and Sleep Apnea

Snoring and Sleep Apnea

Snoring affects nearly 40% of men and nearly 30% of women beyond age 40 and nearly 25% of the at large population. During sleep, especially when sleeping on your back there is a decrease of throat muscles tone and sometimes a total collapse of these muscles. The tongue goes back and obstructs also the airway. Air passing through this obstructed airway produces the characteristic noise of snoring. Aggravating factors:

  • Tobacco usage
  • Sleep position
  • Alcohol consumption
  • Age
  • Weight increase
  • Fatigue
  • Anatomical/hormonal factors
  • Medication/drug use

Beyond its socially disturbing aspect, snoring could hide a much more dangerous issue called Sleep Apnea.

Sleep Apnea

Caused by cessation of air flow in the airway, leading to a decrease of oxygen in the blood and an increased pressure on the heart, forced to pump more blood in the system provoking multiple micro awakenings per hour, resulting in a fractioned, non refreshing sleep.

Apnée du sommeil


  • Daytime Sleepiness
  • Morning Headaches
  • Concentration Troubles
  • Memory Lapses
  • Irritability
  • Decreased Libido
Apnée Ronflement

Apnea is an important risk factor for:

  • High Blood Pressure
  • Heart Attack
  • Stroke
  • Type II Diabetes

25% of snorers suffer from obstructive sleep apnea (OSA)

4% of the population at large suffers from OSA

  • Sleep apnea is defined by a complete cessation of air flow for at least 10 seconds.
  • Hypopnea is defined by a 50% decrease of air flow.
  • Light apnea: up to 15 events per hour.
  • Moderate apnea: 15 to 30 events per hour
  • Severe apnea: More than 30 events per hour


Diagnosis and treatment are done by a multi-specialty team including respirologists, ENT’s, sleep specialists, and a dentist with an advanced training in sleep.

A sleep exam done under the supervision of a respirologist or sleep physician is fundamental. This test is done at home or in a sleep laboratory in order to diagnose sleep apnea and its degree of severity.


C.P.A.P (Continuous Positive Airway Pressure) is the gold standard for treating sleep apnea. However, many treatment options are available.

  • C.P.A.P for Severe Apnea
  • Oral Appliances for Snoring and Light to Moderate Sleep Apnea
  • Laser surgery for Snoring
  • Bimaxillary surgical advancement for Severe Cases


A thorough examination and screening tests are done by Dr. Arcache who will then refer the patient to a specialized physician for an evaluation and sleep test.

In light to moderate cases, or in some severe cases, but intolerant to C.P.A.P, the physician might prescribe an oral appliance.

Clinical Protocol

First Visit: Impressions of upper and lower teeth are taken and sent to a specialized lab.

Second Visit: The appliance is fitted and adjusted. All the necessary instructions are given. All the following visits during the first year are included in the price of the appliance.

In subsequent visits the appliance is adjusted forward gradually until the symptoms decrease or stop completely. Once this is achieved, a control test is mandatory. The patient is sent back to the physician who will prescribe the appropriate test to verify the efficacy of the treatment.

Mode of Action (Function)

The appliance maintains the jaw in a forward position keeping the tongue forward and preventing it from obstructing the airway. Thus the air flow is facilitated.

Advantages of MAS

  • Efficient for light to moderate sleep apnea
  • Made to measure; Comfortable fit
  • Rapid adaptation
  • Validated by numerous studies
  • Recommended by many medical associations worldwide


Transient muscles, joints and teeth sensitivity or pain. A small percentage of patients might have more long lasting discomfort or have changes in their occlusion. Dr. Arcache will be able to address rapidly these issues if they had to arise.

Epworth Sleepiness Scale

How likely are you to doze off or fall asleep in the following situations, in contrast to just feeling tired? This refers to your usual way of life in recent times. Even if you have not done some of these things recently try to work out how they could have affected you. Use the following scale to choose the most appropriate number for such situation:

0 Would never doze or sleep
1 Slight chance of dozing or sleeping
2 Moderate chance of dozing or sleeping
3 High chance of dozing or sleeping
1. Sitting and reading 0 1 2 3
2. Watching TV 0 1 2 3
3. Sitting inactive in a public place 0 1 2 3
4. Being a passenger in a motor vehicle for more than an hour or more 0 1 2 3
5. Lying down in the afternoon 0 1 2 3
6. Sitting and talking to someone 0 1 2 3
7. Sitting quietly after lunch (no alcohol) 0 1 2 3
8. Stopped for a few minutes in traffic 0 1 2 3

TOTAL (Add all numbers) ___________


1.6 Congratulations! You have a good quality and quantity of sleep.

7.8 An average result. Become aware of your sleeping habits.

9 and + You need sleep. Contact a professional sleep.