Studies have shown that approximately 40% of the population of the industrialised countries snore and that this increases to 60% in men above the age of 60.
Most of the noises produced by snoring are generated by vibration of areas of the soft tissues. During sleep, there is a natural relaxation of the muscle tone in the neck and throat and the normal firmness of the tissues decreases, resulting in the formation of bottlenecks or even complete obstruction of the airways, especially when the patient lies on their back.
Due to this narrowing of the throat space, the required volume of air must be respired at a higher speed to deliver the same quantity of air. This results in stimulation and vibration of soft tissues such as the soft palate generating the snoring noise.
It has been found that snoring can also be caused by external factors such as alcohol or sedatives. A reduction or elimination of any of these may in mild cases be sufficient to remedy the condition.
Obstructive sleep apnoea
Defined as a respiratory arrest (of more than 10 seconds).
Hypopnea is a decrease in the blood oxygen concentration in blood resulting from a reduction in the respiratory volume during sleep.
At a certain level of severity, this is serious condition that may cause not only sleepiness during the day but also serious secondary effects. The severity of the disease is assessed using the apnoea/hypopnea index, which is calculated by dividing the number of apnoea (longer than 10 seconds) and hypopnea episodes by the number of hours sleep. An index of up to 5 is considered normal, indices of 6-20 or 20-40 are indicative of moderate and sever sleep apnoea, respectively. The index can be determined only in a sleep laboratory.
Referral to a sleep laboratory is urgently indicated, if apnoea is suspected.
Methods of Treatment
- ORAL DEVICES
These devices are worn at night and usually operate by displacing the lower jaw forward in a forward direction in order to achieve the opening of the throat section of the airways. Acceptance rates can be as low as 2% but as long as the patient tolerates their use, these devices can be expected to be quite successful in curing the social problem that apnoea poses as well as obstructive sleep apnoea of up to moderate severity. The main reason for patient rejection of these appliances is because of their bulk.
- BREATHING MASK
The breathing mask is used for positive air pressure respiration, keeping the airways open. The masks are effective even in severe apnoea cases and are considered the method of choice in these cases. However, the breathing mask must be set up and adjusted in the sleep laboratory. It is a vital piece of equipment although at times may prove inconvenient.
Usually surgery is used to remove respiration-impairing structures, such as enlarged tonsils, adenoids etc. Widely differing success rates of surgery in treating snoring have been reported (20-40%). Success in terms of the cure of apnoea is unsatisfactory.
The success of the treatment is largely dependent on the patient’s acceptance of the appliance. Obviously, the depth of sleep and comfort of the patient will increase with the reduction in bulk of the appliance.
All these benefits are advantages of the Silensor.
It makes use of the fact that the throat space is enlarged when the lower jaw is displaced in an anterior direction.
This appliance consists of two separate thin mouthguards which fit over the upper and lower tooth arches. The mouthguards are connected by two lateral rotating connectors which gently pull the lower jaw forward. Any further opening of the mouth increases the forward displacement of the lower jaw. Despite wearing this appliance, movement of the lower jaw is possible.
Because the Silensor is of minimum bulk it is comfortable and an effective anti-snoring aid.
The effectiveness of the Silensor Appliance
This appliance has proven highly successful even when breathing through the nose is difficult or blocked, since in almost all cases the noise involved in snoring is caused by constriction of the airways. Similarly, when breathing through the nose is difficult or impossible, e.g. by polyps, use of this appliance is in no way precluded.
The Silensor cannot be used in the edentulous mouth. Where removable partial dentures are worn and are firmly retained within the mouth the Silensor can be used.
In cases of suspected sleep apnoea we would refer the patient back to their GP for referral to a sleep disorder clinic.