Sleep apnea is a serious medical
disorder that affects around 10% of American men over the age of 40, and
6% of American women of the same age. Those who sufferer from it completely
stop breathing during sleep, sometimes hundreds of times in a single
night, due to an obstructed air passage that causes a serious reduction of airflow to the lungs. It can be fatal.
These abnormal pauses in breathing during sleep occur when the soft tissue at the back of the throat relaxes during sleep and allows the tongue to obstruct the flow of air into the lungs. As a result, carbon dioxide levels rise in the blood, while oxygen levels decrease, causing the heart to beat harder and faster to compensate for the lack of oxygen. It’s estimated that 80 to 90 percent of adults with this problem remain undiagnosed and untreated. Because OSA increases risk for several life-threatening conditions, it’s important to tell your doctor—and your dentist—if you’re experiencing signs of sleep apnea.
Warning signs include daytime sleepiness, insomnia, snoring, morning headaches, poor memory and mood changes. It is estimated that 4% of men and 2% of women have OSA and, as a result, daytime sleepiness. If left untreated, OSA can contribute to the risk of serious health problems, such as high blood pressure, heart attack, stroke, and diabetes, especially for those who are overweight or obese. To help manage the effects of this disorder, patients are advised to avoid habits that can aggravate sleep apnea, such as smoking, alcohol consumption, and tranquilizer use; overweight patients are advised to lose weight, as well.
When OSA is suspected, patients may be referred to either a physician or a dentist who has special training in sleep medicine. Treatment options include CPAP, OAT, or oral surgery. The explanations below may help you decide which approach to treatment you would prefer.
Referral to a certified sleep medicine center offers a diagnosis by a physician, who determines the cause and scope of the apnea problem. Doctors frequently recommend CPAP (continuous positive airway pressure) therapy, which involves wearing a mask during sleep that is attached to a machine. As many as half of these patients find the noise of the machine and the discomfort of wearing a mask intolerable. Due to sleep disturbances caused by CPAP therapy, they often fail to comply and increase their risk of developing more serious health problems.
A dentist who is certified to practice Dental Sleep Medicine may recommend one of two treatment approaches. One involves wearing an oral appliance therapy (OAT) device, which repositions the lower jaw and moves the tongue forward in order to maintain a more-open upper airway during sleep. OAT is a safe and effective treatment option that reduces symptoms and helps to improve overall health. Wearing the appliance feels similar to wearing a sports mouth guard. This therapy is appropriate and effective for patients with a mild-to-moderate apnea
problem. It is also a viable option for those who have a more severe apnea, but who want to
avoid upper airway surgery.
In some cases, the dentist may recommend upper airway surgery, which has an impressive success rate. It is typically performed by a dental surgeon and offers a more permanent solution to obstructive sleep apnea. The surgery involves moving both the upper and lower jaws forward, helping move the tongue slightly forward so that it no longer obstructs airflow.
Susan Couzens, DMD, a member of the American Academy of Dental Sleep Medicine, can recommend the best approach to treatment. She has been helping patients with sleep-related breathing disorders, such as obstructive sleep apnea and heavy snoring, since 2009. She fabricates and fits the patient with an oral appliance to be worn during sleep or refers the patient to a dental surgeon for upper airway surgery. Either approach may be used to treat mild-to-moderate apnea and is especially appropriate for a patient who has severe apnea, but who cannot tolerate CPAP therapy.
The American Academy of Dental Sleep Medicine promotes the research and clinical use of oral appliance therapy and upper airway surgery for the treatment of sleep-related breathing disorders. The organization, which serves dentists worldwide, is dedicated to fostering the study and practice of oral appliance therapy, providing educational courses, and distributing cutting-edge information through peer-reviewed communications, as well as setting the standard protocol for appropriate treatment. More information is available at www.aadsm.org.