SLEEP is one of the most important things we as human beings must do. It is an essential component to optimal health, just as is good nutrition and exercise. Sleep provides the physical and emotional renewal we require and is interwoven with every facet of our health, productivity and well being including, energy, emotions, moods swings, behavior, marriage stability, employment factors and happiness. We are created to spend one third of our lives sleeping. If you try to sleep less hours a day, because you think it is a waste of time, you may end up with multiple illnesses, mental disabilities, or a shorter life expectancy before reaching your goal.
Dentists play an important role in the team approach to the treatment of obstructive sleep apnea. Physicians, dentists, psychologists, and respiratory therapists all pool their knowledge to treat each patient appropriately and effectively. Dentists who are specifically trained in aspects of sleep medicine and have a command of multiple appliance modalities are of great help to physicians in treating patients with sleep disordered breathing problems.
While there are many factors why we may not have a good night sleep, such as worries and depression, many people cannot have a peaceful sleep because their sleep is under attack by other forces, such as loud snoring and obstructive sleep apnea. When we sleep, our body relaxes its legs, arms, face, neck, nerves, muscles, and also relaxes the soft tissues in the oral region such as the uvula, soft palate, tonsils, adenoid tissue and tongue. If these muscles relax too much and the tongue falls back too far, it narrows the airway and causes various sleep-related breathing disorders.
If you have such disorders you may experience not only loud snoring, choking and gasping while asleep, but may also suffer from difficulty in breathing, shallow sleep and multiple arousals, which can contribute to an un-refreshed feeling in the morning, daytime sleepiness, morning headache and chronic fatigue. According to many clinical studies and observations, un-treated sleep breathing disorders, especially obstructive sleep apnea, can cause serious health problems. Cardiovascular complications, high blood pressure, worsening diabetes, gastro-esophageal-reflex-disease (GERD), stroke, and sudden death during sleep have all been linked to obstructive sleep apnea.
What is Sleep Apnea?
Sleep apnea is a serious, potentially life threatening sleep disorder. It is as common as adult diabetes and affects more than 12 million Americans. The Greek work apnea means "want of breath". Sleep apnea refers to episodes in which a person stops breathing for 10 seconds or more during sleep. With each episode, the sleeper briefly wakes up in order to resume breathing, resulting in extremely fragmented, poor quality of sleep.
What are the different types of Sleep Apnea?
There are three types, all of which can severely disrupt the regular sleep cycle:
1. Obstructive apnea (OSA)-The walls of your throat relax as you sleep but in this condition they relax to the point where the airway collapses and prevents air from flowing into your nose and mouth, but efforts to breath continue. This is the most common type.
2. Central apnea-Breathing interruptions during sleep are caused by problems with the brain mechanisms that control breathing.
3. Mixed apnea-Begins with central apnea but usually becomes obstructive in the same cycle.
What are the symptoms of obstructive sleep apnea?
1.Morning headaches
2.Excessive daytime sleepiness
3.Irritability and impaired mental or emotional functioning
4.Excessive snoring, choking or gasping during sleep
5.Heartburn What is the difference between snoring and sleep apnea?
Unlike mild snoring individuals with sleep apnea stop breathing completely for 10 or more seconds with frequency of waking episodes between 10-60 times in a single night. If your partner hears loud snoring, punctuated by silences and then a snort or choking sound as you resume breathing, this pattern could signal sleep apnea. Not all snores will develop sleep apnea and not all sleep apnea patients snore.
Why is sleep apnea a concern?
1.Fatigues during the day
2.Driving skills are similar to that of a drunk driver
3.Can lead to impaired daytime functions
4.High blood pressure, heart attack and possible stroke
5.Stress an already weakened heart during sleep
Who is at risk for developing sleep apnea?
1.There is an estimated 18 million American with sleep apnea. 2.The risk is higher in men
3.It is under diagnosed in women and African Americans
4.Runs in families
5.Loud snoring.
6.Physical abnormality in the nose, throat, or other parts of the upper airway
7.Obesity
8.High blood pressure
9.Smoking
10.Use of alcohol or sedative and sleep medications
How your Dentist Can Help?
Your dentist can refer you to a sleep specialist for a proper diagnosis. If you have been diagnosed with sleep apnea your dentist can work closely with the diagnosing physician to implement and mange the prescribed therapy.
What are my treatment options?
Treatment is based on medical history, physical examination and results of polysomnography, which measure heart rate and how many times breathing is interrupted. Treatment for mild OSA may as simple as not sleeping on your back. Dental appliances that reposition the lower jaw and the tongue have been helpful to some patients with mild sleep apnea.
Severe sleep apnea, a nasal continuous positive airway pressure, resembling something a jet pilot might wear-is a commonly prescribed physical therapy. It delivers air through a small mask that covers the nose. The constant pressure keeps the airway open, which prevents snoring and episodes of apnea. Medications are generally ineffective. Oxygen is a controversial treatment and it doesn't eliminate sleep apnea or daytime sleepiness and in not used to treat patients with obstructive sleep apnea.
AGD Impact pg 24, January 2004
Updates on Sleep Apnea
Alert! Always get the reflux under control before considering the sleep apnea. Apnea is nasty but Barrett's esophagus is life threatening and is a much worse thing to have. Remember, weekly or more reflux is an indication that things are getting worse. If left untreated Barrett’s can lead to needing surgery. People who have Barrett's esophagus have a 30 to 40 fold increased risk of developing esophageal adenocarcinoma as compared to the general population. Don't ignore reflux, you can die.
New Breathing Machines Could Help Bring People Sleep
Researchers hope to solve restless sleep, which can aggravate other medical conditions. The Cleveland Clinic is testing breathing machines worn over a patient's nose overnight. The machine, called a Continuous Positive Airway Pressure (CPAP), opens the airway to stop symptoms of sleep apnea, a condition in which people repeatedly stop breathing as they sleep -- sometimes for as long as a minute at a time.
There are lots of physical reasons that can be serious that can cause insomnia. Diagnosis is important. Women may not be associating, or even thinking of other symptoms that may be connected to this.
Hormonal problems -a premature menopause and ovarian cysts cause symptoms of insomnia. Over training and lack of body fat can cause a change in hormone levels. Even if it's "only stress" simply medicating is short sighted. A good idea is to find a gynecologist and open minded physician to help with insomnia.
Treating sleep apnea can ease heartburn
Nighttime heartburn is common among people with a sleep disorder called obstructive sleep apnea, and a device used to treat this disorder may ease patients' heartburn. People with sleep apnea stop breathing for short periods during sleep. Most commonly due to upper airway obstruction, the condition can cause:
loud snoring
repeated near-wakening
increased blood pressure.
About 10 percent of people, who suffer from heartburn, have symptoms at night. People with nighttime symptoms tend to have a much worse quality of life than those whose symptoms occur only in the daytime. SOURCE: Archives of Internal Medicine 2003;163:41-45.
Speech impediments may prove an important diagnostic clue for assessing and treating sleep apnea. The researchers said 38 percent of the sleep apnea patients reported a history of stuttering or speech impairment. Overall, 7 percent of the general population stutters. In the future, doctors may monitor certain brain structures and examine children for speech or movement problems that may predict a higher sleep apnea risk. ADA News 20Nov2002
Sex Is Factor In Sleep Apnea
The public's perception is often that men are more likely to snore and, therefore, to suffer from sleep apnea, but this is not the case. This study suggests that the physical examination for this disorder should incorporate gender differences. The study found that women seeking medical help for sleep apnea were older, had a higher BMI, and had a lower apnea index, when compared with men. Men more often had an obstruction in the nose, a larger uvula and a shorter distance between the uvula and the pharyngeal wall. This differed from women, who revealed a more marked retro- position of the tongue and tended to have more gag reflexes. In women, BMI and the size of the uvula was associated with AHI; in men, the index score was associated with the BMI, the height of the tongue, the size of the uvula and the distance between the uvula and the pharyngeal wall. The researchers concluded that scores indicating a propensity for sleep apnea for men and women are associated with BMI and the size of the uvula. But for men alone, the easily identifiable predictive features for this disorder are a high position of the tongue, a decreased distance between the uvula and the pharyngeal wall; in women, a retro-position of the mandible and large tonsils seem to be the primary risk factors for obstructive sleep apnea. The research was published at the American Academy of Otolaryngology Head and Neck Surgery Foundation 9/02
Dental Appliance Beats Surgery for Sleep Apnea
A dental appliance worn at night appears to be more successful in treating obstructive sleep apnea (OSA) than surgery. People with OSA stop breathing dozens of times each night, causing them to gasp for breath. The condition is conservatively estimated to affect up to 4% of middle-aged Americans, and is particularly common among obese people.
Sleep apnea has been linked to daytime sleepiness, as well as an increased risk of high blood pressure and cardiovascular disease.
The Swedish study found the success rate in patients with OSA who wore the dental appliance was 81%, compared to 53% in OSA patients who had surgery. However, after 4 years, many patients were no longer wearing the device when they slept.
Surgery called uvulopalatopharyngoplasty (UPPP), in which tissue from the back of the throat is removed, may also be performed to treat OSA. This is the main surgical treatment for people with mild to moderate OSA, the study.
The current study compared UPPP to a dental appliance worn at night that pushes the lower jaw slightly forward, increasing airflow in and out of the throat. One group underwent UPPP surgery and the other patients were fitted with the dental appliance. All of the men went through a battery of sleep tests that evaluated their OSA before treatment and again 1 and 4 years after treatment.
"The success rate in the dental appliance group was 81%, which was significantly higher than in the UPPP group, 53%.
However, only 62% of the patients in the dental appliance group were still wearing the device when they slept after 4 years. But the researchers found that the:
dental appliance had few adverse effects on the jaw and throat
number of adjustments and repairs of the appliances over time was moderate.
