Sleep Apnea

You know it instinctively: A good night's sleep is essential for good health. It makes you feel rested and ready to take on the world. Yet many people don't get the sleep they need. Sometimes this is related to sleep-related breathing disorders (SRBD) — their own, or those experienced by their sleeping partners.

SRBD is characterized by recurrent episodes of reduced or interrupted respiratory airflow. This is caused by soft tissues near the back of the throat collapsing during sleep so that they partially close off the windpipe. These tissues — the tongue, for example — can vibrate as air passes by, causing snoring. Snoring is often worsened sleeping on one's back because this encourages the lower jaw to slip back, which in turn pushes the tongue in front of the airway.

Loud snoring often disturbs the person in the bed who isn't the one doing it, robbing him or her of vital sleep. The snorer, on the other hand, may seem to be slumbering peacefully, but this might not actually be the case. Chronic loud snoring is a common symptom of Obstructive Sleep Apnea (OSA; “a” – without; “pnea” – breath), which occurs when the upper airway is blocked to the point of causing significant airflow disruption, or even no airflow whatsoever for 10 seconds or more. This can be dangerous as reduced airflow into the lungs lowers blood-oxygen levels.

A person with sleep apnea may wake 50 or more times per hour — that's almost once a minute! — without having any memory of it. These awakenings, called micro-arousals, last just long enough to restore muscle tone to the airway so the individual can breathe. Unfortunately, all those micro-arousals preclude deep and restful sleep.

What to Look Out For

Obstructive Sleep Apnea is a serious matter as it can lead to heart problems and other health issues. It's possible you may have OSA if you snore and also suffer from any of the following:

Sleep Related Breathing Disorders


How Dentistry Can Help

Only a dentist can fabricate, fit, adjust, monitor, and treat complications associated with Oral Appliance Therapy used in managing SRBD. So if you or a loved one is experiencing any combination of the signs and symptoms mentioned above, a consultation with a dental professional is a good idea.

Common misconceptions of oral appliance therapy in the treatment of obstructive sleep apnea

Oral Appliance

MYTH #1: ORAL APPLIANCES CAUSE BITE CHANGES:

The literature reports that bite changes can occur with patients wearing an oral appliance for long periods of time, anywhere from 3% to 40%. As a result, we have developed an exercise program for our sleep apnea patients. This involves having the patient clench on the back teeth in the morning after the appliance has been removed, four times per minute, until the back teeth interocclude. Those patients that have been using this exercise program have little to no bite changes.

Recent literature seems to indicate that bite changes are related to the development of additional fibrous tissue in the temporomandibular joints, which has created a mandible in a more anterior position. As a result of this anteriorization of the mandible, the bite has changes resulting in a posterior open bite. This exercise program seems to stimulate the tissue within the temporomandibular joint and prevent such changes.

MYTH #2: ORAL APPLIANCES CAUSE TEETH LOOSENING:

Teeth loosening clearly can be an issue in long-term wearing of an oral appliance. Basically, the dentition is what is preventing the mandible from retruding and holding the base of the tongue in a forward position. We carefully examine the patients at their initial evaluation. As dental professionals, training is devoted to the maintenance of this support apparatus of the tooth.

Therefore, we are acutely aware of this possible risk. In isolated cases, splinting of the teeth may be necessary to prevent loosening. We monitor these patients during active treatment and annually to avoid any significant issues related to tooth mobility.

MYTH #3: ORAL APPLIANCES ARE ONLY FOR MILD CASES OF OSA

The position of the American Academy of Sleep Medicine (AASM) states, “All appliances are indicated for use in patients with mild to moderate OSA who prefer them to continuous positive airway pressure (CPAP) therapy, or who do not respond, or who are not appropriate candidates for, or who fail treatment attempts with CPAP”. We have been treating patients with both moderate and severe degrees of obstructive sleep apneas. Studies prove that many of the moderate cases have completely resolved their sleep apnea and have used this as their only treatment modality. Some of the advanced cases of sleep apnea have also eliminated their sleep apnea. Other cases who are completely CPAP intolerant have had substantial reductions in their sleep apnea.

MYTH #4: THERE IS ONLY ONE APPLIANCE THAT IS USED AND CAN BE USED FOR OSA

This is clearly false. At present, we have the ability to utilize five different appliances in our office. Briefly, they are: Herbst appliance, Klearway appliance, TAP 3 appliance, SUAD appliance, and the SomnoMed appliance. All of these appliances have different advantages and we attempt to utilize the appropriate appliance to the specific needs of the patient.

MYTH #5: ORAL APPLIANCES CAUSE TEMPOROMANDIBULAR JOINT (TMJ) ISSUES AND MUSCLE PAIN.

One of the primary subspecialties in our office has been the treatment of patients with TMJ. We carefully examine all patients at their initial visit for any symptoms of Temporomandibular Joint Dysfunction.

These symptoms can be pain in the TMJ or the muscles that move the mandible. The patients are informed of the degree of TMJ involvement and the effect of this involvement on their ability to use a sleep appliance. The appropriate sleep appliance is constructed for these patients, and is carefully monitored. When difficulties occur in the TMJ region, changes in our advancement protocol and/or referral for physical therapy are often utilized to allow these patients to function with oral appliances. Most of these patients are successful using their appliances long-term. On occasion, a patient may have severe TMJ that does not allow for them to wear an oral appliance successfully; however, this is the exception rather than the rule.

Call Attleboro Center for Dental Sleep Medicine in Attleboro Falls, MA at (508) 699-9550 to learn more about our Sleep Apnea treatments today!

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