Do you wake up tired, can't start the day without coffee, are you unable to stay awake after eating, do you find it hard to get through the day?

If you identify with these situations, you may even have thought that they are natural, but they may reveal a very common respiratory disorder with serious health repercussions, called Sleep Apnoea-Hypopnoea Syndrome (SAHS).

What is sleep apnoea?

Apneas are pauses in breathingThese pauses, lasting between 10 and 30 seconds, are repeated throughout the night. These pauses are due to a blockage in the airway, which may be partial, and will manifest as snoring, or a complete blockage, so that the patient stops breathing.

The drowsiness is the most immediate consequence of sleep disordered breathing.

Sleep disordered breathing includes very frequentcurrently affect up to 24% of females and 50% of males according to a recent study (Hypno Laus Study, Switzerland, 2015), although it varies greatly depending on age. The severity of the case will be assessed according to the number of apnoeas occurring during each hour of sleep, ranging from less than five per hour to more than 30.

Symptoms of Sleep Apnoea

In addition to the above, the most frequent symptoms are:

Consequences of Sleep Apnoea

The consequences The health risks are wide-ranging and result from a lack of oxygen in different parts of the body. They include depression, heart attacks, diabetes, Alzheimer's, hypertension, osteoporosis, accidents at home and at work, and cancer.

Treatment of Sleep Apnoea

But it's not all bad news. solutions to improve the quality of your sleep, and require the collaboration of several specialists, including pulmonologists, otolaryngologists, neurophysiologists and dentists. Although in some cases the solution is surgical, many other cases can be treated with certain devices at night.

Moreover, in all cases, a great improvement is experienced by changing some habits, such as lose weight, exercise, reduce the consumption of sedatives, avoid alcohol at dinner and give up smoking.. A correct sleeping posture has also been shown to be effective in improving airflow during sleep, with a foetal position being preferable to a face-up position.

The Mandibular Advancement Device is ideal for mild to moderate cases and snorers.

The non-surgical treatment is performed by means of two devices, which are worn to sleep, and improve the quality of breathing and, therefore, of sleep:

• CPAPconsists of a mask, which is placed on the nose, connected to a machine that pumps air. It seems to be the most effective optionIt reduces obstructive episodes and cardiovascular, neurological and metabolic complications. It is especially indicated in severe apnoea, although it has the disadvantage that some patients do not tolerate it well.

• DAMThe AASM is an intraoral device, performed by a dentist, that advances the jaw position, clearing the airway, thereby increasing airflow. It is recommended by the American Association of Sleep Medicine (AASM) as a first choice for snorers, Mild and moderate SAHS or for those who cannot tolerate CPAP or surgery.

I'm sure you're thinking that the DAM is a very uncomfortable piece of junk, it is not that uncomfortable. There are different types, but we always choose those that allow the jaw and tongue to move, as it is more comfortable for the patient. It is performed in biocompatible and hypoallergenic materialsand it is tough on the outside, but soft and pleasant on the inside.

After all this information you probably still have some questions, I will try to answer some of them:

• Should I wear CPAP or DAM every night?
• Yes, every night without using it is a relapse of SAHS, depriving the body of oxygen and increasing the extent of the sequelae.

• How many years does a DAM last?
• They are made of quality materials, which in some cases can last a lifetime, although they require occasional maintenance to renew the materials.

• Can I wear DAM if I am a bruxer?
• To some extent yes, but in severe cases of bruxism it is preferable to avoid it.

If you still have any questions, you can ask them below in the comments section.

Bibliography

Heinzer R, Vat S, Marques-Vidal P, Marti-Soler H, Andries D, Tobback N, Mooser V, Preisig M, Malhotra A, Waeber G, Vollenweider P, Tafti M, Haba-Rubio J. Prevalence of sleep-disordered breathing in the general population: the HypnoLaus study. Lancet Respir Med. 2015 Apr;3(4):310-8.

García Selva M, Marco Pitarch R, Fons Font A. Mandibular Advancement Devices as a Treatment for Roncopathy and Obstructive Sleep Apnoea-Hypopnoea Syndrome. Dossier SEPES 2015; 132-141.

Martí Almor J, Félez Flor M, Balcells E, Cladellas M, Broquetas J, Bruguera J. Prevalence of obstructive sleep apnea syndrome in patients with sick sinus syndrome. Rev Esp Cardiol. 2006 Jan;59(1):28-32

Ferguson KA, Cartwright R, Rogers R, Schmidt-Nowara W. Oral applian- ces for snoring and obstructive sleep apnea: a review. Sleep 2006; 29 (2): 244-62.
Hoffstein V. Review of oral appliances for treatment of sleep-disorde-red breathing. Sleep Breath 2007; 11: 1-22.

Lee CH, Mo JH, Choi IJ, Lee HJ, Seo BS, Kim DY, Yun PY, Yoon IY, Lee HW, Kim JW. The mandibular advancement device and patient selec- tion in the treatment of obstructive sleep apnea. Arch Otolaryngol Head Neck Surg. 2009; 135 (5): 439-444.

Dr. Diego Saura Miñano, endodontist at Vélez&Lozano