Dental Sleep Medicine-- Oral Appliances or CPAP
The field of Dental Sleep Medicine is growing. Obstructive Sleep Apnea (OSA) has always been a problem, but awareness of the severe effects and the real cause is recent. The resources to easily test and diagnose OSA were not readily available in the past. Now virtually every large city has many accredited sleep centers. Now, there are sleep centers in small communities. This increase in our diagnostic abilities has lead to an increase in the number of patients being diagnosed with OSA. An even better alternative to the sleep centers is the invention of the home sleep test equipment which is becoming widely used. The Home Sleep Test allows you to get the diagnostic test you need in the comfort of your own home in your own bed.
Is It Just Snoring Or Is It Obstructive Sleep Apnea?
Snoring is mostly caused by vibration of the tissues of the oropharynx and the soft palate. Snoring may not only disturb the sleep of the bed partner, but it may fragment the person’s sleep and is usually a sign of OSA. This occurs when the tissues of the oropharynx and tongue collapse during sleep and block the airway. A complete blockage for 10 seconds or more is called an apnea (The average is 30 seconds). A reduction of airflow of 40% or more with an oxygen reduction in the blood (desaturation) of 4% or more is called a hypopnea. The total of apneas and hypopneas measures the severity of OSA and is referred to as the apnea-hypopnea index (AHI). 5-14 events per hour of sleep is mild OSA, 15-29 events per hour of sleep is moderate OSA, and 30+ events per hour of sleep is severe OSA.
The Old Standard
In the past, the only treatment for OSA is continuous positive airway pressure (CPAP). While it was a breakthrough treatment, CPAP has some serious drawbacks About ten percent of those diagnosed with OSA are not willing to try CPAP. Of those who try CPAP, 20%-40% give up within one year. Many of those who continue to use CPAP won't wear the mask long enough at night to achieve the benefits they need to resolve their sleep apnea. The reasons they offer for discontinuing are many;
- The mask fits poorly and is uncomfortable
- The mask leaks or air leaks through the mouth
- A skin reaction occurs or lines on the face are unsightly
- The straps that hold the mask on create problems
- Their bed partner complains of the noise of the system
- Inability to clean properly; cleaning takes too long each morning
- Dry nose or mouth and sinus problems
- Even dental problems
Oral Appliance Therapy ... The Solution For Sleep Apnea
A dentist trained in treatment of OSA can help those patients who are CPAP intolerant. According to American Academy of Sleep Medicine (AASM) guidelines, oral appliance therapy (OAT) is indicated as a first line therapy in mild-to-moderate OSA (AHI=5-29) and is also indicated in severe OSA (AHI=30+) when a patient has failed or refused CPAP. Surgery is generally not successful with OSA. The principle behind OAT is simple. When a patient has obstructive sleep apnea, the airway is blocked by the tongue obstructing the airway during sleep. The oral appliance (OA) keeps the lower jaw forward during sleep. There are several appliances on the market that work well to achieve a reduction in AHI. Knowing which appliance to use, how to adjust it, and treatment of side effects such as TMJ pain, myalgia, tooth movement, and bite changes is where proper training comes in.
But I Just Want To...
Often patients will say something like, "I just want to stop snoring" or "I just want to stop grinding my teeth." They don’t know those are symptoms and that there probably is a much larger problem that is creating those symptoms. They aren't usually aware of the fact that obstructive sleep apnea has severe consequences. It affects not just the quality of life but can take years off of your life (an average of 8-10 years). If their dentist only treats symptoms and ignores the underlying cause, they are doing patients a disservice They are putting patients health at risk by treating snoring without a proper medical evaluation.
There Is No Way To Tell By Just Looking
There is no quick way to know if they just snore or if they have OSA. Accurate diagnosis, and proper treatment is why it is important to be treated by an expert trained in Dental Sleep Medicine. Treating OSA is straight forward. The impact on patient's lives is awesome. Dentists are in a position to be one of the main doctors to refer patients for sleep studies. They spend much more time with patients than medical doctors do. And they are looking right at the patient’s airway all the time! At the "Northwest Treatment Center for Snoring and Sleep Apnea", we see many patients who just think that snoring is their biggest issue. In many cases we will have them take home a portable sleep test unit that we have available in our office. It is important to know for sure what the real cause of their symptoms is. Many patients who are clenching their teeth are doing so because they have an underlying sleep disorder. They are, in effect, protecting the closing of their airway by clenching their teeth. The brain is much more concerned about oxygen than it is about us hurting our teeth.
The Dentist's Role
The dentist’s role in the treatment of obstructive sleep apnea continues to expand. The dentist is in a position to make an incredible contribution and literally add years to the lives and life to the years of many, many patients. We at the "Northwest Treatment Center for Snoring and Sleep Apnea" have been thoroughly trained in Sleep Dentistry by the top experts in the field. We are truly pleased to be in a position to help our patients literally change their lives by finally getting the restorative sleep that they have been missing. If you snore, are tired during the day, or grind your teeth at night you really need to find out if there is more to it than just those symptoms. If you sleep in a different room than your bed partner because of snoring, it may be because you have OSA. You may have sleep apnea and your health is at risk. Get an accurate diagnosis and find a qualified Sleep Dentist to get relief and add years to your life. If you are in North Idaho or Eastern Washington, you can get the relief you need in Coeur d' Alene by calling Lori at (844) 847-6673 to schedule your free consultation .
Dr. Johnson holds a public discussion on snoring, sleep apnea, and CPAP intolerance every month.