Sleep Apnea

The consequences of sleep apnea can be life threatening. An apneic individual is at much higher risk for a long list of serious conditions, such as heart attack, stroke, hypertension, and diabetes. Moreover, sleep apnea places an individual at much greater risk for depression, impaired cognition, gastric reflux, weight gain, and fatal auto accidents. 

• Do You Recognize Any of These Symptoms?
• Bed partner has observed the cessation of breathing while asleep
• Inability to finish reading or watching a movie without falling asleep
• Hypertension (high blood pressure)
• Diabetes
• Acid reflux
• Nocturia (excessive nighttime urination)
• Snoring
• Weight gain
• Kicking/jerking leg(s) while asleep
• Waking up choking or gasping for air
• Dry throat and mouth in the morning
• Morning headaches
• Depression
• Anxiety
• ADD/ADHD symptoms
• Feeling sleepy while sitting in traffic
• Dozing off while driving
• Inability to sleep through the night
• Slow metabolism
• Excessive daytime sleepiness

“It’s Just Snoring!” Or Is It?

Snoring is not simply a nuisance for bed partners. Research has shown that regular snoring – even mild snoring – increases one’s risk for carotid artery atherosclerosis and stroke. One should not dismiss snoring (particularly loud snoring) as a benign condition to be ignored. If you are a loud snorer, there is clinical justification to seek out a therapeutic remedy and/or delve deeper into whether you are suffering from a sleep breathing disorder.

How Can We Help You?

Our clinic specializes in oral appliance therapy in the treatment of obstructive sleep apnea. While a CPAP (“continuous positive air pressure”) machine is the gold standard in apnea therapy, many prefer the comfort and convenience of a custom fabricated oral appliance. As an oral wellness clinic and not simply a general dentistry, we approach your healthcare from a holistic, patient-centric perspective, focusing on your overall wellness and not solely on your teeth.

Our custom-made appliances will help prevent your airway from collapsing during sleep by holding your lower jaw in place so that your tongue and soft tissues are less able to obstruct your breathing. While the concept is simple, to adjust your appliance properly and determine clinical efficacy requires multiple visits to our clinic and a series of sonar and sleep testing because a two-millimeter difference in adjustment across two axes can mean the difference between a more open or closed airway. While our oral appliance will also treat your snoring as a side-effect, getting you breathing again is the goal of oral appliance therapy. We are not simply making a snore guard. We are utilizing state-of-the-art technology and best-practice standards of clinical care to ensure that you are properly treating your potentially life-threatening apneic condition.

Diagnosis

While an initial consultation or dental visit can assess risk factors, only a sleep study reviewed by a physician can determine for sure whether an individual has a sleep breathing disorder. The physician diagnosis combined with our in-office diagnostics and patient education will help determine which therapy is right for you. The process can be confusing, but our dedicated sleep medicine coordinator will help guide you through it all. If you are concerned or suspect you might have a sleep breathing disorder, contacting our office to schedule an appointment for an initial consultation is a good first step.

Sleep Studies

There are two types of sleep studies. The first type is an in-lab study but while the data is comprehensive, patients may find the experience to be uncomfortable. The patient must be wired from head to legs and will sleep in a laboratory or hotel bed under the scrutiny of a technician. The second option is a study done at home in one’s own bed, using a portable device worn on the head only. As part of our initial consultation, both options will be reviewed and explained by our sleep medicine coordinator so you are able to make the best choice to suit your preferences.

Although continuous positive airway (CPAP) pressure therapy is the most recommended treatment for patients with obstructive sleep apnea (OSA), not all patients are able to remain compliant with this form of treatment. Some complain of claustrophobia, dry nasal passages, skin irritation from masks, difficulty tolerating pressurized air, and accidentally removing the mask while tossing at night.

For patients like these, an alternative to CPAP therapy may be recommended, and depending on the level of severity of their disorder, may benefit from a substitute treatment such as an oral dental appliance.

What is an Oral Dental Appliance for Sleep Apnea?

Before diving into how oral appliances work, lets have a brief recap on what sleep apnea is, and how it affects your sleep and health. [If you're already familiar with how sleep apnea works, scroll down to dental appliances]

Obstructive Sleep Apnea

Obstructive sleep apnea is a sleep disorder in which a person stops breathing periodically throughout the night due to physical obstructions of the airway. These stops in breathing usually last for around ten seconds and are often followed by snorts, gasps, or choking sounds as a person's body fights to resume breathing again.

When you sleep, the muscles in your body relax so they can begin to repair themselves to keep you healthy and active everyday. However, muscles in your mouth and throat also relax during sleep, and for some people (an estimated 18-20 million U.S. adults) these muscles along with soft fatty tissues relax to the point where they fall back into the upper airway and block the flow of oxygen from coming in.

When you stop breathing during the night, your brain responds by partially waking to send signals to the respiratory system to work harder to get past the obstruction.

Side effects of obstructive sleep apnea include

• high blood pressure

• heart arrhythmias

• heart disease

• heart attack

• stroke

• increased risk of diabetes

• and even death

Sleep apnea even leads to excessive daytime sleepiness because each time your brain has to "wake up" to tell your body to continue breathing, it's not spending enough time doing all of the other functions that are necessary of quality sleep. Being tired all day can cause poor performance at work or school, memory and other cognitive troubles, depression, and even accidents while driving or while at work.

How severe one's sleep apnea is can be determined by the amount of apnea events (pauses in breathing):

• Mild OSA- The sufferer experiences 5-14 episodes of interruptions in breathing in an hour.

• Moderate OSA- The sufferer experiences 15-30 episodes of interruptions in breathing in an hour.

• Severe OSA- The sufferer experiences 30 or more interruptions in breathing in an hour.

Dental Appliances for sleep apnea

Before any treatment options can be determined, a sleep study must first be performed to determine the severity of one's symptoms as it can have a direct influence on the recommended therapy.

The most common form of therapy is continuous positive airway pressure (CPAP) devices, which blow a steady stream of pressurized air through a mask into the respiratory system. For moderate to severe sleep apnea patients, most sleep professionals will recommend CPAP therapy as a first-line treatment option.

For mild to moderate sleep apnea, a dental device is often the recommended therapy. Dental devices may also be recommended to be worn in conjunction a CPAP device to help lower high pressure needs.

How do dental appliances work?

There are two major categories of dental devices:

1. Mandibular advancement devices (MADs)

2. Tongue Retaining Mouthpieces

MADs used to treat sleep apnea look very similar to sports mouthguards or orthodontic retainers. They fit into the mouth by snapping over the upper and lower dental arches and have metal hinges connecting the two pieces: one fits over the upper teeth, and the other fits over the lower teeth.

MADs work by pushing the lower jaw and tongue slightly forward, which helps prevent throat muscles and issues (such as the pharynx) from collapsing back into the airways allowing for normal breathing during sleep. Most MADs are adjustable, allowing for dentists to fine-tune the position of the jaw for maximum effectiveness.

Tongue retaining mouthpieces are similar in construction to the MAD, but has a small compartment that fits around the tongue using suction to keep it held forward, preventing it from collapsing back into the airway. These devices are mostly used in patients who cannot adequately have their jaw repositioned forward.

Getting dental devices

You will have to have your dentist make a custom fitted oral device to suit your particular needs. Over-the-counter options are available, but not recommended. Over-the-counter devices may be appealing because of their reduced prices, but can actually complicate sleep apnea. Many patients who order oral devices without consulting with a dentist, find that their snoring symptoms went away, but were unaware that it was not preventing apnea events leading to complications down the road as only the snoring symptom was prevented but the disorder itself was not.

Pros of Dental devices

• Many patients find dental devices to be more comfortable and tolerable to wear as opposed to CPAP masks.

• Patients on CPAP often complain of dry, itchy noses from the air pressure drying out their sinuses. Oral devices do not have this problem.

• There is less equipment to become entangled with during sleep, or knock off during slumber, for patients who are active movers during sleep.

• There is a lot less equipment involved, and therefore easier to travel with.

Cons of Dental devices

• Jaw pain, soreness, or tension

• Sore teeth and/or gums

• Excessive salivation or even dry mouth

• Possible damage or permanent change to jaw position/bite

• Loosening of dental restorations (crowns, bridges, etc)

Who qualifies for dental appliances?

• Patients with mild to moderate sleep apnea (not recommended for moderate to severe sleep apnea)

• Patients with primary snoring (in absense of sleep apnea)

• Patients who have tried and failed at CPAP therapy may qualify

• Patients who were unsuccessful with or refused surgeries such as tonsillectomy, adenoidectomy, cranofacial operations, or tracheostomy.

• In combination with CPAP device to help lower patient's apnea/hypopnea index for more tolerable air pressure settings.

If you're concerned you have sleep apnea you should contact your local sleep clinic to schedule a consultation with a sleep specialist or talk with your primary care physician about your sleep troubles. Be sure to ask them about all of the available treatment options including CPAP and dental devices and inquire which may be best suited for you.