John W. Schulz, D.D.S. - San Francisco

I Have Trouble Sleeping
Obstructive Sleep Apnea

The Greek word "apnea" literally means "without breath." Obstructive Sleep Apnea (OSA) is very common. Left untreated people with sleep apnea stop breathing repeatedly during their sleep, sometimes hundreds of times during the night and often for a minute or longer. With each apnea event, the brain briefly arouses people with sleep apnea in order for them to resume breathing, but consequently sleep is extremely fragmented and of poor quality.

Sleep apnea is the stoppage of breathing during the night. Sleep apnea affects 13-17% of adults over 40 years old in the United States. 70% of the time, loud snoring is indicative of OSA; however, unless you are aware of the symptoms of sleep apnea or actually wake yourself during your sleep, you may never know you have a lower level of oxygen intake.

How Serious is Sleep Apnea (OSA)

John's Hopkin's University study of 6,400 men and women over 8 years found that OSA increased the risk of death by 46%.

Did you know that sleep apnea studies have shown that...

  • Severe OSA can take 12-15 years off a person's life.
  • Type ll Diabetes can take 5-10 years off a person's life.
  • Smoking can take 7-10 years off a person's life.

What are the effects of OSA?

  • 25 Million Americans Suffer from Sleep Apnea
  • 38,000 die each year from complications of sleep apnea (i.e. heart attack, stroke etc.)
  • OSA Cost of healthcare in the ER or ICU is in excess of $50,000 per patient - total estimated cost is $1.9 Billion.
  • People with untreated sleep apnea face 4 time higher risk of a stoke and are 3 times more likely to have heart disease if left untreated.
  • 200,000 each year are involved in Motor Vehicle Accidents because of sleep problems.
    • OSA suffers are 6 times more likely to die in a car accident.
    • - Of these at least 50,000 are estimated to be directly related to sleep apnea.
    • - Insurance cost per accidents is estimated to be over $80,000.
    • - Total estimated insurance cost for MVA related to sleep apnea only $4 Billion.
  • Productivity ratio is at least 10% less in people who suffer from sleep apnea
    • That is estimated to costs the US economy $75 Billion each year Sources: The American Sleep Apnea Association and the National Commission on Sleep Apnea Research.

How much sleep are you and your bedmate losing?

Untreated sleep apnea can result in a significant amount of sleep loss. The snoring, gasping for air, and choking episodes during the night can results in a bedmate losing up to an hour of sleep a per night.

Is Snoring and Restless Sleep costing you years off your life!

Ask your spouse if they have witnessed you holding your breath or breathing too fast or too slow. Many sleep disorder sufferers are not aware of habits they may have. Awareness is the first step to your health improvement.


  • Have you been told that you snore?
  • Are you still tired when you get up in the morning?
  • Do you wake up with a dry or sore throat?
  • Are you irritable in the morning or have morning headaches?
  • Do you have trouble concentrating?
  • Do you doze during the day?
  • Do you feel depressed?
  • Do you seem to be losing your sex drive?
  • Do your legs feel twitchy at night?

Symptoms of Obstructive Sleep Apnea Include:

  • Weightgain:
    • Do you feel like your metabolism has slowed down?
    • Have you gained so much weight it is hard to lose?
  • Neck Circumference:
    • Do you have a large neck circumference?
    • A neck circumference of 17 inches for men and 15 inches for women is generally associated with OSA due to the added weight compressing the airway when sleeping.
  • Teeth:
    • Are you grinding your teeth?
    • When you look into the mirror do your teeth look like someone is filing them down?
    • Are your teeth becoming sensitive to hot and cold liquid?
    • Are your teeth darker at the gum line?
    • Have you noticed visible tooth fractures or even broken a tooth off just by eating?
  • Tongue:
    • Do you sometimes bite your tongue when you eat or talk?
    • Do you feel your tongue is too large for your mouth and sometimes restricts your air flow?
    • A large tongue and narrow airway opening to the throat is a risk factor.

Obstructive Sleep Apnea can Increase the Risk of Cardiovascular Disease & Stroke

Sleep Apnea is measured in the stoppage of breathing of more than 10 seconds at a time or the drop in blood oxygen of 4% or more. People with sleep apnea can have these events dozens to literally hundreds of time per night. These apnea events lead to drops in blood oxygen levels. If the body is not getting sufficient oxygen it cannot produce enough nitric oxide. Nitric oxide opens blood vessels. Without nitric oxide, susceptible to plaque buildup which leads to heart attack and stroke.

In additional, when a person finally starts breathing (by gasping or coughing) after not breathing for 10 or more seconds there is sympathetic (flight or fight response), which results in a spike in blood pressure and rapid breathing as the body attempts to get the oxygen levels back up to normal. It is easy to see how those "flight or fight" events happening dozens of times or more a night can lead to strain on the heart and cardiovascular system.

Diagnosing Obstructive Sleep Apnea (OSA)

OSA can only be properly diagnosed by a board-certified M.D. in sleep medicine. This is done either through spending a night in a sleep lab connected to wires and monitors or by a home sleep test. In our office, we have home sleep testing monitors which you can wear to bed in your own home. When you bring the testing unit back to our office, we will upload the data stored in the unit to a board-certified sleep physician who will diagnose if you have sleep apnea. The physician will also determine how severe the sleep apnea is and prescribe what treatment options would be appropriate.

There are three common treatment options for Obstructive Sleep Apnea (OSA)

  1. Dental Treatment for Sleep Apnea

    We offer an oral appliance therapy to treat OSA. By performing a airway diagnostic measurement and the use of a high technology, non-invasive sonar device (a Pharangometer) we can determine the jaw position which will provide the optimal airway opening. We can fabricate an oral appliance, much like a mouth guard, that will position the lower jaw to keep the airway open. By wearing this appliance each night, we can dramatically decrease sleep apnea and snoring. The oral appliance is covered by many private health insurers. For those insurers who do not cover this treatment, we offer the treatment at an affordable level with convenient payment options so we can provide this life-saving and life-changing care to all who need it.

  2. Medical Treatment for Sleep Apnea

    OSA may be treated with a CPAP (continuous positive air pressure) device. It consists of a facial or nasal mask connected by a hose to an air pump next to your bed. The CPAP continually forces air down the airway to keep you breathing. The CPAP works and is considered the standard of care, especially for those patients with severe OSA. Unfortunately, the CPAP has a low level of long term compliance because many stop wearing it over time.

  3. Surgical Treatment for Sleep Apnea

    In extreme cases and only when medically warranted, a surgical solution may be suggested to address sleep apnea and snoring disorders. Surgery may be effective in treating snoring and sleep apnea when bones and tissue in your mouth, neck and throat are not aligned properly.


A continuous positive airway pressure device (CPAP) is used to treat people with sleep apnea. A CPAP is a device that uses a mask, tubes and fan to push the tongue away from the back of the throat and allows proper air flow. It will halt all occurrences of apnea and greatly reduce snoring. An individual with a CPAP device should wear it whenever they sleep, even for short naps. While a CPAP does not cure sleep apnea it will drastically improve your sleep problems.

Snoring Appliance

A snoring appliance is an oral appliance that resembles an athletic mouthpiece. Small and flexible, it has no moving parts, masks, hoses, or batteries. Generally made from sterile plastic it is easy to clean with a regular toothbrush.

Custom fit by a dentist in one simple, painless visit. Fit to the patient's teeth to keep the upper and lower jaw in position when the jaw and throat muscles relax during sleep. This keeps the airway open providing restful, quiet sleep.

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