Peter Manschot woke up in a hotel room and found his wife, Emily, sleeping in the bathroom.
"I felt really bad," says Manschot, 63, of Novi, Mich. "She was curled up with blankets and whatever pillows she could scrounge, trying to make a bed out of the bath tub."
It was the only place she could sleep because he was snoring so loudly.
Manschot's snoring was a symptom of a much bigger problem. He is among the estimated 18 million Americans with obstructive sleep apnea, a chronic condition in which the airway is blocked during sleep. It prevented Manschot from breathing and caused him to snore.
"Basically, I was waking up 30 or 40 times an hour," Manschot says. Doctors evaluated him, and "they said on a scale of 1 to 10, I was a 12. They could hear me down the hall with the doors closed."
The prevalence of sleep apnea is expected to grow with the rise in obesity and the aging population, because age and weight are two factors that increase the chances of developing the chronic condition in which the back of the throat relaxes and the airway becomes blocked.
For some, surgery can alleviate the problem. For others, the use of a continuous positive airway pressure (CPAP) machine opens up the airways and allows for more normal breathing during sleep.
Manschot was prescribed a CPAP machine -- the most common treatment for sleep apnea. The machine pumps air through a hose and into a mask that fits over a person's mouth and nose, or just over the nose. The machine gently blows air into the throat, artificially holding the airway open.
"Now, I'm sleeping through the night and have been for years," Manschot says. "I think it's immensely benefited me."
Emily Maschot is thrilled that her husband is now sleeping through the night -- it means she is, too.
"I think it has saved our marriage," she says, "and maybe even saved his life."
Untreated sleep apnea can increase the risk of high blood pressure, heart attack, stroke, obesity and diabetes.
Neither the CPAP machine nor surgery helped Tom Norgiel, 50, of Walled Lake, Mich.
For years, he'd searched for a way to get a good night's rest.
He was diagnosed about eight years ago with moderate obstructive sleep apnea. Doctors tried to treat the problem with a CPAP machine, but he didn't like using it. Some people find the masks uncomfortable and the machines too loud.
About five years ago, Norgiel had surgery to try to improve his breathing at night. Surgery usually involves shrinking, stiffening or removing excess tissue in the mouth and throat or resetting the lower jaw, according to the National Institutes of Health. "I had implants put into my mouth," Norgiel says. "It supposedly makes your soft palate more rigid."
But it didn't help.
Then, Norgiel visited Dr. Bruce Luria, a Dearborn dentist who makes a dental device that looks like a mouth guard. The appliance forces Norgiel's jaw forward slightly, pulling his tongue from the back of his throat and opening up the blocked airway.
"When I have that thing on, I don't snore a bit," Norgiel says. "It's like night and day.
"It's made a huge improvement for me. I sleep a lot longer."
The use of dental devices to treat sleep apnea is growing in popularity, according to Sheri Katz, the president of the American Academy of Dental Sleep Medicine, a national organization that provides training and resources for dentists and orthodontists who treat sleep apnea.
And that popularity is expected to surge even more. Beginning this year, Medicare is going to consider coverage for custom-fabricated dental devices to treat mild and moderate cases of sleep apnea -- although a pay structure has yet to be determined.
Many insurance companies also cover at least some of the cost of these devices.
"If a patient is covered for CPAP, most insurance companies will cover oral appliance therapy under the right protocol," Katz says. "It's also covered for people who have severe sleep apnea and have failed to use CPAP."
For people who have no trouble with the CPAP treatment, the trend is moving toward smaller masks, lighter equipment and smaller machines.
"They seem to make them more attractive, so you don't mind having them on your bedside table," says Joy Lucas, who has been a sleep technician for nine years at St. Joseph Sleep Disorders Center in Auburn Hills.
Lucas says there are several variations of masks for the machines.
"We tried to figure it out once, and there were something like 180 different types of masks," Lucas says. "Basically, there are three types: There is a mask that goes over the nose, there is a mask that goes in the nose, and there is a mask that goes over the nose and mouth."
Different machines have different comfort features.
"One decreases the pressure as you exhale, or they might have heated tubing. "
Lucas says some women have apprehension about wearing the CPAP mask.
"Maybe it's a little harder for women because it's not very attractive," Lucas says. "It just kind of gets in the way of things."
As an alternative to CPAP, dental devices can be 90 percent effective for mild to moderate cases of sleep apnea, Katz says, but there can be a downside.
"In more than half the cases, teeth can shift," she says. And when that happens, the devices need to be altered or patients may need braces.
Luria makes dental devices only for patients who can't use a CPAP machine.
"If you can wear the mask, wear the mask," Luria says. "CPAP machines work phenomenally. But not everyone can wear the masks. That's how dentistry got involved in this."
Luria says the dental appliances cost anywhere from $1,200 to $2,500. But all of them do the same thing: They move the jaw forward, pulling the tongue out of the back of the throat.
"It's not like your tongue is hanging out of your mouth," he says. "It's just that the back of your throat remains open."
>Symptoms of sleep apnea
One of the most common signs of obstructive sleep apnea is loud, habitual snoring, although not everyone who snores has sleep apnea. Other signs to watch for :
*Memory or learning problems and not being able to concentrate.
*Feeling irritable, depressed or having mood swings or personality changes.
*A dry throat when you wake up.
Source: National Institutes of Health
What's your snore score?
Answer these questions to find out whether you may have sleep apnea:
1) Are you a loud or regular snorer?
2) Have you ever been observed to gasp or stop breathing during sleep?
3) Do you feel tired or groggy upon awakening, or do you awaken with a headache?
4) Are you often tired or fatigued during waking hours?
5) Do you fall asleep sitting, reading, watching TV or driving?
6) Do you often have problems with memory or concentration?
If you or someone close to you answers "yes" to any of these questions, you should discuss your symptoms with your physician or a sleep specialist. Factors that increase the risk of having sleep apnea include being overweight or obese, having a large neck and having high blood pressure.
Source: American Sleep Apnea Association
Sleep apnea risks
Sleep apnea is a chronic condition that requires long-term management. If left untreated, it can lead to increased risk of:
*High blood pressure, stroke, obesity and diabetes.
*Heart failure, heart attack and irregular heartbeats.
*Having work-related or driving accidents.
Source: National Institutes of Health