Sleep disordered breathing

Sleep is a major component of our health, allowing our body to repair itself, improving our physical performance, as well as reformatting the hard drive that is our brain.
Sleep disorders affect the ability to recover and can lead to serious health issues.

The origin of snoring & sleep apnoea

Sleep disordered breathing is extremely common:

  • 1 in 4 adults snore regularly.
  • 2 to 4 % of the adult population suffer from sleep apnoea (1).

Snoring is caused by the vibration of the soft tissues (uvula, soft palate), under the acceleration of the air passage. This acceleration occurs during a partial obstruction or following a complete obstruction of the upper airway. Minor snoring (ronchopathy), while not immediately dangerous, alters the quality of the tissues of the oropharynx, thus increasing the risk of reaching the much more dangerous stage of sleep apnoea.

Sleep apnoea means a total interruption of the respiratory flow for more than 10 seconds. We speak of hypopnoea when there is a reduction of more than 50% of the respiratory flow for 10 seconds.

Both disorders have the same origin: partial or complete obstruction of the upper airways, located in the pharynx.

Are you experiencing sleeping disorders?


Better understand sleep apnoea

The number of apneas and hypopneas, over the sleep time expressed in hours, gives the AHI index. If this index is higher than 10, we speak of Obstructive Sleep Apnea Syndrome (O.S.A.S.). Obstructive sleep apnoea is therefore a severe form of snoring which will have evolved, particularly with age or weight gain.

The mechanism of OSA is expressed as follows: during deep sleep, muscular relaxation occurs, particularly in the manducatory system, leading to pharyngeal collapse, which closes the patient's upper airways.

All too often, snoring problems are taken lightly when in fact they may conceal a sleep apnoea syndrome.

The incidence of Sleep Apnoea Syndrome (SAS) is estimated to be around 10% of the male population, with a lower prevalence in the female population. However, we also find the same percentage in women after the menopause.

What are the associated risks?

Sleep apnoea is recognised as a significant component of cardiovascular disease, stroke, and metabolic disorders, such as diabetes.

Scientists estimate that untreated apnoea patients are:

  • 2.8 times more likely to suffer fatal cardiovascular events.
  • 2.4 times more likely to have a stroke.
  • 2.9 times more likely to have high blood pressure.

A swiss study (2) has also shown that an untreated apnoea patient has a 15-fold increase in the risk of having a car accident.

Many apnoea patients are unaware of their condition and seek to treat the symptoms of their condition (fatigue, sleepiness, depression) rather than the cause: sleep apnoea. It is worth noting, for example, that if signs of depression, which is not depression, are treated with benzodiazepines, the severity of the sleep apnoea increases.

Symptoms to keep an eye on

Are you experiencing any of the following symptoms?

  • Constant snoring.
  • Feeling tired even after a full night's sleep.
  • Hyper-somnolence during the day.
  • Obesity and/or increased neck size.
  • Morning headaches.
  • The need to urinate two to three times a night.
  • Signs of depression or cognitive impairment.

To differentiate between sleep apnoea syndrome and simple ronchopathy, it is necessary to carry out an analysis, using a sleep recording, by a sleep specialist, also known as a somnologist.

It is possible to measure the presence of sleep apnoea in a sleep centre or thanks to simple and portable devices, and thus to quantify the severity of the pathology and the associated risks.

You are experiencing some of the mentioned symptoms?


Evaluate yourself

Epworths sleepiness scale (ESS).

Use the following scale to choose the most appropriate number for each situation:

  • 0 = would never doze
  • 1 = slight chance of dozing
  • 2 = moderate chance of dozing
  • 3 = high chance of dozing

If you score more than 9 points on this self-test, then contact us as soon as possible. A score of more than 12 is potentially a sign of pathological sleepiness.

SituationZero (0)Sligh (1)Moderate (2)High (3)
Sitting and reading        
Watching TV        
Sitting, inactive in a public place        
As a passenger in a car for an hour without a break        
Lying down to rest in the afternoon when circumstances permit        
Sitting and talking to someone        
Sitting quietly after a lunch without alcohol        
In a car, while stopped for a few minutes in the traffic        

Did you obtain a high score?


Treating sleep disordered breathing

Depending on the cause of snoring and the severity of the associated sleep syndrome, several types of treatment can be offered:

  • Continuous Positive Airway Pressure (CPAP).
  • Surgical treatment.
  • Mandibular Advancement Orthotic (MAO).
  • Mandibular Retention Optimisation Orthotic (MRO).

Today, for sleep apnea, the reference treatment is Continuous Positive Airway Pressure (CPAP).

Unfortunately, this treatment is difficult to bear for some patients. 30% of them stop wearing the mask during the night.

Just surf the Internet and you will see how many systems have been invented to treat snoring and sleep apnea. These range from inexpensive gadgets to self-made thermoformed trays.

One of the problems with self-medication is that it ignores the diagnosis of whether or not you have sleep apnoea, and you run the risk of making your symptoms worse or missing the root of the problem. It is therefore essential to consult a specialist.

Mandibular Advancement Orthotics (MAO) are simple systems that are relatively comfortable and very effective in most cases.

A Mandibular Advancement Orthotic is a medical device that keeps the lower jaw in an advanced position during sleep. This position frees up the airflow to the pharynx and reduces the obstruction phenomenon.

Numerous clinical studies have demonstrated the effectiveness of custom-made orthotics in the treatment of snoring and mild to moderate sleep apnoea syndromes (3). This effectiveness is reflected in:

  • Decrease in sleepiness.
  • Reduced fatigue on waking.
  • Better quality of sleep.

Effectiveness is immediate, from the first night's wear.

The medical consensus (4) also recognises mandibular advancement orthotics as a second-line treatment for severe apnoeic patients who cannot tolerate CPAP.

The ORM (Optimisation of Mandibular Retention) orthotic is a new generation solution. Made to measure, it uses flexible and comfortable materials, making it possible to offer patients an effective treatment with little constraint.

To be effective, mandibular advancement orthotics must respect precise rules, such as retention, to prevent the mandible from returning to a position allowing pharyngeal collapse. Only professionally made orthotics can fully comply with the criteria necessary for their proper functioning.

At the dental office, we will check whether all the requirements for wearing a mandibular advancement orthotic are met. We will also be able to select the best orthotic for your case, depending on your habits, such as bruxism, for example.

Extremely precise moulds are used to make this orthotics in specialised laboratories. The adjustments on the degree of advancement of the mandible will be made by the dental surgeon, a specialist in the field of sleep apnea treatment, in collaboration with the sleep specialist.

For patients suffering from apnoea, a second sleep analysis will be carried out while the orthotic is being worn at night, to assess the effectiveness of the treatment.

(1) Young, Peppard et coll. Epidemiology of Sleep Apnea - American Journal Of Respiratory and Critical Care 2002

(2) Horstman S et coll. Sleep. 2000 May 1 ; 23 (3): 383-9

(3) Cistulli et coll Sleep Medicine Review 2004 8,443-457

(4) Schmidt-Nowara et coll Sleep 1995 Jul ; 18 (6) : 501-10