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How Your Dentist Can Help with Sleep Apnea

When most of us think of dentistry, the maintenance of our teeth immediately comes to mind. However, if you suffer from sleep apnea, your dentist may be one of the first practitioners to recognize this and offer treatment options.

The most common sleep breathing disorder is sleep apnea. It is a serious condition characterized by irregular breathing throughout sleep cycles with a lack of oxygen. During an episode, a person’s breathing can stop for at least 10 seconds. These episodes can occur between 10 to 60 times a night. Depending on the severity of sleep apnea, the disorder can inhibit regular mental and physical health. Therefore, an early diagnosis can aid you a great deal towards treatment and better health.

What Is Sleep Apnea?

Sleep apnea has three different classifications: obstructive apnea (OSA), central apnea or a combination of both. Obstructive apnea is the most common type of sleep breathing disorder. It is when the muscular walls of your throat relax excessively to the point where your airway begins to collapse. Central apnea, on the other hand, occurs due to a neurological gap when the brain fails to signal your muscles to breathe.

Symptoms

Since it is difficult for people to remember their sleep cycles, the episodes are often left undiagnosed as well. The biggest signal for sleep apnea is loud snoring. During OSA, the tongue often falls back into the airway, crowding the connective tissue in your neck which causes vibrations during breathing. This vibration is heard as loud snoring. Oftentimes, one’s partner is the first to notice the symptoms of sleep apnea.

Symptoms include loud snoring, interrupted by pauses in breath and then a choking sound as breathing resumes. Additionally, sleep apnea comes with extreme daytime fatigue, irritability, insomnia as well as waking up with a headache, dry mouth or sore throat. It is also important to look for risk factors like narrow patency of the airway, large tongue, large uvula, enlarged tonsillar tissue, large neck circumference, and elevated blood pressure.

Prevalence

According to a Frost and Sullivan report commissioned by the American Academy of Sleep Medicine, approximately 5.9 million adults are diagnosed with OSA in the US. The study estimates that as many as 29.4 million Americans, or 12% of the US adult population, suffer from obstructive sleep apnea (OSA). This led to an astounding cost of $149.6 billion due to undiagnosed OSA in 2015.

Health Risks if Left Untreated

Considering the life-threatening risks associated with sleep apnea, it needs immediate treatment. Since a person can have several episodes overnight, sleep quality diminishes rapidly and is often accompanied by severe fatigue. Undiagnosed sleep apnea has been linked to various injuries due to this fatigue. When behind the wheel, sleep apnea patients with chronic fatigue are under high risk of fatal automobile accidents. Mood disorders like mania, bipolar disorder, depression and dysthymia are also frequent among sleep apnea patients. Sleep apnea is also connected to high blood pressure, heart disease, diabetes and obesity. Because of this relation to cardiovascular diseases like heart attacks and strokes, early detection is important. There has also been recent evidence that chronic sleep apnea impairs memory (Dementia and Alzheimer’s Disease) due to the chronic reduction in oxygen.

If you think you have sleep apnea, it is best to consult your physician or dentist. While the overall treatment of sleep apnea involves general physicians, surgeons and sleep specialists, a dentist can screen you and help you to obtain a diagnosis of sleep apnea.

Treatment

If a dentist suspects you may have sleep apnea based on your health and physical assessment, they may order a home sleep test to confirm sleep apnea or refer you to a sleep specialist.

The sleep specialist may perform a polysomnography, an overnight sleep study in a clinic, to properly diagnose the patient’s sleep apnea. During the polysomnography, the physician will monitor heart rate measurements, blood oxygen levels and the intervals between sleep apnea episodes.

If the diagnosis is mild or moderate OSA, often it can be treated with a dental appliance by allowing non-obstructive breathing by repositioning the lower jaw and tongue. Two main devices include Mandibular Advancement Devices (MADs) and tongue retaining mouthpieces. MADs which are like mouthguards or retainers, position the lower jaw and tongue slightly forward, thus opening the airway. Quite similar to MADs, tongue retaining mouthpieces fit around the tongue and hold it forward.

Severe sleep apnea is typically treated by continuous positive airway pressure machines (CPAP). A CPAP uses a mask and hose to keep the airway open by providing air and pressure. Surgical procedures for extreme cases of sleep apnea also exist and they usually involve surgically opening up the airway. This surgery is done by ENTs or oral and maxillofacial surgeons.

It is highly recommended that you quit smoking, avoid sleeping on your back, try to lose weight, avoid caffeine after lunch time, and do not consume alcohol within 2 hours of sleep.

Sleep apnea is a very serious condition that affects tens of millions of Americans and often goes undiagnosed, which can lead to much more serious health risks such as high blood pressure, diabetes, depression, AFIB, and stroke. If you have excessive daytime sleepiness, if you wake up more than once during the night, or if someone has observed you snoring or gasping for air during sleep, you need to have an evaluation for sleep apnea. If you want more information, or help getting on the right path to treatment, consult Dr. Halsema.