SLEEP DISORDERS, SNORING, AND SLEEP APNEA


Dentists are becoming increasingly active in recognizing patients with sleep disorders.  A dentist trained to recognize sleep disorders may observe a patient with a history of fatigue and non-restorative sleep who may be overweight with a large neck, signs of mouth breathing, and a high palate.


Trained dentists would refer the patient to a physician, commonly a medical specialist (pulmonologist) who would order a sleep study (polysomnogram).  This study documents the number of sleep arousal episodes as well as monitors the blood oxygen levels and makes the diagnosis of a sleep disorder.After the proper diagnosis is made by a physician, a dentist trained to treat this condition, can provide one of many designs of oral sleep appliances.  Patients with sleep disorders except those with Severe Sleep Apnea and Central Sleep Apnea may be treated with oral appliances. Physicians may also prescribe the use of a Continuous Positive Airway Pressure device (CPAP).

There is a great deal of correlation between sleep apnea and poor jaw alignment. If the mandible must go posteriorly to occlude the teeth while chewing and swallowing, the tongue must go back towards the throat impairing the pharyngeal airway.  People that have temporomandibular disorders often have damaged and loose joint ligaments, permitting the jaw during sleep to fall further back, worsening the already compromised airway.  High coincident prevalence of patients with sleep disorders and TMD have been reported. Combined treatment by a neuromuscularly trained dentist of a TMD with a daytime removable orthosis and a properly designed and adjusted oral sleep appliance can be very helpful to patients suffering from both conditions.

When there is airway obstruction during sleep, the blood oxygen level drops. Heart rate goes way up to get more oxygen to the brain. Sometimes the heart beats three times its normal rate during these episodes! Such an occurrence night after night, weakens the heart muscles, which may result in an enlarged heart. People with sleep disorders struggle in response to this "choking". This high stress event results in the release of the stress hormone, cortisol. High cortisol levels lead to weight gain, which only worsens the airway obstruction.  It could be assumed that this would awaken a person. While this "choking" disturbs the sleep cycle, often it is not enough to completely wake a person up. Patients suffering from a sleep disorder do not experience a restful sleep.  They are often tired, sleepy and irritable during the day.

Sleep Disordered Breathing (SDB)

The most common Sleep Disordered Breathing is related to obstruction of airway. It is a continuum with varying degrees of blockage of airway. On the milder end of the spectrum is snoring. If the obstruction is partial, there is vibration of the soft palate that constitutes the noise of snoring. If the blockage leads to a mild (less than 4%) drop in blood oxygen level it is termed a Hypopnea. RERA (Respiratory Effort Related Arousal) is the phenomenon of struggling for breath that disturbs the sleep. Complete stopping of breathing of over 10 seconds with effort to breath and leading to more than 4% drop in blood oxygen level is Obstructive Sleep Apnea (OSA). The frequency of events per hour determines if OSA is mild, moderate or severe (over 30 events per hour).

It is estimated that 50 million Americans suffer from sleep apnea. Losing sleep deprives patients of a sound quality of life. Obstructive sleep apnea (OSA) is associated with snoring, daytime drowsiness, obesity, and other risk factors. Patients with OSA may be at increased risk for any of the following:

High blood pressure, Irregular heart beats, Heart attacks, Stroke, Decreased libido, Impotence, Gastro esophageal reflux disease (GERD), Heartburn, Morning headaches, Dry mouth, Irritability, Impaired concentration, Depression

Dental sleep appliances are not night guards, typically given to patients who clench or grind their teeth while sleeping.  They are maxillo-mandibular appliances designed to move the jaw anteriorly during sleep along with the tongue, thereby increasing the airway volume for better breathing and oxygenation.


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