What does it take to keep people happy? Being married and having enough sleep.

The answers topped the poll in a new British survey form the Whitehall Wellbeing Group. That’s just dandy, but for many older women sharing a marital bed rules out any possibility of that good night’s sleep. Sharing a bed with a middle aged man, particularly if he is overweight and partial to regular alcoholic nightcaps, is sometimes little different from sleeping next to a freight train.

Snoring! We often treat it as a joke, but for the long-suffering partners of snorers it’s no joking matter. While people of all ages might snore, older men carrying extra kilos are most likely to produce the thunderous sounds that can inspire murderous rage in even the most saintly partner. About 40% of adult men snore, compared with 20 to 30 percent of women. Alcohol, smoking, obesity and ageing all increase the odds of becoming a noisy sleeper. We’re talking about a mighty big noise. Some snorers clock in at 92 decibels, which is a noise similar to low-flying jet aircraft.

Partners can even sustain hearing damage from the really big boomers. Snoring is the major reason many older women sleep badly, according to Jenny Hislop, an Australian sociologist working at Keele University in the UK. Dr Hislop has been studying the sleep patterns of older women. British research shows that 63% of women cite snoring as the prime culprit in depriving them of sleep. Dr Hislop’s own research shows almost a third of women in their 50s report snoring related sleep disruption three or more nights a week. Women in their 40s and 50s average 61/2 hours of sleep for every eight hours in bed, according to this research.

All those disturbed nights mean mid-life marriages are producing some very grumpy, sleep –deprived women.

What makes things worse is when snorers deny they are making suck a racket. A YOUNG woman wrote into a snoring support group from by the Centre for Snoring and Sleep Disorders in Sydney asking for help with her boyfriend. He refused to believe he was snoring. It prompted a flood of sympathetic responses. Women described how snoring could destroy relationships and forced their evacuation to spare bedrooms or the couch.

Bedtime can become a nightly ordeal, which can only be faced with an arsenal of earplugs and sleeping pills.  The prospect of sharing a bed on your holidays means anything but peace and relaxation. Yes, women snore and Jenny Hislop’s research shows they are often embarrassed that they do. Their partners are likely to be less tolerant than they would be and female snorers are more likely to end up divorced.

Obviously snoring won’t be the only reason for marriage break-down, but when couples are sleep-deprived because of snoring, other problems ten to be magnified. There are successful ways of treating snoring, including the use of airway pressure machines, as well as a wide range or oral devices and surgery.

Snoring is linked to hypertension, stroke and heart problems as well as the rises of apnoea and dangerous overtiredness, all very good reasons for snorers to seek help. But ending the misery of the grumpy, sleep-deprived spouse is the best on of all.

Dental Sleep Appliances are now regarded as front line therapy for Snoring and Sleep Apnea

Oral appliances should be considered for patients with mild-to-moderate obstructive sleep apnea who prefer oral appliances to continuous positive airway pressure (CPAP) systems, who do not respond to CPAP, or who are not appropriate candidates for CPAP.

Review

WESTCHESTER, Ill., Feb. 1 – Oral appliances can be used as a first-line therapy in patients for treating mild-to-moderate obstructive sleep apnea, according to updated guidelines from the American Academy of Sleep Medicine. The updated guidelines, based on studies published since the original 1995 guidelines, appeared in the February 2006 issue of Sleep.

The previous guidelines recommended continuous positive airway pressure (CPAP) systems as first-line treatment for obstructive sleep apnea. But research suggests that in mild or moderate cases, usually defined as an apnea-hypopnea index from 10-30, oral appliances improve subjective and objective measures of sleepiness about as well, according to Clete A. Kushida, M.D., Ph.D., of Stanford, and colleagues.

CPAP systems are still superior in reducing measures of respiratory disturbances, and for this reason they should remain first-line therapy for patients with severe sleep apnea, the guidelines said. “Although not as efficacious as CPAP, oral appliances are indicated for use in patients with mild-to-moderate obstructive sleep apnea who prefer oral appliances to CPAP, or who do not respond to CPAP, are not appropriate candidates for CPAP, or who fail treatment attempts with CPAP or treatment with behavioral measures such as weight loss or sleep-position change,” according to the guidelines.

In various studies, the success rate of oral appliances hovered just above 50%, but in one study it reached as high as 81% for patients with mild obstructive sleep apnea, the guideline authors noted. Oral appliances, which resemble athletic mouth guards, may be associated with better compliance than CPAP systems, which many patients find uncomfortable because they require a mask delivering positive pressure to be worn while sleeping, the authors said. Oral appliances can also be used as a first-line treatment for primary snoring without features of obstructive sleep apnea, the guidelines noted.

Oral appliances should be fitted by a qualified dentist who has experience with the temporomandibular joint, dental occlusion, and associated oral structures, the guidelines said. To verify the efficacy of the device, patients should be followed with polysomnography or an attended cardiorespiratory sleep study. Patients should have regular follow-up office visits with their dentist to monitor adherence and make sure the device is functioning correctly. Patients should also have regular follow-up with a primary physician or sleep specialist to make sure that symptoms are not worsening, the guidelines said.

The guidelines were issued in conjunction with the Academy of Dental Sleep Medicine.

Primary source: Sleep Journal
Source reference: Kushida CA et al. Practice parameters for the treatment of snoring and obstructive sleep apnea with oral appliances: an update for 2005. Sleep. 2006; 29(2).

Oral appliance therapy

Oral dental appliances have helped many people who snore or suffer from obstructive sleep apnoea. The types of appliances are numerous. They are worn during sleep and help to keep the airway open by:

• Bringing the jaw forward, or
• Lifting up the soft palate, or
• Holding the tongue forward.

In every 100 snorers, about 95 will have a decrease in the noise levels they make during sleep. Of every 100 people with mild to moderate obstructive sleep apnoea, about 80 will have either good or excellent results while using these appliances.

Advantages of oral appliance therapy

The treatment of snoring or obstructive sleep apnea with oral appliance therapy is safe, painless and effective. Treatment is usually reversible and does not involve surgery. The appliances are relatively inexpensive and easy to wear. It is often possible to speak, yawn or even drink while wearing an oral appliance. As the appliances are small and light, they are easy to carry during travel. If an oral appliance is cleaned and stored correctly, it should last for years.

Side effects of oral appliance therapy

Side effects of oral appliance therapy may include:

• Temporary discomfort around the teeth or jaw joint
• Dry mouth
• Excessive salivation
• Irritation to the soft tissues of the mouth
• Minor irregularities to the bite (this is usually temporary)

More severe side effects are rare. These may include significant discomfort to the jaw joint or permanent changes to the bite.

The symptoms and signs of obstructive sleep apnea

People who have obstructive sleep apnea almost always snore loudly and usually have a number of other symptoms, including:

• Choking or gasping during sleep
• Tiredness on waking
• Sore, dry throat on waking
• Morning headache
• Excessive daytime sleepiness
• Poor concentration
• Memory deterioration
• Decreased sex drive or impotence
• Personality changes that may include irritability
• Decrease in job performance
• Anxiety or depression

Please note: Abridged version.
Full version available from Mi-tec Medical Publishing 03 98901766

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