"Laugh and the world laughs with you, snore and you sleep alone."
-- Anthony Burgess, British composer and novelist
"Sleep apnea is a common disorder in which you have one or more pauses in breathing or shallow breaths while you sleep," according to the National Heart, Lung and Blood Institute of the National Institutes of Health.
If you've been around someone snoring ... whether they're snoring the siding off the side of the house or if it's a gentle purr ... snoring can be a sign of obstructive sleep apnea which can lead to serious side effects.
"Breathing pauses can last from a few seconds to minutes. They may occur 30 times or more an hour. Typically, normal breathing then starts again, sometimes with a loud snort or choking sound," according to the NIH.
A doctor who is a sleep specialist must determine if you have obstructive sleep apnea or another type of sleep disorder. Diagnosis involves a sleep study where data is gathered and used to determine the severity of the symptoms. It also helps in determining a recommended therapy.
At Eisenhower Army Medical Center, Dr. Barbara Joslow and her team perform on average four sleep studies per night and about 28 per week.
"The goal," Joslow said, "is for the patient to have fewer than five [interrupted-sleep] events per hour with treatment. Mild sleep apnea is five to 15 events per hour."
Left untreated, sleep apnea can lead to:
• Increased risk of high blood pressure, heart attack, stroke, obesity and diabetes
• Increased risk of, or worsening, heart failure
• Arrhythmias, or irregular heartbeats, more likely
• Increased chance of having work-related or driving accidents
Sleep apnea usually is a chronic condition and mild cases may be treated with lifestyle changes such as losing weight, avoiding alcohol and sleeping pills, changing sleeping positions, stopping smoking and not sleeping on your back.
Probably the most familiar treatment is a Continuous Positive Airway Pressure machine, also called a CPAP.
With a CPAP, a mask is worn over the nose while you sleep. The machine delivers a continuous flow of air through the hose.
'My philosophy," Joslow said, "is to use anything that works to control events that the patient will use."
Some people object to the CPAP's noise, mask or becoming entangled in the hose.
"The CPAP is not the only way to go," she said. "Oral appliances are an alternative."
Once a physician determines a dental appliance is the treatment of choice, a prescription is written and, at EAMC, the DENTAC near the hospital will custom-craft appliances to the prescription specifications.
"This is a custom fit for each Soldier," said Col. Daniel Dunham, a board-certified prosthodontist and deputy commander of the U.S. Army Dental Laboratory at Fort Gordon.
The process begins with making a mold or impression of the patient's upper and lower teeth.
"The appliance is similar to a mouth guard," Dunham said. "The upper and lower pieces are hinged together at the front of the mouth and are designed to pull the lower jaw forward" which helps eliminate the obstruction of the airway by the tongue.
"The cost to the Army for an ADL-fabricated oral device is about a quarter of what the Army pays for a CPAP," he said.
The ADL serves active duty service members and is doing a booming business in oral appliances for the treatment of sleep apnea.
"Since February, we have made around 400 appliances," Dunham said.
There are at least a dozen "boil and bite" appliances available over the counter, Dunham said, but they claim to treat snoring, not obstructive sleep apnea.
Appliances that treat apnea must be approved for that use by the Food and Drug Administration.
"Not all snorers have sleep apnea," said Dunham, but almost all people with sleep apnea snore.