Device Lets Couple Breathe Easier, Him Literally And Her Figuratively

Posted: August 30, 1992

Gene Wroblewski's rumbling snores kept his wife, Lorry, wide awake for years.

In desperation, she finally sought refuge in a spare bedroom.

Wroblewski, 67, of Doylestown, has sleep apnea, a serious medical condition characterized by loud snoring and pauses in breathing that last five to 60 seconds.

About a month ago, he was fitted with a small dental device that has eased his breathing problem. Called a Herbst device after the German orthodontist who invented it, it was custom-made for Wroblewski by the Main Clinical Campus of Medical College Hospitals in Philadelphia.

Sleep apnea is caused by sagging throat tissue that blocks the airway, said Rochelle Goldberg, cardiopulmonary director at the campus' sleep disorder center.

"People who snore don't always have sleep apnea, but people with apnea always snore," said Nadia Laniado, an orthodontist at the campus.

The breathing pauses may occur hundreds of times each night, causing daytime drowsiness and irritability. If left untreated, the condition will lead to life-threatening problems, said Laniado.

The breathing pauses don't cause sudden death, Goldberg said, but the daytime drowsiness slows reflexes, sometimes leading to work-related or driving accidents. Also, the pauses cause the patient's oxygen level to repeatedly drop, which eventually can lead to high blood pressure and an increased risk of heart attacks or strokes, she said.

"Waking is the body's way of protecting itself from the breathing pauses," Goldberg said.

Although the disorder usually afflicts people 40 or older, children also can suffer from it. In youngsters, it is typically caused by enlarged tonsils or adenoids and is cured by their removal.

In May, Laniado teamed up with the sleep center to custom-make the device for apnea patients.

The device, originally made to correct overbites in children, fits over the patient's teeth. It opens the patient's airway by moving the jaw forward slightly, Laniado said.

Dozens of available dental devices work similarly, but Laniado favors the Herbst version because "it's the easiest to use, easiest to take care of and can't fall out," she said.

Still, the device is not for everyone, cautions Goldberg. A person must first be evaluated by a sleep center. Good candidates have mild to moderate rather than severe apnea, and have no joint-related problems of the jaw, she said.

Severe apnea requires surgery to correct, or a bulky machine called a nasal Continuous Positive Air Pressure (CPAP) device, which uses a blower and a face mask to deliver air that props open the floppy tissue, Goldberg said.

Wroblewski said he became aware of his apnea about two years ago when his wife told him his breathing stopped intermittently during sleep.

"She didn't know if I was alive. I didn't know anything was going on," he said.

Wroblewski's apnea wasn't serious enough to require surgery, and he rejected the CPAP because it seemed cumbersome.

Recently he learned of the Herbst device during a Seattle vacation when Lorry Wroblewski met a dentist's wife who happened to describe it.

"It sounded so simple," Gene Wroblewski said.

About four weeks ago he was fitted for the device, and in mid-September he will return to the center for a re-evaluation of its effectiveness.

The device, which also lessens snoring, costs about $1,400 and is covered by most medical insurers, Goldberg said. It must be prescribed by an orthodontist.

Those with sleep apnea snore loudly. Their long pauses in breathing can alarm spouses.

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