Sleep Dentistry

Obstructive Sleep Apnea and Sleep Dentistry

In my opinion, no other condition impacts general health as much as sleep apnea. Imagine that during your sleep someone chokes you for a whole minute, and repeats this every 5 minutes throughout the whole night. Worst of all, you don’t know it’s happening.

In our office, we take sleep apnea very seriously, mainly because it seems to be an underlying factor for many conditions. Furthermore, I have noticed that most of my patients who have had braces as teenagers after having had four sound teeth extracted for the purpose of “creating space,” invariably suffer from a multitude of deleterious effects, such as

• excessive tooth wear,
• orthodontic relapse,
• stunted jaw growth,
• jaw-joint dysfunction,
• a mid-face deficiency,
• a flat face with lack of proper lip support,
• insufficient jaw size to accommodate proper tongue position,
• snoring, and
• sometimes sleep apnea.

Sleep apnea often accompanies these patients because smaller jaws may not accommodate the tongue, which tends to fall back and obstruct the airway during sleep. As dentists, we must identify this serious disorder and offer treatment after a physician diagnoses it.

ADULT SLEEP APNEA FACTS:

• Obstructive Sleep Apnea, or OSA for short, afflicts 20 million Americans. 9% of men and 4% of women have OSA.
• Statistically, most heart attacks happen in the early morning hours. Many of these can be blamed on O.S.A.
• The Anales Medicina de Interna reported in 1999 that patients with untreated sleep apnea have a 37% chance of dying within 8 years.
• Nasal breathing and an ample oxygen supply encourage the nasal and sinus epithelium to produce Nitric Oxide, a tissue mediator that prevents blood clotting, protects arteries, and dilates blood vessels.

CHILDHOOD SLEEP APNEA FACTS:

• Most growth hormone is produced during the first few hours of sleep.
• 90% of growth and tissue repair happens during NREM stage 4 sleep.
• According to the American Academy of Pediatrics, all children should be screened for sleep apnea and treated immediately.
• Chronic tonsil and adenoid enlargement is the most common cause of childhood sleep apnea
• Since enlarged tonsils and adenoids are a major cause of sleep apnea and mouth breathing in children, consequently, smaller jaws and dental crowding are also common findings.
• A 2001 survey in the journal Pediatrics found that children who snored during early childhood tended to perform poorly in middle school.

HIGH RISK FACTORS FOR O.S.A.

• Being overweight
• Snoring (not all snorers have sleep apnea)
• Small or underdeveloped jaws
• Lower jaw too far back in relation to the upper jaw.
• Narrow upper airway diameter
• Increasing age
• Alcohol/tobacco/sedative use

SIGNS OF O.S.A.

• Snoring, intermittent, with occasional gasping for air
• Excessive daytime sleepiness
• Non-refreshing sleep
• Fatigue and irritability
• Morning headaches
• Gastro-esophageal reflux

CONSEQUENCES OF O.S.A.

Sleep apnea is considered an independent risk factor for the following conditions

• Poor memory
• Increased auto and work-related accidents
• Poor performance
• Depression
• Decreased quality of life
• Heart problems, increased chances for developing high blood pressure, arrhythmias or stroke
• Increased risk for adult type II diabetes

Diagnosis of O.S.A.

Because OSA is a life-threatening medical condition, a multidisciplinary approach is necessary to address it. A physician should be involved in diagnosing the presence and degree of sleep apnea. A physician should also conduct an examination to determine if other correlated health conditions exist, such as hypertension, cardiovascular disease, diabetes, and chronic fatigue.

Watch-PAT100

We are proud to carry this FDA-approved, compact, ambulatory sleep-monitoring system.

In the comfort of your own home, it is a welcome alternative to a stressful and expensive hospital-based sleep study. Based on the results of this study, an online pulmonologist provides a diagnosis, allowing us to start treatment much sooner.

Treatment of O.S.A.

For mild to moderate OSA, a dentist may fabricate an oral appliance to keep the airways open so enough air can flow into the lungs during sleep. This treatment is far more tolerable than the conventional CPAP machine, which many patients with OSA find very cumbersome to use. (CPAP is still required for severe sleep apnea cases). In our office, we conduct a thorough evaluation of the multiple contributing factors and signs of sleep apnea, including daytime sleepiness and nighttime sleep evaluation scores. Homeopathic and naturopathic treatment many times provides additional support in improving sleep quality or addressing the hormonal, biochemical, and physiological ravages of this condition.

Sleep hygiene

Among other things, implement the following habits to improve sleep quality.

1. Do not eat dinner within 3 hours preceding bedtime.
2. Follow a regular sleep routine by not staying up late and not oversleeping.
3. Cut back on alcohol, soda, and caffeine.
4. Take an herbal supplement or a hot herbal relaxing tea half an hour before bedtime.
5. Take a warm bath before bedtime.
6. Do not eat snacks, watch TV, or read in bed.
7. Follow a light, individualized exercise routine, preferably in the morning and one hour before dinner.
8. Avoid stressful or mentally challenging activities before bedtime.
9. Shut off all lights.