Sleep Apnea Dentistry






Overview

 What is sleep apnea?

Sleep Apnea is one of the most common sleep disorders in which breathing stops and then restarts again recurrently during slumber. Sleep apnea means that your breathing often is blocked or partly blocked during sleep. The problem can be mild to severe, based on how often your lungs don’t get enough air. This may happen from 5 to more than 50 times an hour.

This topic focuses on obstructive sleep apnea, which is the most common type.

A less common type of apnea, called central sleep apnea, can occur in people who have had a stroke, have heart failure, or have a brain tumor or infection. Even though this topic isn’t about central sleep apnea, some of the treatments discussed here may also help treat it. Talk with your doctor to find out more about central sleep apnea.

Sleep Apnea is one of the most common sleep disorders in which breathing stops and then restarts again recurrently during slumber.

Obstructive Sleep Apnea (OSA) occurs when the airway temporarily collapses during sleep, preventing or restricting breathing for up to ten seconds or more. OSA patients will commonly suffer from low oxygen levels in the blood, high blood pressure and an overall decrease in the quality of life due to daytime drowsiness and headaches.

Breathing pauses can last from a few seconds to minutes. Such events can occur several hundred times a night severely disrupting sleep. Typically, normal breathing then starts again, sometimes with a loud snort or choking sound. The term “sleep-disordered breathing” (SDB) includes a spectrum of respiratory disorders ranging in severity from snoring to OSA.

Sleep apnea usually is a chronic (ongoing) condition that disrupts your sleep three or more nights each week. You often move out of deep sleep and into light sleep when your breathing pauses or becomes shallow.

This results in poor sleep quality that makes you tired during the day. Sleep apnea is one of the leading causes of excessive daytime sleepiness.

Causes

What causes obstructive sleep apnea?

Blocked or narrowed airways in your nose, mouth, or throat can cause sleep apnea. Your airways can become blocked when your throat muscles and tongue relax during sleep.

Sleep apnea can also occur if you have large tonsils or adenoids. During the day, when you are awake and standing up, these may not cause problems. But when you lie down at night, they can press down on your airway, narrowing it and causing sleep apnea. Sleep apnea can also occur if you have a problem with your jawbone.

If you have obstructive sleep apnea, your airway can be blocked or narrowed during sleep because:

  • Your throat muscles and tongue relax more than normal.
  • Your tongue and tonsils (tissue masses in the back of your mouth) are large compared to the opening into your windpipe.
  • You are overweight. The extra soft fat tissue can thicken the wall of the windpipe. This causes the inside opening to narrow and makes it harder to keep open.
  • The shape of your head and neck (bony structure) may cause a smaller airway size in the mouth and throat area.
  • The aging process limits the ability of brain signals to keep your throat muscles stiff during sleep. This makes it more likely that the airway will narrow or collapse.

In children, the main cause of sleep apnea is large tonsils or adenoids.

Sleep apnea is more likely to occur if you are overweight, use certain medicines or alcohol before bed, or sleep on your back.

Symptoms

What are the symptoms?

The main symptoms of sleep apnea that you may notice are:

  • Not feeling rested after a night’s sleep.
  • Feeling sleepy during the day.
  • Waking up with a headache.

Your bed partner may notice that while you sleep:

  • You stop breathing.
  • You often snore loudly.
  • You gasp or choke.
  • You toss and turn.

Children who have sleep apnea:

  • Nearly always snore.
  • May be hyperactive or have problems paying attention during the day.
  • May be restless during sleep and wake up often. They also may have problems with bed-wetting.

But children may not seem very sleepy during the day (a key symptom in adults). The only symptom of sleep apnea in some children may be that they do not grow as quickly as most children their age.

Can sleep apnea cause other problems?

Having sleep apnea can lead to serious problems such as:

  • High blood pressure.
  • High blood pressure in your lungs.
  • An abnormal heart rhythm, heart failure, coronary artery disease (CAD), or stroke.
  • Depression.
  • Diabetes.

If you have sleep apnea, you also may not be sleeping as well as you could. If you feel sleepy during the day and this gets in the way of the normal things you do (like work, school, or driving), it’s important to talk to your doctor. Be safe. Do not drive while you are drowsy.

Obstructive Sleep Apnea – Airway is blocked by your tongue and oxygen levels drop.

Oxygen starvation can cause:

Cardiac problems

Diabetes

Fatigue

Mental fogginess

Headaches

Deteriorating health

Depression

Weight gain

Daytime sleepiness

Scalloping of the tongue

Teeth grinding at night

Abfractions – erosion of the tooth around the gum line.

Tori – excessive bone deposit buildup around the tongue side of the mandible

CPAP Intolerant

Diagnosis

How is sleep apnea diagnosed?

Diagnosis by a physician by the use of sleep study

Your doctor will probably examine you and ask about your past health. He or she may also ask you or your sleep partner about your snoring and sleep behavior and how tired you feel during the day.

Your doctor may suggest a sleep study. A sleep study usually takes place at a sleep center, where you will spend the night. Sleep studies find out how often you stop breathing or have too little air flowing into your lungs during sleep. They also find out how much oxygen you have in your blood during sleep. You may have blood tests and X-rays.

The Home Sleep Test

Technology has revolutionized sleep disorder testing. While laboratory testing has become more comfortable and more accurate, the most profound advancements have taken place in at-home diagnostic technology. Focused on size, comfort and ease of use, at-home solutions have become, an accessible alternative to in lab testing.

This test is conducted at the home of the patient. This test is specifically designed to assist in the diagnosis of sleep disorder breathing, specifically Sleep Apnea. The test is convenient for the patient and many experts agree that testing the patients sleep in their normal home environment offers many advantages to the laboratory setting.

Home sleep tests start with a visit to a primary care physician who first assesses patients for abnormalities in sleep behavior. When abnormalities are found, the physician will dispense a take home device that they have available in their office. The patient will take the device home, wear it that evening while they sleep, and return it to the physician’s office the next day. Results will be available usually within 24 hours.

Based on the results, the physician can rule out OSA, diagnose OSA and prescribe therapy, or prescribe further testing or titration to be performed in a sleep laboratory using PSG. Prior to the home sleep test, only the latter option was available to primary care physicians, at the expense and inconvenience of millions of patients.

Treatments / Procedures Available

 How is it treated?

Oral Appliance

You may be able to treat mild sleep apnea by making changes in how you live and the way you sleep. For example:

  • Lose weight if you are overweight.
  • Sleep on your side and not your back.
  • Avoid alcohol and medicines such as sedatives before bed.

If lifestyle changes don’t help sleep apnea, you may be able to use an oral breathing device or other types of devices. These devices help keep your airways open while you sleep.

Sleep apnea is often treated with a machine that helps you breathe while you sleep. This treatment is called continuous positive airway pressure, or CPAP (say “SEE-pap”). Sometimes medicine that helps you stay awake during the day may be used along with CPAP. If your tonsils, adenoids, uvula, or other tissues are blocking your airway, your doctor may suggest surgery to open your airway.

An oral device is fitted by a dentist and worn much like a retainer or sport mouthguard. They are designed to keep the mandible (jaw) and/or tongue in a forward position that allows the airway to remain open. Generally, oral devices work best for patients with mild to moderate OSA, patients who experience OSA mostly in the supine position (when sleeping on their backs), and for those who are not obese and do not have a large neck.

Optimizing Your Sleep

Sleep Adequacy and Regularity

  • Get enough sleep. Typical, healthy adults require an average of 7 to 9 hours of sleep each night. It is important to note, however, that getting too much sleep can also be disruptive because it can make you less sleepy the following night.
  • Keep your bedtime and wake-up time stable across the week, including weekends. Have you ever “slept in” on the weekends and found that it was difficult to fall asleep the next night? Oversleeping can actually cause you to have difficulty falling asleep at night and daytime sleepiness the next day.
  • Avoid napping, especially in the afternoon. A power nap (15 minutes) can be an effective tool for managing sleepiness, but anything longer or in the evening can disrupt your ability to fall asleep quickly.

 A Healthy Bedroom Environment

  • Cool your bedroom. Generally speaking, temperatures over 75 degrees Fahrenheit can disrupt your sleep. Use an air conditioner in the hot summer months.
  • Make your bedroom dark. Melatonin, the key hormone that tells your brain to sleep, gets “turned off” when exposed to light. This is especially true when you expose your eyes to the direct bright white light that is emitted by computers, smart phones, and tablets. Try blackout shades or an eye mask.
  • Make your bedroom quiet. Even light noises disrupt sleep. Earplugs, a fan, or a white noise machine can help mask noisy environments.
  • Limit activities in the bedroom to those that are relevant to the bedroom. It is generally not recommended that you do work, eat, or exercise in your bedroom because your brain can “learn” that relationship which can make it difficult to sleep.

 Eating and Drinking

  • Avoid consuming a heavy and/or spicy meal close to bedtime (within 2 to 3 hours of sleep). Digestion tends to slow down during sleep so your body can have an extra difficult time processing foods rich in fats, sugar, and spice. Instead, if you are hungry, try to have a light snack like almonds, cheese, or milk. These foods have chemicals in them that can actually help you sleep!
  • Limit nicotine and caffeine, especially within 4 hours of bedtime. Caffeine and nicotine are generally stimulating and thus not conducive for restful sleep. Foods that contain caffeine include coffee, chocolate, energy drinks, tea, and even some clear sodas.
  • Limit alcohol, especially within 4 to 6 hours of bedtime. Although alcohol can make you feel sleepy and actually make you fall asleep quicker, it can also disrupt your sleep as it is processed by the body. As such, we never recommend using alcohol as a sleep aid.

 A Healthy Routine

  • Dedicate at least 30 to 45 minutes before bed to do something relaxing. This could include reading, taking a warm bath, meditating, etc. A relaxing routine can help train your brain to differentiate “sleep time” from “wake time” and ultimately can help you fall asleep faster and maintain deeper sleep.
  • Don’t go to bed unless you are sleepy. If you lay down without being sleepy, your brain can “train” itself that being awake is normal when lying in bed. If you are finding it difficult to fall asleep (after 15 minutes), get up and go to another room and do not return to bed until you feel sleepy.
  • Exercise daily. Regular, vigorous exercise for approximately 30 minutes is a good ingredient for a good night’s sleep. However, please try to refrain from vigorous activity right before bedtime.
  • Expose your eyes to natural sunlight in the morning. Exposure to light in the morning (and avoiding it at night) is one of the essential elements to regularizing our circadian rhythm, the internal clock that our body runs on.

Benefits

  • Increase oxygen saturation
  • Reduce the number of times you stop breathing per hour.
  • Increase oxygen to the brain
  • Improved mental clarity

Facts

Over 40 million Americans suffer from a sleep disorder, and 20 million suffer from OSA. Despite the high prevalence, 93% of women and 82% of men with moderate to severe OSA remain undiagnosed.

In a community-based study, men were found to be two times more likely than women to have OSA. However, men are eight times more likely to be treated for OSA than women. This suggests that the symptoms of OSA in women are often attributed to other conditions, such as chronic fatigue syndrome, depression and fibromyalgia.

Untreated OSA can severely affect quality of life, health and mortality. Clinical research shows that it is linked strongly to a range of serious, even life-threatening, chronic diseases such as stroke, heart failure, hypertension, diabetes, obesity and coronary heart disease.

  • 70MM suffer sleep deprivation of which 40MM have a chronic disorder;
  • 20 million OSA patients, only 5% of which have been diagnosed and treated
  • The US OSA market is estimated at $2.5 Billion with an AGR of over 20%
  • Currently, there is a greater than one month patient wait time for sleep lab evaluations.

SDB affects around 20% of the adult population¹, making it as widespread as diabetes or asthma. However, awareness is low and we believe that about 90% of people who have OSA remain undiagnosed and untreated. Along with an increasing understanding of the morbidity and mortality caused by SDB, this discrepancy has created one of the fastest growing segments of the respiratory industry.





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