Over 20 MILLION Americans suffer from Sleep Apnea and don't even know it! An apnea is when breathing stops for 10 seconds of more. Such occurrences may last up to 90 seconds in length and may occur many times and 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.
Symptoms of Sleep Disordered Breathing:
- Loud Snoring
- Daytime tiredness
- Gasping,choking,struggling for breath during sleep
- 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
- Griding teeth at night
- Cardiavascular disease
- Excessive perspiration at night
- Dry mouth upon waking
- Rapid weight gain
- Frequent trips to the bathrrom during the night
Risk Factors for Sleep Disordered Breathing:
- Neck size greater than 17" for men and 16" for woman
- Increasing age
- Cardiovascular disease
- Pulmonary disease
- Abnormal tooth alignment or crowded mouth
- Tongue scalloping (imprints of teeth on tongue
- Male gender
- Family history
- Drinking alcoholic beverages at night
*If you have any of these symptoms, please contact our office for an evaluation.
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” 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.
A CPAP(Continuous Positive Airway Pressure) 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 into 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:
- Bloating of the stomach
- Nasal irritation and skin rashes
- Social implications
- Dry throat and sinus irritations
- Difficult to travel
- Noisy and uncomforatble
- Anxiety and claustrophobia
- Not suitible for pregnancy
- Limited sleeping positions
- Laceration of the bridge of the nose from the mask
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.
Several surgical procedures are utilized to address snoring and sleep apnea. These include:
- Tongue reduction surgery
- Jaw reconstruction
- Removal of tonsils and adenoids
- UPPP (uvulopalarophyngeoplasty)
- LAUP (laser assisted uvulopalatoplasty)
- RF (Radio frequency) - surgery to shrink obstructive tissues
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 appliance 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
A few general measures, found below, may benefit those suffering with snoring and obstructive sleep apnea:
- Sleep on your side.
- 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 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 Rheometer measures nasal airway and records obstructions.
The dental device is safe, well-tolerated, and effective treatment for snoring and obstructive sleep apnea.
Children & Sleep Disordered Breathing:
Does your child:
- Wet the bed?
- Fall alseep or daydream in school or at home?
- Snore loudly and often?
- Act irritable, aggressive or cranky?
- Sweat heavily during sleep?
- Have school-related or other behavioral problems?
- Sleep in an abnormal position, with head off the bed or propped up with pillows?
- Have headaches during the day, particularly in the morning?
- Seem difficult to wake up, even though sleep should have been long enough?
- Been diagnosed with Attention Deficit Disorder-with Hyperactivity? (ADHD)
- Stop breathing during the night for 10-20 second periods, followed by choking, gasping or waking up?
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 child’s 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.
If You Suspect Sleep Disordered Breathing...
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 night sleep.
Fewer interruptions will leave you with a higher energy level, greater alertness, and a new outlook on life!