Oral appliances (OA) are a front-line treatment available in comprehensive family dentistry for patients with varying needs. They are frequently recommended as the initial treatment for mild to moderate sleep apnea but are also used in conjunction with CPAP therapy to enhance breathing. Indications for Oral Appliance Sleep Apnea therapy Mild to moderate Obstructive Sleep…
Sleep Apnea Diagnosis and Treatment
Dentistry’s involvement in diagnosis and treatment of sleep apnea
Contemporary research has show that as much as 85% of people with obstructive sleep apnea, or OSA, are currently undiagnosed. This is a significant health risk that is responsible for many chronic and potentially serious medical conditions.
Health Risks associated with Sleep Apnea
- High blood pressure
- Increased risk of heart attack
- Increased risk of stroke
- Weight gain
- Development of Type 2 diabetes
- ADHD risk in children resulting in poor school performance.
Signs and Symptoms of Sleep Apnea
- Loud snoring: a more prevalent sign in men than woman.
- Cessation of breathing witnessed by your bed partner: this is called an apneaic event and usually follows a snoring episode. You literally stop breathing for many seconds and then gasp for breath after the blockage stops.
- Recurrent nighttime awakenings
- Daytime sleepiness and/or forgetfulness
- Falling asleep when sitting for a few minutes. This may be in a chair in your office or even in your car at a stoplight.
- Morning headaches and tooth clenching or grinding
Diagnostic issues and dentistry’s involvement
Sleep apnea often goes undiagnosed. Medical doctors usually can’t detect the condition during routine office visits. Also, no blood test can help diagnose the condition. It is only when you complain about sleep problems to your doctor will something be accomplished. The problem here is that many people have sleep problems and simply accept it as normal and, as a result, never mention it to their doctor.
We as dentists know that there are certain oral anatomic signs that alert us to the potential for sleep apnea. At that point we administer a medical industry standard sleep questionnaire that gives us more direction. If we strongly believe that you have sleep apnea we will work with your medical doctors to properly diagnosis the severity of the problem.
In some mild cases of sleep apnea, you may be able to treat it by changing your behavior. Understandably this can be difficult for some. Proper assessment is critical.
- Losing weight
- Avoiding alcohol and sleeping pills. Both may seem to help you “get” to sleep, but both actually are detrimental to good sleep.
- Changing sleep positions to improve breathing.
- Stopping smoking. Smoking can increase the swelling in the upper airway, which may worsen both snoring and apnea.
- Avoiding sleeping on your back.
CPAP and Oral appliance therapy
More severe sleep apnea will require additonal treatment.
Continuous positive airway pressure is a treatment in which a mask is worn over the nose and/or mouth while you sleep. The mask is hooked up to a machine that delivers a continuous flow of air into the nose. This air flow helps keep the airways open so that breathing is regular. CPAP is considered by many experts to be the most effective treatment for sleep apnea. However, many patients have great difficulty in adjusting to the CPAP device.
- Oral appliances
Oral appliances can be fabricated for many people and will effectively treat mild to moderate sleep apnea. Addtionally, oral appliances can be use in conjunction with CPAP to reduce the pressure and make the device more tolerable.