We all know that the hustle and bustle of modern society can create many problems for our sleep. Many of us work long hours, wake early, have long commutes to and from work, as well as responsibilities at home. This creates a significant amount of fatigue in our lives and poses serious health risks due to lack of sleep duration and quality sleep. However, even those who get the recommended 7.5 hrs of sleep per night can still wake up feeling groggy, disoriented and not ready to tackle the day. It can be a struggle to get out of bed let alone function at a high level with adequate concentration if sleep deprivation occurs. So why do people who sleep enough still have these concerns? It could be related to a sleep disorder known as sleep apnea.

So What Exactly is Sleep Apnea?

The term apnea is defined as a temporary cessation of breathing. When this occurs during sleep it can be a potentially serious disorder with significant health risks.

There are three types of sleep apnea:

  1. Obstructive Sleep Apnea (OSA) which is the most common
  2. Central Sleep Apnea which relates to lack of brain communication with the respiratory muscles during sleep
  3. Complex Sleep Apnea which is a combination of both OSA and central sleep apnea.

What Causes Obstructive Sleep Apnea?

OSA is a sleep related respiratory disorder characterized by reduced or total blockage of airflow during inspiration while asleep. This is caused by soft tissue blockage, either via the tongue or other surrounding tissues in the back of the throat such as the soft palate. This reduction or cessation in air flow causes decreased airflow to the lungs which causes poor oxygen perfusion to the blood. The lower amount of oxygen in the blood then decreases oxygen delivery to the brain as well as all other organs in our body. This can create severe fatigue problems if the oxygen levels of the blood drop too low for a prolonged period of time, as well as other possible health risks.

Obstructive Sleep Apnea compared to snoring and normal breathing

Common Signs & Symptoms of OSA

Both OSA and Complex sleep apnea may have similar signs/symptoms, therefore it is imperative a screening be done by a dentist or physician for the proper referral to the appropriate physician who has extensive training in sleep apnea. Some common signs and symptoms are:

  • Recent increase in weight gain
  • Excessive daytime sleepiness
  • Attention problems
  • Irritability
  • Loud snoring which may be heard by bed partner as well as periods of apnea during sleep
  • Suddenly waken during sleep with the feeling of gasping for air or labored breathing
  • Morning headaches
  • Insomnia (problems staying asleep)
  • Dry mouth
  • Nocturnal Bruxism (grinding of teeth at night)

It should be noted that not everyone who snores has sleep apnea which is why it is imperative to seek medical advice to determine if your snoring is related to sleep apnea. If your snoring is not related to sleep apnea there may be other underlying conditions which may be attributing to it. Proper referral to an ENT maybe made by a dentist to rule out other conditions. Sometime patients may be fitted with an intra-oral appliance to reduce the amount of snoring even in the absence of sleep apnea. Your bed partner may thank you!

What are the health risks associated with sleep apnea?

  • Increased risk of high blood pressure or associated heart problems & stroke
  • Increased risk Type II diabetes
  • Increased risk of Metabolic syndrome which includes abnormal cholesterol levels, hypertension, increased blood sugar levels
  • Problems with Anesthesia during surgery if undiagnosed
  • Increased risk of fatty liver
  • Sleep deprivation associated with snoring for ones bed partner

How is OSA diagnosed and treated?

It is important that the type of sleep apnea be diagnosed by the appropriate physician. Your family practice physician or dentist may screen you for sleep apnea by asking multiple questions related to your sleep, evaluating your airway, tongue, teeth as well as height and weight calculations and neck circumference measurements. You may also be asked to fill out a form called an Epworth sleepiness study to determine your probability of having a sleep associated disorder.

Once it is determined that there is an increased risk for sleep apnea, a referral to a board certified sleep physician will be given. At this time more evaluations may be performed including looking at the back of the throat and vocal cords with a endoscope which is a flexible tube with a camera on the end. This allows the physician to visualize structures your dentist or other physician could not see with the oral exam.

In order to give the appropriate diagnosis, the patient will then be sent to a sleep lab for a polysomnogram (PSG). The patient with be evaluated by a overnight sleep physician and technicians in which machines monitor you sleeping and breathing. Once the PSG is performed the report is then read by the board certified sleep physician and a diagnosis given depending upon the parameters of your results. Usually a follow-up will be done by the sleep physician and treatment recommendations will be provided.

What is the Dentist’s Role in Sleep Apnea?

The gold standard given by the American Academy of Sleep Medicine for the first line of defense against OSA is the CPAP or continuous positive airway pressure. This medical device is worn at night and works by providing a steady stream of air which is titrated (adjusted for optimal use) by the lab to keep the airway open and allow for unobstructed breathing at night. Depending upon the severity of your diagnosis you may be given the option of wearing an intra-oral appliance fabricated by your dentist. A diagnosis of mild to moderate may warrant the use of these types of devices. Also, if you have previously be prescribed a CPAP for mild, moderate or severe OSA and find that it is restrictive to your sleep, a viable alternative maybe the intra-oral appliance. This is otherwise known as CPAP intolerance.

How Does the Intra-Oral Appliance Work?

Essentially the intra-oral appliance works by mechanically pulling the lower jaw forward and opening the airway behind the tongue. This movement actually increases the volume of the airway and prevents the tongue from falling back during sleep and blocking the airway. It may also reduce the amount of snoring during sleep. You will need to be seen by your dentist for fabrication of the device and adjustments, known as titrations, to find the best position of the lower jaw. If you suspect you may have sleep apnea, ask your family physician or dentist to do an oral evaluation for sleep apnea. Who knows, this screening may eventually save your life or your marriage.