where the true restorative value is enjoyed.

As a general rule, if you’ve been getting enough sleep in comfortable conditions but you wake feeling tired, then you should get checked for an underlying sleep disorder.  Logically, when we wake is the time when we should feel most refreshed — so if you’re not feeling that way, get it checked.

For more information, call The Sleep Therapy Clinic and speak with one of the friendly clinical staff.  They’ll provide plenty of free advice and guidance … and if appropriate, they can help you arrange a full polysomnogram.  Medicare rebates apply for qualifying patients.

(The Sleep Therapy Clinic focuses exclusively on the treatment of snoring and sleep apnoea and other SDB conditions, primarily through CPAP and oral appliance therapy (OAT).   Our clinic, in Aspley on the Northside of Brisbane is unique in providing a full range of professional treatments for snoring and apnoea — so we don’t have a vested interest in promoting one form of treatment over another.  Instead, our objective is purely to provide the best form of treatment for each patient.  Call us on 07 3263 4655 or visit www.SleepTherapyClinic.com for more information.)

Snoring is common.  But it certainly isn’t normal, and it certainly isn’t good for you.  Think about it:  if you saw someone awake and breathing like a snorer does, you’d think they were in need of medical attention.  Yet when we see a person breathing like that while they’re asleep, we think it’s just an embarassing or irritating noise. 

Crazy.  Any rational consideration of the matter must conclude that sleep is the WORST time to be breathing like that.

The simple fact is that snoring is a LOUD SIGNAL that your airflow is obviously impaired.  The noise of snoring is CAUSED by the air being dragged into the body against impeding tissue.  That means your body must work harder to breathe and/or your body gets less airflow (i.e., oxygen) than it properly needs.

There is now no doubt that snoring is itself a serious ’sleep disordered breathing’ condition.  Thankfully it isn’t as nasty as sleep apnoea … but in most cases, a person who snores will soon enough become an apnoea sufferer.  Why wait until you’re ‘really sick’ before getting treatment?  It is always best to commence treatment as soon as possible — and thus minimise the impact of any condition, while reducing the likelihood of the condition worsening.

If you snore or know someone who does, seek treatment.  At the very least, arrange to have a polysomnogram (diagnostic sleep study) done to determine the true severity of the condition.  

Medicare and health insurance rebates cover many of the costs.

For more information, call The Sleep Therapy Clinic on 07 3263 4655 or visit www.SleepTherapyClinic.com

Research from the University of New South Wales has found that snoring associated with sleep apnoea may impair brain function more than previously thought.

The research shows sufferers of obstructive sleep apnoea experience similar changes in brain biochemistry as people who have had a severe stroke or who are dying.

The study by the Brain Sciences department of the university was published in the May edition of Journal of Cerebral Blood Flow and Metabolism.  “It used to be thought that apnoeic snoring had absolutely no acute effects on brain function but this is plainly not true,” said lead author of the study, New South Global Professor Caroline Rae.

Professor Rae and collaborators from Sydney University’s Woolcock Institute used magnetic resonance spectroscopy to study the brains of 13 men with severe, untreated, obstructive sleep apnoea. They found that even a moderate degree of oxygen desaturation during the patients’ sleep had significant effects on the brain’s bioenergetic status.

“The findings show that lack of oxygen while asleep may be far more detrimental than when awake, possibly because the normal compensatory mechanisms don’t work as well when you are asleep,” Professor Rae, who is based at the Prince of Wales Medical Research Institute, said.

“A lack of oxygen in the brain during even small time increments of obstructive sleep apnoea caused levels of the high-energy currency adenosine triphosphates (ATP) to fall and levels of inorganic phosphate to rise, without the usual changes in phosphocreatine or brain pH – the mechanisms that normally would protect the brain against oxygene depletion,” Professor Rae explained.

“This is happening in someone with sleep apnoea acutely and continually when they are asleep. It’s a completely different biochemical mechanism from anything we’ve seen before and is similar to what you see in somebody who has had a very severe stroke or is dying.”

The findings suggested societal perceptions of snoring needed to change, Professor Rae said.

“People look at people snoring and think it’s funny. That has to stop.”   Professor Rae said it was still unclear why the body responded to oxygen depletion in this way. It could be a form of ischemic preconditioning at work, much like in heart attack sufferers whose initial attack makes them more protected from subsequent attacks.

“The brain could be basically resetting its bioenergetics to make itself more resistant to lack of oxygen,” Professor Rae said. “It may be a compensatory mechanism to keep you alive, we just don’t know, but even if it is it’s not likely to be doing you much good.”

Sleep apnoea affects as many as one in four middle-aged men, with around three percent going on to experience a severe form of the condition characterised by extended pauses in breathing, repetitive asphyxia and sleep fragmentation.  Children with enlarged tonsils and adenoids are also affected, raising concerns of long-term cognitive damage.

Our Director of Clinical Services, Dr Kelly Waters, recently joined Brisbane’s leading radio commentator, Greg Carey, in the studio at Radio 4BC.  This is the second time Dr Waters has been interviewed by Greg and further ‘appearances’ are planned. 

In a wide ranging interview, Greg and Dr Waters covered the prevalence and seriousness of snoring and apnoea, as well as the treatments available.  Callers were able to have their questions answered ‘live’ by Dr Waters.

You can hear the interview by clicking on the links on our website homepage:  www.SleepTherapyClinic.com

Patients often notice that they’ve begun to snore, or their condition has worsened, since they gained weight. 

This is not surprising.  In many cases, especially as we get older, some of the increased weight will be in the throat / neck region.  Suddenly we find we have a double chin and jowls, and need a larger collar size!

Though less apparent, the same thing is happening INSIDE the throat and neck.  Fat deposits increase the bulk of the tongue, soft palate, uvula and the soft tissue of the pharyngeal wall.  As a result, the airway becomes crowded and the airflow is impaired. 

Unfortunately, the problem doesn’t stop there.  There is very good scientific research which shows a ‘two way’ relationship between weight gain and snoring or apnoea.  

Specifically, when a person suffers from snoring, apnoea or any other form of  sleep disordered breathing condition, the impaired airflow often leads to a retarded metabolism.  As a result, the sufferer finds it easier to gain weight and harder to lose or keep it off.

This is the top of a slippery slope.  Whether caused by weight gain or not, the sleep disordered breathing condition retards the metabolism, which leads to weight gain, which exacerbates the snoring or apnoea, which retards the metabolism further, which leads to further weight gain … and so forth. 

The link between the conditions is so strong, we regularly get referrals from dieticians and nutritionists who tell their patients they can’t help them lose weight until they first get their sleep and metabolism under control.

For this reason, snoring and sleep apnoea will almost always worsen over time — so early diagnosis and treatment is the best solution.   The good news is that treatment of your snoring or sleep apnoea will often automatically result in improved metabolism and energy levels, and consequently reduced weight.  So not only are you a better bed partner, you’re a better looking bed partner too! 

Call and speak with one of the clinic staff if you’d like more information.