Dental Sleep Medicine
Obstructive Sleep Apnea
Obstructive sleep apnea is a serious sleep disorder. It causes breathing to repeatedly stop and start during sleep. There are several types of sleep apnea, but the most common is obstructive sleep apnea. This type of apnea occurs when your throat muscles intermittently relax and block your airway during sleep. A noticeable sign of obstructive sleep apnea is snoring.
Obstructive sleep apnea affects at least 25 million adults in the United States. It is now estimated that 26 percent of adults between the ages of 30 and 70 years have sleep apnea. It is also estimated that more than 80% of individuals that have obstructive sleep apnea haven’t been diagnosed and don’t even know that they have it!
Commonly Seen Consequences of Untreated Sleep Apnea
- Daytime fatigue. The repeated awakenings associated with sleep apnea make normal, restorative sleep impossible. People with sleep apnea often experience severe daytime drowsiness, fatigue and irritability. You may have difficulty concentrating and find yourself falling asleep at work, while watching TV or even when driving. People with sleep apnea have an increased risk of motor vehicle and workplace accidents. You may also feel quick tempered, moody or depressed. Children and adolescents with sleep apnea may do poorly in school or have behavior problems.
- High blood pressure or heart problems. Sudden drops in blood oxygen levels that occur during sleep apnea increase blood pressure and strain the cardiovascular system. If you have obstructive sleep apnea, your risk of high blood pressure (hypertension) is greater than if you don’t. Obstructive sleep apnea may increase the risk of recurrent heart attack, and abnormal heartbeats, such as atrial fibrillation. Obstructive sleep apnea also increases the risk of stroke. If there’s underlying heart disease, these multiple episodes of low blood oxygen (hypoxia or hypoxemia) can lead to sudden death from an irregular heartbeat.
- Sleep-deprived partners. Loud snoring can keep those around you from getting good rest and eventually disrupt your relationships. It’s not uncommon for a partner to go to another room, or even on another floor of the house, to be able to sleep. Many bed partners of people who snore may be sleep-deprived as well.
- Type 2 diabetes. People with sleep apnea are more likely to develop insulin resistance and type 2 diabetes compared with people without the sleep disorder.
- Complications with medications and surgery. Obstructive sleep apnea is also a concern with certain medications and general anesthesia. People with sleep apnea may be more likely to experience complications following major surgery because they’re prone to breathing problems, especially when sedated and lying on their backs. Before you have surgery, tell your doctor that you have sleep apnea and how it’s treated.
- Metabolic syndrome. This disorder is a collection of other risk factors linked to a higher risk of heart disease. The conditions that make up metabolic syndrome include high blood pressure, abnormal cholesterol, high blood sugar and an increased waist circumference.
- Liver problems. People with sleep apnea are more likely to have abnormal results on liver function tests, and their livers are more likely to show signs of scarring. This is a condition known as nonalcoholic fatty liver disease.
Treatments for Obstructive Sleep Apnea
Continuous positive airway pressure (CPAP). If you have moderate to severe sleep apnea, you may benefit from a machine that delivers air pressure through a mask placed over your nose while you sleep. With CPAP (SEE-pap), the air pressure is somewhat greater than that of the surrounding air, and is just enough to keep your upper airway passages open, preventing apnea and snoring. Although CPAP is the most common method of treating sleep apnea, many people find it cumbersome or uncomfortable. Some people are unable to tolerate wearing the mask due to claustrophobic associations or have difficulty with the hose getting in their way.
Oral appliances. Another option is wearing an oral appliance designed to keep your throat open. Here at Argyle Dental we have been fabricating these appliances for many of our patients that have been diagnosed with sleep apnea and are intolerant to CPAP. We also have patients that continue to use their CPAP machines but also use an oral appliance which often times will allow the sleep physician to decrease the amount of pressure that the air is forced in. Some of our patients have asked us to fabricate an oral appliance for them when they go places where CPAP machines are more cumbersome to bring along (ie. Traveling, Camping, etc.) Oral appliances have a 90% compliance rate making them a great choice for many sufferers of obstructive sleep apnea.
Surgery. Surgery is usually only an option after other treatments have failed. Generally, at least a three-month trial of other treatment options is suggested before considering surgery. However, for those few people with certain jaw structure problems, it’s a good first option. The goal of surgery for sleep apnea is to enlarge the airway through your nose or throat that may be vibrating and causing you to snore or that may be blocking your upper air passages and causing sleep apnea. Surgical options may include:
Tissue removal. During this procedure, which is called uvulopalatopharyngoplasty (UPPP), your doctor removes tissue from the rear of your mouth and top of your throat. Your tonsils and adenoids usually are removed as well. This type of surgery may be successful in stopping throat structures from vibrating and causing snoring. It’s less effective than CPAP, and isn’t considered a reliable treatment for obstructive sleep apnea. Removing tissues in the back of your throat with radiofrequency energy (radiofrequency ablation) may be an option for people who can’t tolerate CPAP or oral appliances.
Jaw repositioning. In this procedure, your jaw is moved forward from the remainder of your face bones. This enlarges the space behind the tongue and soft palate, making obstruction less likely. This procedure is known as maxillomandibular advancement (MMA).