Carrie Fisher’s Death: How Dangerous Is Sleep Apnea?

The world of geek culture lost one of it’s icons in 2016 when Carrie Fisher, better known for her role as Princess Leia Organa in the Star Wars saga, passed away unexpectedly. Carrie Fisher’s full autopsy revealed cocaine, morphine, codeine, and oxycodone in her system at the time of her death, TMZ reports. It is unclear what role, if any, any of the drugs played in the death of the actress last year. However, one thing it’s clear, Fisher suffered from a condition that ultimately could’ve to lead to her passing, this is called sleep apnea.

According to the coroner’s report in the death of Carrie Fisher found that “sleep apnea and other undetermined factors” caused the Star Wars actress’ massive heart attack days before her December 27th death.

Sleep Apnea is a common disorder that affects roughly 22 million Americans — with the vast majority of cases going undiagnosed.Sleep apnea is a condition that causes breathing disruptions during sleep that can last anywhere from seconds to minutes, according to the U.S. National Heart, Lung and Blood Institute. Apnea is a Greek word meaning “want of breath.”

Now, you must be wondering “Why is my dentist talking about Carrie Fisher and Sleep Apnea?”. Sleep apnea has a big relation to bruxism, or as it’s more commonly known, teeth grinding. Obstructive Sleep Apnea (OSA) is defined as the cessation of airflow during sleep preventing air from entering the lungs caused by an obstruction. These periods of ‘stopping breathing’ only become clinically significant if the cessation lasts for more than 10 seconds each time and occur more than 5 times every hour. This is something you must consider very important as it not only relates to your oral health, but your general health state and could possibly save your life.

OSA only happens during sleep, as it is a lack of muscle tone in your upper airway that causes the airway to collapse. During the day we have sufficient muscle tone to keep the airway open allowing for normal breathing. When you experience an episode of apnea during sleep your brain will automatically wake you up, usually with a very loud snore or snort, in order to breathe again.

People with OSA will experience these awakening episodes many times during the night and consequently feel very sleepy during the day: they have an airway that is more likely to collapse than normal.

What is Sleep Apnea?

Obstructive Sleep Apnea (OSA) is defined as the cessation of airflow during sleep preventing air from entering the lungs caused by an obstruction. These periods of ‘stopping breathing’ only become clinically significant if the cessation lasts for more than 10 seconds each time and occur more than 5 times every hour. OSA only happens during sleep, as it is a lack of muscle tone in your upper airway that causes the airway to collapse. During the day we have sufficient muscle tone to keep the airway open allowing for normal breathing. When you experience an episode of apnea during sleep your brain will automatically wake you up, usually with a very loud snore or snort, in order to breathe again. People with OSA will experience these awakening episodes many times during the night and consequently feel very sleepy during the day: they have an airway that is more likely to collapse than normal.

How Do I Know I Have Sleep Apnea?

People with sleep apnea may complain of excessive daytime sleepiness often with irritability or restlessness. But it is normally the bed partner, family or friends who notice the symptoms first. Sufferers may experience some of the following:

  • Extremely loud heavy snoring, often interrupted by pauses and gasps
  • Excessive daytime sleepiness, e.g., falling asleep at work, whilst driving, during conversation or when watching TV. (This should not be confused with excessive tiredness with which we all suffer from time to time)
  • Irritability, short temper
  • Morning headaches
  • Forgetfulness
  • Changes in mood or behavior
  • Anxiety or depression
  • Decreased interest in sex

Remember, not everyone who has these symptoms will necessarily have sleep apnea. We possibly all suffer from these symptoms from time to time but people with sleep apnea demonstrate some or all of these symptoms all the time.

Diagnosing Sleep Apnea

OSA can range from very mild to very severe. The severity is often established using the apnea/hypopnea index (AHI), which is the number of apneas plus the number of hypopneas per hour of sleep – (hypopnoea being a reduction in airflow). An AHI of less than 10 is not likely to be associated with clinical problems. To determine whether you are suffering from sleep apnea you must first undergo a specialist ‘sleep study’. This will usually involve a night in hospital where equipment will be used to monitor the quality of your sleep. The results will enable a specialist to decide on your best course of treatment. The ultimate investigation is polysomnography, which will include:

  • Electroencephalography (EEG) – brain wave monitoring
  • Electromyography (EMG) – muscle tone monitoring
  • Recording thoracic-abdominal movements – chest and abdomen movements
  • Recording oro-nasal airflow – mouth and nose airflow
  • Pulse oximetry – heart rate and blood oxygen level monitoring
  • Electrocardiography (ECG) – heart monitoring
  • Sound and video recording

This is a very expensive investigation, with few centers able to offer it routinely for all suspected sleep apnea patients. A ‘mini’ sleep study is more usual, consisting of pulse oximetry and nursing observation. A home sleep study is becoming more popular.

Treating Sleep Apnea

There are several forms of treatment for sleep apnea. In mild and moderate cases weight loss and the use of mandibular advancement devices can be wholly successful. In moderate and severe cases mandibular advancement device or nasal continuous positive airway pressure (CPAP) are normally prescribed. CPAP is the gold standard treatment for OSA.

Central & Mixed Sleep Apnea

OSA is the commonest form of sleep apnea, (about 4% of men and 2% of women) but there is also a condition called Central Sleep Apnea (CSA). This is a condition when the brain does not send the right signals to tell you to breathe when you are asleep. In other words, the brain ‘forgets’ to make you breathe. It can also be associated with weakness of the breathing muscles. The assessment for CSA is often more complicated than for OSA and the treatment has to be carefully matched to the patient’s requirements. There is also a condition called Mixed Sleep Apnea that is a combination of both obstructive and central sleep apnea.

What’s the relation between bruxism and OSA?

If you go to the dentist because of suspected bruxism, chances are they’re going to recommend a night guard. While you definitely need to have a night guard to protect your teeth from grinding, it’s just the first step of treating bruxism.

To treat bruxism you must go beyond the night guard and address what is actually causing your bruxism. There are many possible causes for bruxism that should be considered when seeking treatment, of those is sleep apnea – one of the leading causes for bruxism.

How do you treat bruxism?

In many cases, treatment isn’t necessary. Many kids outgrow bruxism without treatment, and many adults don’t grind or clench their teeth badly enough to require therapy. However, if the problem is severe, options include certain dental approaches, therapies, and medications to prevent more tooth damage and relieve jaw pain or discomfort. Talk with to our specialists find out which option may work best for you.

However, if you or your child has bruxism, your doctor may suggest ways preserve or improve your teeth. Although these methods may prevent or correct the wear to your teeth, they may not stop the bruxism:

Splints and mouth guards. These are designed to keep teeth separated to avoid the damage caused by clenching and grinding. They can be constructed of hard acrylic or soft materials and fit over your upper or lower teeth.

Dental correction. In severe cases — when tooth wear has led to sensitivity or the inability to chew properly — your dentist may need to reshape the chewing surfaces of your teeth or use crowns to repair the damage.

Other approaches

One or more of these approaches may help relieve bruxism:

Stress or anxiety management. If you grind your teeth because of stress, you may be able to prevent the problem by learning strategies that promote relaxation, such as meditation. If the bruxism is related to anxiety, advice from a licensed therapist or counselor may help.

Behavior change. Once you discover that you have bruxism, you may be able to change the behavior by practicing proper mouth and jaw position. Ask your dentist to show you the best position for your mouth and jaw.

Biofeedback. If you’re having a hard time changing your habits, you may benefit from biofeedback, a method that uses monitoring procedures and equipment to teach you to control muscle activity in your jaw.

The last option would be to take medication, but only if it’s been prescribed by a professional. If you or a member of your family are experiencing any of the symptoms related to bruxism or sleep apnea, call our specialists at Serena Family & Cosmetic Dentistry for a consultation and get the treatment you need.

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