Do you often feel tired during the daytime? Do you find yourself snoring or gasping for breath in your sleep? Then you may very well have a condition called sleep apnea. This common sleep disorder affects millions of men, women, and children. Dr. Mark Sowell is a board-certified dentist in Plano, TX, and trained in the evaluation of sleep apnea. He provides sleep apnea treatment options that go beyond the traditional Continuous Positive Airway Pressure (CPAP) machine.
What is Sleep Apnea?
Sleep apnea occurs when adult breathing stops for at least ten seconds. In children, consider two and one-half missed breaths as apnea. Similar to apnea is hypopnea, in which an individual continues reduced breathing. Obstructive sleep apnea is one of the most common sleep disorders. The airway closes completely during obstructive sleep apnea, causing the sufferer to stop breathing. Sometimes as much as 100 times an hour!
Sleep Apnea Treatment Solutions in Plano, TX
We accomplish relief from dental sleep apnea by fitting the sufferer with a sleep apnea appliance or snore guard. This guard helps prevent the throat from closing up. The type of sleep apnea appliances we use include:
- Mandibular advancement device (MAD). This is the most popular dental device for sleep apnea. It brings the lower jaw forward and down, which helps prevent the throat from collapsing.
- Snoring appliance
- Stop-snoring mouthpiece
After we fit you with one of these sleep apnea appliances, we will check it shortly afterward to ensure that it is working. Adjustments or periodic replacements are sometimes necessary.
Sleeping on your side can fix gentile snoring. Using aids to keep you on your side, raising the head of the bed so it is not flat, weight loss, and avoiding alcohol and drugs are also steps you can take. If these simple measures do not prove sufficient, then surgical procedures by an ENT specialist may be appropriate. ENT specialists concentrate their practice on airway procedures. You can also get an oral appliance from a dentist who treats snoring and sleep apnea.
Sleep Apnea Treatment
Dentists commonly treat obstructive sleep apnea (OSA) with a CPAP machine. The machine applies continuous positive airway pressure through a nasal mask. This method is the “gold standard” in treating OSA. It will treat it 100% of the time, and for this reason, the medical profession recommends it.
The problem is that multiple research articles have shown that CPAP has as low as a 50% compliance level. Meaning only 50% of the patients use the device because of discomfort and inconvenience. OSA sufferers who do not use the machine increase their risk of other issues. Problems include heart failure, high blood pressure, stroke, drowsiness during the day, gasping for air, choking loudly, and falling asleep while driving.
If severe levels of OSA are found during your sleep study, doctors will only recommend a CPAP machine for the most effective results. However, mild and moderate OSA sufferers have alternatives if they are CPAP-intolerant. Having better-quality sleep at night leads to feeling more alert and energetic during the day.
Problems people have with CPAP:
- The mask is uncomfortable, irritates the skin, or causes claustrophobia
- The mask is taken off at night without the sleeper knowing it or forgotten to put it back on
- Air in the stomach or sinuses
- The mask leaks air
- The CPAP machine is too noisy to allow sleep
- The tubing gets in the way
- Your nose can be stuffy because of a cold or allergies
- The air is too hot or too cold
Surgery is another option that may help OSA patients. Oral surgery removes tissue from the upper airway to increase the size of the back of the throat or expand the jaw structures that restrict the space for the throat. The success rate varies greatly, as the obstructions vary between individuals.
In general, as the severity of OSA increases, so does the invasiveness of the required procedure to achieve a successful result. Some procedures have higher relapse rates than others.
Oral appliances for Sleep Apnea
Oral appliance therapy, provided by dentists specifically trained in the use of these devices, can be an effective alternative to CPAP.
A recent parameters paper published in the journal Sleep by the American Academy of Sleep Medicine stated that oral appliances could be used as first-line therapy in some patients for treating mild to moderate OSA. The guidelines state:
“Although not as efficacious as CPAP, oral appliances are indicated for use in patients with mild-to-moderate obstructive sleep apnea who prefer oral appliances to CPAP, or who do not respond to CPAP, are not appropriate candidates for CPAP, or who fail treatment attempts with CPAP or treatment with behavioral measures such as weight loss or sleep position change.”
Oral appliances, which resemble sports mouthguards, are associated with better compliance than CPAP systems for many patients. Oral appliances can also be used as a first-line treatment for primary snoring that is not associated with OSA.
These appliances should be fitted by dentists specifically trained in oral appliance therapy and those experienced in the treatment of temporomandibular joint and dental occlusion. Treatment with oral appliances should be followed on a regular basis, and follow-up with polysomnography.
You’re invited to come to our Plano, TX dentist office for an evaluation. We have a Watermark take-home sleep study device for diagnosis, so you don’t have to go to a sleep lab overnight. The data is downloaded to our computer, and a medically reviewed report is sent to us.
Snoring vs. Sleep Apnea
About half of men and a quarter of women snore regularly. Both men and women are more likely to snore as they age. Snoring is also more common in people who are overweight. The tissue in the back of the throat becomes looser, and the greater amount of fat in the back of the throat narrows the airway and vibrates as they sleep.
If you cannot breathe through your nose due to nasal obstruction, you are more likely to snore.
How do I stop snoring?
Often sleeping on your side will help. When you are on your back, the weight of your jaw and tongue fall back, narrowing your airway and causing you to labor to breathe. This results in snoring. Sleeping on your side causes your jaw and tongue to fall with gravity away from your airway so you can breathe easier and reduce snoring.
Some people benefit from snore strips on their noses if they have nasal obstructions. Losing weight will help open up the airway and decrease snoring. Alcohol consumption and drugs meant to help us sleep also increase snoring.
Dental oral appliances can hold the lower jaw forward and thus open the airway to allow a person to breathe easier and reduce snoring. They are much like a sports night guard or a retainer worn at night. Snore guards also help many people stop snoring in this manner.
What people do not often realize is that snoring is a warning noise produced by the force of air through a narrowed upper airway. The collapse of the soft tissue in the back of the throat causes it. It is an indication that there is a problem with normal breathing. Any time we cannot get enough oxygen into our system, we have a problem.
As the problem progresses, the snoring gets louder, and eventually, the snoring is interrupted by pauses in breathing and then a gasping noise for breath. As our oxygen levels go down, a feedback mechanism in our body takes us out of deep sleep to a lighter level of sleep so we can gasp for air.
The snorer is never awake enough to remember or be aware of these episodes. This can happen a few times per night to several hundred times per night. The result is the snorer cannot get into a deep sleep where we feel rested and rejuvenated in the morning. This is sleep apnea.
Do I have Central Sleep Apnea or Obstructive Sleep Apnea?
Sleep apnea is present when we do not breathe for 10 seconds or longer. This causes our blood oxygen levels to drop, which takes us out of deep sleep so we can gasp for breath and get the oxygen levels back up in our blood. This can happen a few times per night or several hundred times per night, resulting in no deep sleep and many health problems. There are two types of sleep apnea: central and obstructive.
Central sleep apnea: is much less common and is a problem in the regulatory function of the brain or heart. This occurs most frequently in people who have chronic congestive heart failure, stroke, prolonged opioid drug use, heart disease, or kidney disease.
Obstructive sleep apnea: is more common and is caused by the physical blockage of the airway at night by the tissue in the back of the throat collapsing to block the airway. This keeps oxygen from getting to the lungs as the muscles and, thus, tissues relax in the throat as you sleep, combined with the force of gravity causing the tongue to fall back and block the airway when you are lying down.
Sleep Apnea FAQs
Are snoring and sleep apnea serious?
Snoring can be serious, both medically and socially. Snoring can disrupt marriages and cause sleepless nights for bed partners. Medically, snoring can be a precursor of obstructive sleep apnea that has been linked to heart failure, high blood pressure, and stroke. Often people with large necks, overweight, and large uvula and soft palate or nasal congestion can be more likely to die in their sleep as their heart disease advances since the heart is already compromised.
Doctors associate snoring with type II diabetes and a higher rate of heart disease in its own right. People with untreated obstructive sleep apnea suffer from daytime fatigue, sleepiness, and irritability. Additionally, they have higher rates of high blood pressure, heart disease, stroke, depression, and erectile dysfunction.
Often people with severe untreated sleep apnea will fall asleep at a stoplight or dose off (micro-sleep) for a moment while driving, sometimes causing them to swerve or lose control of their car. The daytime fatigue associated with the lack of quality sleep can affect your job performance, memory loss, and ability to concentrate and make you irritable, affecting your relationships.
How many times a night do you wake up with sleep apnea?
On average, OSA wakes patients 30 times per hour at night. OSA is extremely disruptive to sleep. If your breathing stops more than 5 times a night, then you may be classified as having Obstructive Sleep Apnea.
Is sleep apnea a disability?
Sleep apnea is not classified as a disorder, according to the Social Security Administration. However, it used to be. There are some breathing disorders listed. If your sleep apnea meets the guidelines for any of the breathing disorders listed, you may qualify for disability benefits.
Can Sleep Apnea be cured naturally?
The main way to naturally prevent sleep apnea is to keep your body at a healthy weight. Obesity is one of the most common causes of sleep apnea. When you are overweight, it is more likely for your airways to be tight.
Sleep apnea symptoms & warning signs
- Snoring interrupted by a pause in breathing, followed by gasping (sudden strong intake of air)
- Daytime fatigue & falling asleep at inappropriate times
- Loud, chronic snoring
- Trouble concentrating, poor memory
- Depression, irritability, or loss of sex drive
- Frequent nighttime urination
- Dry mouth, sore throat, or nausea in the morning
Unfortunately, you cannot diagnose yourself. As long as you snore, you are at risk, and until you have a sleep study, you may not know, as not all people have symptoms or warning signs. Your dentist in Plano, TX can diagnose and treat your sleep apnea.
Diagnosis: How do you know if you need apnea treatment?
Taking the simple test below is a starting point. However, be sure to visit your physician or dentist (if they offer home sleep studies) if you think you have a problem. This test is for daytime sleepiness, not specifically for snoring and apnea.
Epworth Sleepiness Scale
We use the Epworth Sleepiness Scale to determine the level of daytime sleepiness. A score of 10 or more is considered sleepy. A score of 18 or more is very sleepy. If you score 10 or more on this test, you should consider whether you are obtaining adequate sleep, need to improve your sleep hygiene, and/or need to see a sleep specialist. You should discuss these issues with your personal physician.
Use the following scale to choose the most appropriate number for each situation:
0 = would never doze or sleep.
1 = slight chance of dozing or sleeping
2 = moderate chance of dozing or sleeping
3 = high chance of dozing or sleeping
Print out this test, fill in your answers, and see where you stand.
Chance of Dozing or Sleeping
|Sitting and reading||
|Sitting inactive in a public place||
|Being a passenger in a motor vehicle for an hour or more||
|Lying down in the afternoon||
|Sitting and talking to someone||
|Sitting quietly after lunch (no alcohol)||
|Stopped for a few minutes in traffic while driving||
|Total score (add the scores up)(This is your Epworth score)||
Sleep Apnea Risk Assessment
Assess your risk for sleep apnea. The total score for all five sections is your Apnea Risk Score. Print out this questionnaire, write in your best answer for each question and see where you stand.
A. How frequently do you experience or have you been told about snoring loud enough to disturb the sleep of others?
2. Rarely (less than once a week)
3. Occasionally (1 to 3 times a week)
4. Frequently (more than 3 times a week)
B. How often have you been told that you have “pauses” in breathing or stop breathing during sleep?
2. Rarely (less than once a week)
3. Occasionally (1 to 3 times a week)
4. Frequently (more than 3 times a week)
C. How much are you overweight?
1. Not at all
2. Slightly (10 to 20 pounds)
3. Moderately (20 to 40 pounds)
4. Severely (more than 40 pounds)
D. What is your Epworth Sleepiness Score?
1. Less than 8
2. 9 to 13
3. 14 to 18
4. 19 or greater
E. Does your medical history include:
1. High blood pressure
3. Heart disease
4. More than 3 awakenings per night (on average)
5. Excessive fatigue
6. Difficulty concentrating or staying awake during the day
If you answered 3) or 4) for questions A-D, then you may be at risk for sleep apnea and should discuss this with your physician. Especially if you have one or more of the conditions listed in question E.
Note: You should always discuss sleep-related complaints with your physician before deciding on medical evaluation and treatment.
We invite you to call our sleep apnea dentist in Plano, TX today at (972) 382-6855 to schedule your sleep apnea consultation, or you can use our online Request an Appointment form.