Dental Sleep Medicine (Sleep Apnea)
Snoring & Sleep Apnea
What Causes Snoring?
Snoring occurs when the soft tissue structures of the upper airway collapse onto themselves and vibrate against each other as we attempt to move air through them. This produces the sound we know as snoring. Large tonsils, a long soft palate, a large tongue, the uvula, and excess fat deposits in the throat all contribute to airway narrowing and snoring. Usually, the more narrow the airway space, the louder or more habitual the snoring.
Obstructive Sleep Apnea
Obstructive Sleep Apnea (OSA) occurs when the tongue and soft palate collapse onto the back of the throat. This blocks the upper airway, causing airflow to stop. When the oxygen level drops low enough, the brain moves out of deep sleep and the individual partially awakens. The airway then contracts and opens, causing the obstruction in the throat to clear. The flow of air starts again, usually with a loud gasp. When the air flow starts again, you then move back into a deep sleep. The airway muscles collapse, as you awaken with a gasp. The airway clears once again as the process repeats itself. This scenario may occur many times during the night. The combination of low oxygen levels and fragmented sleep are the major contributors to most of the ill effects that the sleep apnea patient suffers. In addition to excessive daytime sleepiness, studies show that sleep apnea patients are much more likely to suffer from heart problems (heart attack, congestive heart failure, hypertension, atrial fibrillation), strokes, as well as having a higher incidence of work and driving related accidents.
Diagnosis of Obstructive Sleep Apnea
Since OSA is a serious medical condition, it must be diagnosed by a physician. Diagnosis is based on the results of an overnight sleep study called a Polysomnogram (PSG) or ambulatory (home based) study. Other factors of determining OSA are patient evaluation and history.
Good sleep hygiene, weight loss, and exercise are some helpful OSA treatments a patient can practice on their own. However, medical and dental treatments include Continuous Airway Pressure, Oral Appliance Therapy, and surgery.
Continuous Positive Airway Pressure
Continuous Positive Airway Pressure (CPAP) is pressurized air generated from a bedside machine. The air is delivered through a tube, connected to a mask, covering the nose. The force of the pressurized air splints the airway open. The CPAP opens the airway like air into a balloon; when air is blown into a balloon, it opens and gets wider. This is exactly how CPAP clears the airway.
Oral Appliance Therapy
Oral Appliances are worn in the mouth to treat snoring and OSA. These devices are similar to orthodontics retainers. Oral Appliance Therapy involves the selection, design, fitting and use of a custom designed oral appliance that is worn during sleep. The appliance then maintains an opened, unobstructed airway in the throat. There are many different oral appliances available. Our office strictly adheres to the American Academy of Sleep Medicine guidelines and only uses FDA approved appliances. Oral appliances may be used alone or in conjunction with other means of treating OSA.
These means include general health, weight management, surgery, or CPAP. Oral Appliances work in several ways:
• Repositioning the lower jaw, tongue, soft palate and uvula
• Stabilizing the lower jaw and tongue
• Increasing the muscle tone of the tongue
As a Diplomate of The American Board of Dental Sleep Medicine, Dr. Dean is experienced with the various designs of oral appliances and can determine which one is best suited for your specific needs. Being affiliated with all of Dayton’s major hospitals, Dr. Dean will work with your physician as part of the medical team in your diagnosis, treatment, and on-going care. Determination of proper therapy can only be made by joint consultation of your dentist and physician.
In addition to Oral Appliance Therapy, oral and maxillofacial surgeons may consider a variety of methods to evaluate, diagnose and treat upper airway obstruction. These specialists treat upper airway obstructive disorders by utilizing both minimally invasive procedures as well as more complex surgery, including jaw advancement. Additionally, an ENT specialist may evaluate you for other types of surgery, mainly the removal of excess tissues in the throat. It may be necessary to remove tonsils and adenoids (especially in children), the uvula, or even parts of the soft palate and the throat.
Snoring and Obstructive Sleep Apnea
Snoring is the sound of partially obstructed breathing during sleep. While snoring can be harmless, it can also be a sign of a more serious medical condition known as obstructive sleep apnea (OSA). When obstructive sleep apnea occurs, the tongue and soft palate collapse onto the back of the throat and completely block the airway, which restricts the flow of oxygen. The condition known as Upper Airway Resistance Syndrome (UARS), is midway between primary snoring and true obstructive sleep apnea. People with UARS suffer many of the symptoms of OSA but require special testing techniques.
Standards of Care
Oral appliance therapy is indicated for:
Patients with primary snoring or mild OSA who do not respond to, or are not appropriate candidates for treatment with behavioral measures such as weight loss or sleep position change.
Patients with mild to moderate OSA who prefer oral appliances to CPAP, or who do not respond to CPAP, are not appropriate candidates for CPAP, or fail treatment attempts with CPAP or treatment with behavioral measures such as weight loss or sleep position change.
Patients with severe OSA, who are intolerant or refuse treatment with nasal CPAP. Oral Appliances are also indicated for patients who refuse treatment, or are not candidates for tonsillectomy and adenoidectomy, or craniofacial surgery.
Types of Oral Appliances
Nearly all appliances fall into one of two categories. Oral appliances can be classified by mode of action or design variation.
Tongue Retaining Appliances
Tongue retaining appliances function by holding the tongue in a forward position by means of a suction bulb. When the tongue is in a forward position, it serves to keep the back of the tongue from collapsing during sleep and obstructing the airway in the throat.
Mandibular Repositioning Appliances
Mandibular Repositioning Appliances function to reposition and maintain the lower jaw (mandible) in a protruded position during sleep. This serves to open the airway by indirectly pulling the tongue forward, stimulating the activity of the muscles in the tongue and soft palate, and making them more rigid. It also holds the lower jaw and other structures in a stable position to prevent excessive mouth opening.
Advantages of Oral Appliance Therapy
Oral appliances are comfortable and easy to wear
Oral appliances are small and convenient, making them easy to carry when traveling
Treatment with oral appliances is reversible and non-invasive
Information provided courtesy of the American Academy of Dental Sleep Medicine