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Sleep Medicine

Dr Elaine Ng offers comprehensive sleep screening which includes

a home sleep apnoea test, chairside diagnostics and clinical assessment. 

IF YOU HAVE ALREADY BEEN DIAGNOSED WITH OBSTRUCTIVE SLEEP APNOEA PLEASE CLICK HERE

STEP 1 : Do you suspect you may have an issue with your breathing during sleep?

If you have experienced choking, coughing gasping in the night or have been observed snoring or even completely stopped breathing, you have taken a step in the right direction by just reading this.

 

  1. Most of us know of a friend or family member who snores, and for years people falsely believed it is harmless.  

  2. Snoring itself is the sound of airflow limitation, and may be the only sign indicating a serious underlying condition called obstructive sleep apnoea (OSA).  

  3. OSA causes an individual to take very shallow breaths, or often stop breathing completely during the night. 

 

OSA is a condition that threatens not only our physical health, with effects on multiple organ systems in our body,  but also our psychological and emotional well-being.

 

Patients are frequently elbowed by their bed-partners who report watching them snore night after night, and often witnessing long pauses in breathing, which is extremely frightening for a spouse to witness, and can be a major source of anxiety.  

Snoring should not be seen as shameful or embarrassing. The person who snores is not at fault, and should not be blamed as they have no control over the sound they make. Snoring does not impact just one person - bed-partners of snorers can suffer from many years of broken or insufficient sleep which has significant impacts on their health and quality of life.  Studies have shown that partners of snorers sleep quality improves significantly when the snoring partner is treated for the condition.  It is a condition that could be the alarm bell for a more serious underlying disorder which should not be ignored.  Get screened today!

Step 2 : Know what is Obstructive Sleep Apnoea

  1. Obstructive sleep apnoea is due to a physical obstruction or collapse of the upper airways.  It results in excessive daytime tiredness, impaired concentration, learning, memory consolidation and attention in the day, which seriously affects work and school performance, as well as driver safety. Cardiovascular, endocrine, digestive, immune, cognitive, psychological and emotional disorders are frequently associated with OSA.

  2. Specifically, it increases the risk for medical issues such as high blood pressure, heart attacks, atrial fibrillation(irregular heartbeat), stroke, obesity, Type 2 diabetes, erectile dysfunction, low libido, male infertility, gastric acid reflux disease, frequent illness, asthma, upper respiratory tract infections, and recurrent sinusitis.  It is also associated with an increased risk of anxiety disorders and depression. 

  3. Audible symptoms such as snoring, choking, gasping and coughing can sometimes be observed, but often it is silent in up to 50% of patients. Some people may be completely without tiredness or symptoms but may manifest in unexplained high blood pressure or irregular heartbeats.

  4. As mentioned before, pure snoring is also not without its risks. Recent research has found that people who snore loudly for many years are at risk of developing OSA due to vibration and trauma to the soft tissues of the throat and soft palate, causing them to enlarge and become "floppier" which leads to increasing severity of snoring and greater upper airway resistance.  Also, cases of untreated OSA has been found to double in severity over a 10 year period.

Step 3 : How do I get screened?

Consultation 

  • The Sleep-disordered breathing comprehensive screening program, established by Dr Elaine Ng in 2008, is used to help identify and accurately detect patients at risk of sleep breathing disorders.

  • A detailed examination of your head, neck, jaws, teeth and airways is conducted, along with specialised tests, standardised subjective questionnaires as well as in depth medical and sleep history to evaluate your level of risk.

Sleep Screening

  • Using high resolution pulse oximetry technology, we can conduct a non-invasive, single-night or multi-night sleep test in the comfort of your own home. 

  • The test is categorised as a high level 4 home sleep apnoea test, and differs from consumer wearables on the market.

  • It is highly accurate and reliably screens for a variety of sleep and sleep breathing disorders, as well as generates a detailed report including information about sleep architecture.

  • Sleep-trained clinicians such as Dr Ng are able to interpret sleep study reports and advise patients on further steps to be taken.

  • Screening is recommended for patients who have signs and symptoms, and also for patients who are unsure about their risk. Screening is also advisable for anyone who wishes to have knowledge about their sleep health condition in general. 

 

Assessment 

  • After a full assessment has been made, the patient will be given the results of the screening test and clinical findings, and referrals will be made to specialists within the multidisciplinary team of sleep practitioners - usually, this may involve ENT specialists (otolaryngologists), orthodontists, oral surgeons, respiratory specialists and neurologists. 

  • Often allied health care such as speech pathologists may be included for functional issues such as swallowing, feeding and speech

  • Sleep psychologists and mindfulness coaches are able to help and treat sleep issues such as insomnia, which can be effectively treated by cognitive behavioural therapy (CBTi)  CBTi is scientifically proven to be more effective in the long term than treatment with medications. Mindfulness-based therapy (MBT) is an adjunct to CBTi, and can be effective for certain types of insomnia.

 

It is important for patients to note that OSA is a disorder which affects multiple organ systems, hence being given more than one referral is not uncommon and in some cases, is necessary to treat the condition completely.  OSA patients should keep their records organised, as they may need to be managed by multiple disciplines.

The respiratory physician or ENT specialist will prescribe the recommended treatment to the patient which may include the following:

Treatment

Oral Appliance Therapy

For mild to moderate OSA it is a well-established, acceptable first-line treatment.  For severe OSA patients, oral appliances are an acceptable alternative for patients who are intolerant of CPAP or have stopped using their CPAP.  Oral appliances are an excellent solution for patients who wish to have a non-invasive, compact and portable solution alongside their CPAP, or for holidays or work travel. All treatments are FDA-approved, clinically validated and evidence based. Find out more here

Continous Positive Air Pressure Therapy

The gold standard treatment for OSA is continuous positive airway pressure (CPAP). This is air supplied to the wearer though a tube and delivered to the patient via face mask, nasal mask or nasal pillows. However there is a significant number of patients who are not able to tolerate CPAP on a nightly basis long term, and hence oral appliance therapy is a treatment alternative for these patients. Find out more here

Surgery

Soft tissue surgical solutions, which reduce physical obstructions caused by overgrown tissues (tonsils, adenoids, turbinates), tumours, excessively long or stretched soft tissue (palate area) for example.

In patients who have skeletal discrepancies or abnormal jaw growth patterns may be given the option for Orthognathic surgery + orthodontics in adults, and orthodontics + dentofacial orthopaedics in children.  These will require consultation with an orthodontist as well as an oral maxillofacial surgeon.

Hypoglossal nerve stimulation (HGNS) which is relatively new surgical intervention which may be performed in patients who are unable to tolerate or are not candidates for the treatments above.

Treatment adjuncts

Positional therapy, weight loss, dietary counselling, avoidance of alcohol and sedative medications, and myofunctional therapy may be advised.

Be patient with yourself and your body, as it takes time to respond to the challenges and changes it may encounter during treatment.

 

Most of all, stay focused on the goal of successful treatment by following the instructions given to you by your doctor during any course of treatment.

Sleep Monitoring

Patients who have already been diagnosed with sleep disordered breathing and are on long-term oral appliance therapy, are advised to return for screening yearly to detect any break through apnoea or worsening of their condition, especially after menopause for women, or after weight gain for both sexes.  Long-term monitoring is important to make sure that you have always have control over your condition, by ensuring your treatment is optimised.

It is important for patients to remember that OSA is a disorder which affects multiple organ systems, hence being being referred to more than one specialist is not uncommon, and in some cases is necessary to ensure the condition is treated properly.  OSA patients should keep their health records well organised, as they may need to be managed by multiple disciplines.

Airway and TMJ

Watch this 3 minute video to find out more about how breathing, the development of the face and dental arches relates to swallowing, grinding the teeth, TMJD (jaw joint/muscle dysfunction) and posture.

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