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SYMPTOMS OF SLEEP DISORDERED
BREATHING...
- LOUD SNORING
- DAYTIME TIREDNESS
- GASPING, CHOKING, STRUGGLE FOR BREATH OR STOP
BREATHING DURING SLEEP
- TOSS AND TURN FREQUENTLY
- AWAKENING REPEATEDLY DUE TO BREATHING
DIFFICULTY
- KICK OR JERK LEGS
REPEATEDLY
- MORNING HEADACHES
- GASTROESOPHAGEAL REFLUX DISEASE (GERD)
- POOR MEMORY OR CLOUDED INTELLECT
- IRRITABILITY, PERSONALITY CHANGES
- DECREASED SEX DRIVE, IMPOTENCE
- GRINDING TEETH AT NIGHT
- CARDIOVASCULAR DISEASE
- HEARTBURN
- DEPRESSION
- EXCESSIVE PERSPIRATION AT NIGHT
- DRY MOUTH UPON WAKING
- FREQUENT TRIPS TO THE BATHROOM DURING
THE NIGHT
- RAPID WEIGHT GAIN
RISK FACTORS
FOR SLEEP DISORDERED BREATHING...
- OVERWEIGHT
- INCREASING AGE
- CARDIOVASCULAR DISEASE
- PULMONARY DISEASE
- ABNORMAL TOOTH ALIGNMENT OR CROWDED
MOUTH
- TONGUE SCALLOPING (imprints of teeth
along the sides of the mouth)
- MALE GENDER
- POST-MENOPAUSAL WOMAN
- AFRICAN-AMERICAN
- FAMILY HISTORY
- DRINKING ALCOHOLIC BEVERAGES AT NIGHT
- SMOKING
- NECK SIZE GREATER THAN 17" FOR MEN and
16" FOR WOMEN
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MECHANISMS OF SLEEP
DISORDERED BREATHING:
Over 20 MILLION
Americans suffer from Sleep Apnea and don't even know it! An
apnea is when breathing stops for 10 seconds or more. Such
occurrences may last up to 90 seconds in length and may occur many times
an hour.
OBSTRUCTIVE SLEEP APNEA
is a potentially life threatening condition which prevents air from
reaching the lungs, even though your body continues to try and breathe.
Narrowing of the throat or a backwards movement of the tongue as one
falls asleep is usually the cause of obstructive sleep apnea.
As we age, the muscles
in the neck lose their tone and the accumulation of fat may also lead to
airway obstruction. Each time the airway is obstructed, the oxygen
level is lowered, blood pressure is raised, and blood sugar is raised.
SNORING is a partial
mechanical blockage of the airway. It can be caused by obstructed
nasal breathing, retruded tongue position, and loss of muscle tone in
the airway. Snoring can be present with or without sleep apnea.
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DIAGNOSIS OF SLEEP
DISORDERS
Traditionally, sleep disorders were
diagnosed and treated only by physicians such as primary care doctors,
ENT's, pulmonologists, and neurologists. Currently, the dental
profession plays an important role in early detection and treatment of
sleep disordered breathing. Modern technology has made it
practical for dental offices, such as the Center for TMJ & Sleep
Disorders, LLC, trained in dental sleep medicine and physicians trained
in traditional sleep medicine, to work together and treat patients
collectively. However, an accurate diagnosis may only be achieved
through the efforts of properly trained practitioners. Two
distinct testing protocols are used for diagnosis of sleep disorders:
OVERNIGHT POLYSOMNOGRAPHY (PSG) 
This test measures a variety of body
functions during sleep. It is conducted overnight in a clinic or a
hospital and sensors are attached to the body, measuring brain, heart
and muscle activity, eye movements, oxygen saturation, airflow through
the nose and mouth along with several other monitors. There is
audio and video taping of the entire test. Most medical insurance
companies reimburse for a PSG study, however, the typical deductible or
co-pay may range from $400. - $850. It is not unusual to have a
wait time of several weeks to obtain an overnight PSG test.
AMBULATORY or "AT HOME" SLEEP STUDY
 This test records many of the same
measurements as the PSG but it is conducted in the privacy of your own
home. Several devices are available. At the Center for TMJ &
Sleep Disorders, LLC, we use several devices, including the Watch Pat
ambulatory study and the MediByte ambulatory study. Both devices
have exhaustive clinical research validating their accuracy. The
take home studies are compact and easy to wear devices. You simply press the "on" button and then go to
sleep. The next morning the device is returned to our office and
results are received in a matter of minutes after downloading the
information to the computer. The average cost of an ambulatory study is far less than an
overnight lab study AND the device is more comfortable and less invasive. In
our office, you may walk out of the initial consultation with the device
and test yourself that same evening.
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TREATMENT
OPTIONS FOR SLEEP DISORDERED BREATHING...
WHY SEEK TREATMENT?
The long-term deprivation of oxygen to the
brain can result in many unpleasant symptoms such as exhaustion,
irritability, depression, impotence, memory loss, poor work performance, and
sudden unexpected falling asleep. In time, the chronic shortage of
oxygen and general stress on the body can lead to more severe conditions
such as high blood pressure and heart disease, stroke, and even death in
some cases.
CPAP (Continuous Positive Airway Pressure)
A CPAP Machine is a medical device that
delivers continuous air pressure through a mask attached to a pump.
The unit is usually placed next to the bed and is plugged in to a standard
household electrical outlet. It works by blowing positive air pressure
into the airway to keep it unobstructed during sleep. Proper
adjustment of the pressure is vital to achieve maximum benefits. Side
effects of using a CPAP machine may include:
laceration of the bridge of the nose from the mask
bloating of the stomach
nasal irritation and skin rashes
social implications
dry throat and sinus irritations
difficult to travel
noisy and uncomfortable
anxiety and claustrophobia
not suitable for pregnancy
limited sleeping positions
SURGERY
Several surgical procedures are utilized to
address snoring and sleep apnea. These include:
removal of tonsils and adenoids
RF (Radio frequency) surgery to shrink the obstructive tissues
UPPP (uvulopalaropharyngeoplasty)
LAUP (laser assisted uvulopalatoplasty)
tongue reduction surgery
jaw reconstruction
tracheostomy
As with all surgeries, there is a risk of
post-surgical complications. An ENT doctor or an oral surgeon trained
in these procedures will determine if you are a candidate for any of the
above to treat sleep disordered breathing.
ORAL APPLIANCE THERAPY
Dental devices are often a viable alternative
to CPAP Therapy. A specially designed oral appliance repositions the
lower jaw and tongue during sleep. It enlarges the airway by moving
the tongue and jaw forward, thus creating more space for the air to flow.
Our center has specialized equipment to measure the airway and predict the
success of an oral appliance. The appliances can be highly effective
for those who suffer from snoring and mild to moderate sleep apnea.
Benefits of an oral appliance include:
comfortable and easy to wear
small and convenient for travel
reversible and non-invasive
quiet, accepted by bed partner
high compliance rate
LIFE STYLE CHANGES
A few general measures, found below, may
benefit those suffering with snoring and obstructive sleep apnea:
Diet if you are overweight
Exercise regularly
Avoid alcohol before going to sleep.
Avoid taking sleeping pills.
Take only OTC medicines approved by your physician.
Sleep on your side.
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SLEEP DISORDERS DENTISTRY
Sleep Disorders Dentistry
is the dental treatment of Sleep Disordered Breathing with oral
appliance therapy. Obstructive sleep apnea is due to a mechanical
blockage of the airway. During sleep, the muscles in the throat
surrounding the airway, along with the tongue, relax. For those who
suffer with this condition, the relaxation occurs to the point where the
tissues and tongue restrict or completely block the airway.
An oral appliance works by opening
the bite and moving the lower jaw forward. This expands the airway.
Our office uses diagnostic tools to help determine the amount of tissue
collapse and correct positioning of the jaw for treatment. The correct
jaw position is critical for optimum air flow.
The specialized equipment is
comprised of a Pharyngometer which is a digital device to measure the oral
airway. The Rhimometer measures nasal airway and records obstructions.
The dental device is safe,
well-tolerated, and effective treatment for snoring and obstructive sleep
apnea.
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IF YOU SUSPECT SLEEP
DISORDERED BREATHING...
Call our office at
1-888-TMJ-SLEEP or
610-796-2835 for a
sleep screening.
Before any therapy is
performed in our office, a
diagnosis of snoring or obstructive sleep apnea is required.
An oral appliance is then made to fit comfortably and provide the maximum
amount of airflow through your airway. A follow-up sleep test will be
performed to screen for treatment efficacy.
Successful treatment of snoring and
sleep apnea should help you gain a fuller, more refreshed nights sleep.
Fewer interruptions will leave you with a higher energy
level, greater alertness, and a new outlook on life!
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CHILDREN AND
SLEEP DISORDERED BREATHING
Does
your child
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sleep in an abnormal position, with head off the bed
or propped up with pillows?
snore loudly and often?
stop breathing during the night for 10-20 second
periods, followed by choking, gasping or waking up?
sweat heavily during sleep?
wet the bed?
seem difficult to wake up, even though sleep should
have been long enough?
have headaches during the day, particularly in the
morning?
act irritable, aggressive or cranky?
fall asleep or daydream in school or at home?
have school-related or other behavioral problems?
been diagnosed with Attention Deficit Disorder with
Hyperactivity? (ADHD)
If your child is
experiencing any of the above, he or she could be suffering from Sleep
Disordered Breathing. This is a condition that results from an
obstructed, narrowed, or collapsed airway, either in or behind the nose
or the throat. As a result of the compromised airway, oxygen is blocked
from entering the lungs.
In children, this lack
of oxygen during sleep is generally caused by one of two things:
enlarged tonsils or adenoids or a malformation in the oral-facial area
such as the teeth, jaws, nasal passages, etc.
If your child is
experiencing any of the behaviors listed above, our office may be able
to help. Along with a thorough examination and visual inspection of the
oral airway, we are able to use non-invasive technology to map a
real-time picture of your childs nasal passages and oral airway. This
technology uses sound waves to detect possible constrictions and
obstructions that may be preventing the normal oxygen flow while your
child sleeps.
If the problem lies in
the nasal passages or adenoids and tonsils, our office will refer your
child to an otolaryngologist (ENT). If the problem lies in the anatomy
of the oral-facial area, our office will provide you with the education
and a treatment plan as to how this may be corrected. Some treatments
include orthodontics (palatal expansion, braces) and
oral appliances which open
the airway while sleeping to allow proper breathing.
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HEALTHY SLEEP TIPS:
- Go to bed
and try to awaken on a consistent schedule,
even on weekends.
- Avoid
caffeine, nicotine and alcohol, within three
to six hours of bedtime.
- Avoid heavy
meals within three hours of bedtime.
- Use your bed
only for resting, sleeping, and intimacy.
- Exercise
moderately for 30 minutes a day, but no
later than three hours before bedtime.
- Sip warm
milk or herbal tea before bed.
- Prior to
sleep, snack on bananas, turkey, peanut
butter or other tryptophan-rich foods to
gain the aid of this naturally calming
compound.
- Nap no later
than mid-afternoon to avoid sleep
interferences.
- To help your
mind disengage, write out your "to do" list
or worries before bed.
- Use massage,
meditation, soothing music, yoga,
biofeedback, a warm bath or other techniques
that help the brain relax and unwind.
- Keep the
bedroom dark, cool, and quiet.
- If you
cannot fall asleep within 20 minutes, get
out of bed and read something soothing for a
while.
- If sleep
continues to elude you, consider a visit to
a sleep specialist.
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SLEEP TIPS FOR SHIFT WORKERS:
On The Job at Night:
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Take Short Nap
Breaks throughout the shift. Naps can restore alertness,
enhance performance and reduce mistakes and accidents. A study at
NASA on sleepy military pilots and astronauts found that a 40-minute
nap improved performance by 34% and alertness 100%. However, even a
short nap (20-30 minutes) may help. Keep in mind that a long nap or
a nap taken shortly before bed time may adversely affect the length
and quality of sleep.
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Try to be active
during breaks. Take a walk, shoot hoops in the parking lot or
even exercise.
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Drink a
caffeinated beverage. Drinking coffee, tea, or cola will
promote alertness, but you can easily build a tolerance to it, so
save it for when you really need it.
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Dont leave
tasks requiring the most alertness or the most tedious or boring
tasks to the end of your shift when you are apt to feel the
drowsiest. Night shift workers are most sleepy around 4-5 am.
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Get support from
your co-workers. Exchange ideas with your colleagues on ways to
cope with the problems of shift work. Set up a support group at
work so that you can discuss these issues and learn from each
other. Try a buddy system so that you can care of each other and
switch responsibilities.
SLEEP TIPS
FOR CHILDREN:
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Follow a consistent
routine at bedtime
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Establish a
relaxing and calm environment at bedtime
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Use personal
interaction with your child instead of watching TV or videos
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Don't let your
child fall asleep while nursing, with a bottle, or being held or
rocked.
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SLEEP
DISORDERS DENTISTRY 
