JCSAS is an office that treats patients for sleep disordered breathing, snoring and sleep apnea. We offer a full range of services including oral appliances for sleep apnea, hybrid therapy utilizing CPAP and oral appliances, as well as appliances for snoring. Equally, we offer orthodontics and are best able to manage pediatric developmental concerns associated with sleep disordered breathing. Finally, in certain instances, we partner with surgeons in managing facial surgery to provide therapy at providing ideal management of obstructive sleep apnea.
Our goal is to provide the optimal experience and best treatment solution possible to people who suffer from sleep disordered breathing. We want to make the process of getting a diagnosis and treatment as easy as possible for the patient. We are committed to working with our patients to manage their airway and sleep health over a lifetime.
The mission of Jacksonville Center for Snoring and Sleep Apnea is to:
- Provide comprehensive, custom treatment solutions to all patients with sleep disordered breathing
- Treat patients appropriately, at the right time, over a lifetime
- Ensure quality of care and improved outcomes through regular follow-up and patient management
- Reduce the impact of cardiovascular and neurological morbidities
- Provide area physicians with a highly skilled and reliable partner in patient management and care
About Dr. Levine
Dr. Levine is both board certified in Dental Sleep Medicine and in Orthodontics. In fact, he is the only Diplomate of the American Board of Dental Sleep Medicine (ABDSM) in all of Northeast Florida and is one of only two specialists in the state of Florida to be both board certified in Orthodontics and in Sleep. The American Academy of Sleep Medicine (AASM) only recognizes Diplomate status granted by the ABDSM.
Dr. Levine has completed a distance residency in Dental Sleep Medicine with Tufts University in Boston and lectures on sleep disordered breathing. He is a leader in Dental Sleep Medicine and serves as Chairperson of both the Health Policy Committee and the Ethics Committee of the American Academy of Dental Sleep Medicine. As well, he serves as vice chair for the Essentials of Dental Sleep Medicine curriculum of the American Academy of Dental Sleep Medicine.
Diagnosis of Sleep Apnea
What Causes Sleep Apnea?
While awake, throat muscles help keep your airway stiff and open so air can flow into your lungs. When you sleep, these muscles are more relaxed. Normally, the relaxed throat muscles don't stop your airway from staying open to allow air into your lungs. But if you have obstructive sleep apnea, your airway can be blocked or narrowed during sleep especially when:
- You are overweight, as there is a good chance that extra fat tissue can thicken both your tongue and the walls of your throat. This causes the inside opening to narrow and makes it harder to keep open.
- The shape of your face and or jaws is not in harmony. A retruded or set back jaw may cause a smaller airway size in the mouth and throat area. There may be less idealized space for your tongue causing it to fall back in the throat more often.
- As we age there may be additional neurologic, endocrine deficits or cardiovascular challenges which both disrupt the sleep process and aggravate sleep disordered breathing.
- Children are plagued with large tonsils and adenoids or deviated septum and allergies. These anomalies oftentimes result in narrow and high vaulted palates and do not allow air to flow normally and the child is at risk for sleep apnea.
- Women reach the time of menopause. It turns out that women’s hormones are potent dialators of the airway and following menopause these protective hormone levels drop considerably. It is not uncommon for women who have never snored to begin snoring in menopause.
What Happens When Air Flow is Reduced?
When an inadequate amount of air flows into your lungs while are sleeping, there often results snoring and frequently blocked a drop in your blood oxygen levels.
When the oxygen drops to dangerous levels, it triggers your brain to disturb your sleep. This helps tighten the upper airway muscles and open your windpipe. Normal breathing then start again, often with a loud snort or choking sound.
The frequent drops in oxygen levels and reduced sleep quality trigger the release of stress hormones. These compounds raise your heart rate and increase your risk for high blood pressure, heart attack, stroke and irregular heartbeats. The hormones also raise the risk for or worsen heart failure.
Untreated sleep apnea also can lead to changes in how your body uses energy. These changes increase your risk for obesity and diabetes.
The Diagnosis of Sleep Apnea
Physicians diagnose sleep apnea based on your medical and family histories, a physical exam, and the results from sleep studies. Often, your primary care provider evaluates your symptoms first. He or she then decides whether you need to see a sleep specialist. These specialists are physicians who diagnose and treat people with sleep problems. Such doctors include many medical specialists. Our office works with Pulmonologists, Neurologists, Otolaryngologists (ear/nose and throat), and Psychiatrists throughout North Florida.
Medical and Family Histories
Your physician will ask you and your family questions about how you sleep and how you function during the day. To help your doctor, consider keeping a sleep diary for 1 to 2 weeks. Write down how much you sleep each night, as well as how sleepy you feel at various times during the day. Do you tend to fall asleep easily at certain times? There is a family disposition to sleep apnea so be sure to let your physician know if this exists in your family.
Your physician will want to know how loudly and how often you snore or make gasping or choking sounds during sleep. Often you are not aware of such symptoms and must ask a family member or bed partner to report them.
If you are a parent of a child who may have sleep apnea, tell your child's doctor about your child's signs and symptoms.
A sleep study is often done in a sleep center or sleep lab and is important in confirming a diagnosis of sleep apnea. You will spend the night in what looks like a hotel room and the attending therapists will be monitoring your sleep and breathing pattern throughout the night. In some instances, a sleep study may be able to be accomplished in your own home, though this depends greatly on your history.
Polysomnogram (Sleep Study or PSG)
A polysomnogram is the most common study for diagnosing sleep apnea. This test records
- Brain activity including eye movement and other muscle activity
- Breathing and heart rate and the amount of oxygen in your blood
- How much air moves in and out of your lungs while you're
A PSG is painless. The staff at the sleep center will place various sensors on your body and use the sensors to check on you throughout the night.
A sleep specialist reviews the results of your PSG to determine whether you have sleep apnea and how severe it is. He or she will use the results to plan your treatment which might include an oral appliance to be worn at night.
Sleep Disordered Breathing
Those at risk:
- elderly men and wome
- postmenopausal women
- people who are overweight
- where some physical abnormality in the nose or throat is present
- abnormalities in other parts of the upper airway
- night-shift workers
- people who habitually drink too much alcohol
- people with depression and other psychotic disorders
- people with hypoactive thyroids, hyperactive growth or down’s syndrome
Habitual loud snoring is the most common symptom of breathing disorders that occur during sleep. Snoring is a sign of abnormal breathing. It occurs when physical obstruction causes fluttering of the soft palate and the adjacent soft tissues between the mout . All snorers do not necessarily have sleep apnea; however, because they almost certainly have some physical obstruction in their airways, they may develop sleep apnea. The person who snores not only sleeps restlessly, but also is at risk for serious disorders of the heart and lungs. Snoring can therefore be life-threatening because it can lead to high blood pressure, irregular heart beats, heart attacks, and sudden death.
Normal breathing must continue at all times whether awake or asleep. The act of breathing is an automatic, highly regulated mechanical function of the body. In healthy sleeping individuals, most muscular and neural activities will slow or even shut down but respiration goes on under a neuromuscular "auto pilot." However, if something goes wrong with the auto pilot during sleep, breathing may become erratic and inefficient.
Symptoms of Sleep Apnea
Patients with sleep apnea have many repeated involuntary breathing pauses during sleep. The length of the breathing pause can vary within a patient, and among patients, and can last for 10 seconds to 60 seconds. Most sleep apnea patients experience anywhere from 5 to 70 "apneic events" per hour, more than 200 per night. These pauses may occur in clusters.
The breathing pauses are often accompanied by choking sensations which may wake up the patient, intermittent snoring, nighttime insomnia, early morning headaches, and excessive the apneic events.
Other features of sleep apnea include irregular heart beat (cardiac arrhythmias), high blood pressure (both systemic and pulmonary arterial), diabetes and obesity. Neurological deficits may exist and driving may become a serious concern. The absence of restful sleep may cause deterioration of performance, depression, irritability, sexual dysfunction, and defects in attention and concentration.
Types of Sleep Apnea
There are three types of sleep apnea: obstructive, central, and mixed. However, since all three types can have the same symptoms and signs, a sleep study is needed to tell the difference among them.
Obstructive Sleep Apnea (OSA) is the most common type. During OSA efforts to breath continue but air cannot flow out of the patient's nose or mouth. The patient snores heavily and has frequent arousals (abrupt changes from deep sleep to light sleep) without being aware of them.
OSA occurs when the throat muscles and tongue relax during breathing and partially block the opening of the airway. When the muscles of the soft palate at the base of the tongue and the uvula (the small conical fleshy tissue hanging from the center of the soft palate) relax and the airway becomes obstructed making breathing labored and noisy.
The reduction in oxygen and increase in carbon dioxide which occur during apnea cause arousals. With each arousal, a signal is sent to the upper airway muscles to open the airway; breathing is resumed with a loud snort or gasp. Although arousals serve as a rescue mechanism and are necessary for a patient with apnea, they interrupt sleep, and the patient ends up with less restorative and sleep than normal individuals.
Central Apnea (CSA) occurs less frequently than obstructive apnea. There is no airflow in or out of the airways because efforts to breathe have stopped for short periods of time. In central apnea, the brain temporarily fails to send the signals to the diaphragm and the chest muscles that maintain the breathing cycle. It is present more often in the elderly than in younger people but often goes unrecognized.
Mixed Apnea (MA), a period of central apnea is followed by a period of obstructive apnea before regular breathing resumes.
Sleep Apnea and the Heart
Sleep apnea appears to take the greatest toll on the cardiovascular system and increases the likelihood of having a variety of cardiovascular diseases. These include high blood pressure, heart attack , cardiac arrhythmias (abnormal heartbeat rhythm), and stroke. However, there many comorbidities associated with sleep apnea including diabetes and obesity. Each in their own right is serious and may require additional management.