Have you ever woken in the middle of the night during a delightful, peaceful sleep to the sound of obnoxious snoring coming from your spouse? Has the virtual growling, snarling and audible cues that suggest this individual may have swallowed a kazoo gotten so bad it seems the walls within your home may crumble at any time? Are you simply fed up with stuffing ear plugs in your canals or wrapping a pillow around your head to no avail?
The person you are sharing a bed with may have what is known as obstructive sleep apnea, a potentially dangerous sleep disorder in which breathing repeatedly stops and starts during this nightly human ritual of rest. There are different types of sleep apnea that exist, but obstructive apnea is by far the most common kind; it occurs specifically when muscles intermittently relax and block the airway during sleep, with the most noticeable sign of this problem being the aforementioned snoring.
Signs and Symptoms of Sleep Apnea
While any of us can develop obstructive sleep apnea, it is middle-aged and older adults – and those who are overweight – that are commonly affected. Before we go into the connection between sleep apnea and dentistry/oral care, let’s take a look at some of the symptoms that define the obstructive variant and later on discuss treatment options – which may involve using a device to keep airways open, or using a mouthpiece to thrust the jaw forward during sleep.
Sleep apnea symptoms include:
• Excessive daytime sleepiness
• Loud snoring
• Episodes of breathing cessation during sleep that are observed
• Abrupt awakenings accompanied by shortness of breath
• Dry mouth or sore throat during awakening
• Chest pain during awakening
• Morning headaches
• Concentration difficulties during the day
• Mood change experiences including depression or irritability
• Difficulty remaining asleep (insomnia)
• High blood pressure
Cues that should alert you to contact a physician encompass:
• Snoring loud enough to disturb your sleep…or, as we covered earlier, that of others
• Shortness of breath that awakens you from sleep
• Intermittent pauses in your breathing pattern during sleep
• Daytime drowsiness of an excessive nature, possibly leading to falling asleep while working, watching television or, at its worst, driving a motor vehicle
Park Avenue Dental Fact: Obstructive sleep apnea tends to yield loud, obnoxious snoring when an individual sleeps on his or her back and quiets when he/she turns on their side.
Causes of Obstructive Sleep Apnea: Getting Closer to its Connection in Dentistry
Obstructive sleep apnea occurs when the muscles in the back of the throat relax to the point that they stop allowing normal breathing. These muscles support structures including the soft palate, uvula – a triangular piece of tissue hanging from the soft palate – tongue and tonsils. When the muscles are in a state of relaxation, the airway narrows or closes as we breathe in, rendering breathing inadequate for 10 to 20 seconds. From lowering the level of oxygen in the blood to the brain sensing this and rousing us from sleep in response, these patterns can repeat themselves five to 30 times or more each hour – all night long.
These disruptions impair our ability to reach desired sleep depths and usually make us feel sleepy during waking hours – a sensation not unlike that of how we feel after taking high doses of sleeping medication the night before. What’s important to note here is that people suffering with sleep apnea may not even be aware that their sleep was interrupted – in fact more often than not, people with this type of sleep disorder think they have slept soundly all night.
A Dentist’s Detection
According to an article in the AGD Impact, the Academy of Dentistry’s monthly news magazine, obstructive sleep apnea is a serious, life-threatening disorder that isn’t always evident through signs such as snoring. A dentist can detect the less-evident signals through a candid conversation with a patient, in conjunction with an exam about the patient’s recent pain or discomfort. Further, a experienced dentist can make a connection between sleep apnea and the way a patient complains about lethargy, morning headaches or dry mouth – some of the factors we’ve already discussed above.
Dr. Sherman believes that dentists are typically the first professionals to become aware of a potential apnea problem because they are normally in contact with patients more frequently than are general physicians. Depending on the severity of the case, dentists can refer patients with symptoms of sleep apnea to sleep specialists who will assess the conditions; if a patient is diagnosed with obstructive sleep apnea, he or she may return to the dentist to receive treatment.
Specialists for Sleep Apnea
Outside of behavioral changes an individual may have to make to combat this condition such as altering sleep position, losing weight or quitting smoking, he or she may need to wear a dental appliance during sleep. This appliance, which resembles an athletic mouthguard, repositions the jaw and tongue to improve airflow.
Like any other appliance, however, they do require some adjustment and a commitment on the part of the patient, though Dr. Sherman of Park Avenue Dental assures patients they are typically as easy to wear as most retainers or other removable dental appliances. Treatment for severe cases of sleep apnea involves more aggressive management, which can encompass the use of a continuous positive airway pressure (CPAP) system – a device that delivers air via a small mask and applies constant pressure to ensure the airway remains open – or surgery.
Interestingly, most dentists have indeed undergone specialized training for the treatment of sleep apnea disorders and remain highly skilled in its management techniques using behavioral modification and dental appliances. Still, a confirmed diagnosis from a specialist seasoned in sleep medicine and analysis is required before any treatment by a dentist can be considered. Because sleep apnea can be, as we have been discussing, a silence-endowed condition, it can go undiagnosed for many years – what’s most important is to keep an open and honest dialog with your healthcare professional(s) to ensure that conditions such as obstructive sleep apnea can be identified and treated properly.
Oral Appliances to Treat Obstructive Sleep Apnea
Oral appliance therapy (OAT) has become an effective treatment option for patients suffering with mild-to-moderate obstructive sleep apnea, even though continuous positive airway pressure (CPAP) therapy remains the first line of defense. Many patients seem to prefer an oral appliance to CPAP, however, and Park Avenue Dental’s retainers help prevent the collapse of the tongue and soft tissues in the back of the throat to keep airways open during sleep and promote adequate air intake. What’s more, oral appliances may be used alone or in combination with other treatments for sleep-related breathing disorders such as the aforementioned weight management, surgery or CPAP.
The therapy process encompasses the selection, fitting and use of a specially-designed oral appliance that maintains an open, unobstructed airway in the throat when worn during sleep. Park Avenue Dental can customize these appliances, which have been proven by Dr. Sherman to be more effective than over-the-counter-style devices (not recommended as a “screening tool” nor as a therapeutic option), as dentists boasting training in oral appliance therapy are familiar with the myriad of designs and can help determine which is best suited for a patient’s specific needs.
The initial evaluation can last several weeks or months due to factors such as examinations, determination of the most appropriate oral appliance, fittings, adaptation maximizing of the appliance and function. Some of the advantages of oral appliance therapy to combat obstructive sleep apnea include:
• They’re comfortable and easy to wear
• They’re small and convenient to travel with
• They’re considered a treatment that’s reversible and non-invasive
In summary, oral appliances work by way of:
• Repositioning the lower jaw, tongue, soft palate and uvula
• Stabilizing the lower jaw and tongue
• Increasing the muscle tone of the tongue
With so many different appliances available, selection of a specific kind may appear to be something of a daunting task – but Dr. Sherman and Park Avenue Dental makes it simple by putting these devices for obstructive sleep apnea into two categories: Tongue Retaining Appliances and Mandibular Repositioning Appliances. Tongue Retaining Appliances hold the tongue in a forward position using a suction bulb, serving to keep the back of the tongue from collapsing during sleep and obstructing the throat’s airway. Mandibular appliances, meanwhile, reposition and maintain the lower jaw in a protruded position during sleep, serving to open the airway by indirectly pulling the tongue forward and stimulating muscle activity. The device also holds the lower jaw and other structures in a stable position to prevent the mouth from opening.