Sleep Apnea Treatment Techniques
Relief from dental sleep apnea may be accomplished by fitting the sufferer with a sleep apnea appliance or snore guard that 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
Those who are fitted with one of these sleep apnea appliances need to have it checked shortly afterward to ensure that it is working. Adjustments or periodic replacements are sometimes necessary.
Benefits of sleep apnea treatment
Untreated sleep apnea has been known to cause job impairment and vehicular accidents. However, those who are successfully treated can often look forward to safer driving and an improved quality of life. Having better-quality sleep at night leads to feeling more alert and energetic during the day.
Benign snoring can be treated by sleeping on your side, 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 for sleep aids. If these simple measures do not prove sufficient, then surgical procedures by an ENT specialist who concentrates their practice on airway procedures or an oral appliance by a dentist who has experiences and treats snoring and sleep apnea may be appropriate.
Sleep Apnea Treatment
Obstructive sleep apnea (OSA) is most commonly treated by CPAP (continuous positive airway pressure) applied through a nasal mask and is considered the “gold standard” in treating OSA. It will treat it 100% of the time and for this reason, is always recommended by the medical profession. The problem is, multiple research articles have shown CPAP has as low as a 50% compliance level. Meaning only 50% of the patients use the device because of discomfort and inconvenience. OSA suffers who do not use the machine increase their risk of heart failure, high blood pressure, stroke, drowsiness during the day and falling asleep while driving, snoring, gasping for air and choking loudly.
Severe levels of OSA diagnosed in a sleep study can only be treated effectively with CPAP machines. Mild and moderate OSA sufferers have alternatives if they are CPAP-intolerant.
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 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 by removing tissue from the upper airway to increase the size of the back of the throat or by the expansion of 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 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 can 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 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 have follow-up polysomnography.
You’re invited to come in 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.
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 to 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. Sewing tennis balls into the back of your pajamas to prevent you from rolling onto your back is another home aid.
Some people benefit from snore strips on their nose 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 much like a sports night guard or a retainer worn at night can hold the lower jaw forward and thus open the airway to allow a person to breathe easier and reduce snoring. Snore guards also help many people stop snoring in this manner.
Snoring & Sleep Apnea
But what people do not often realize is snoring is a warning noise produced by the force of air through a narrowed upper airway caused by the collapse of the soft tissue in the back of the throat. 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 progress, the snoring gets louder and eventually the snoring is interrupted by pauses in breathing and then a gasping noise for breath. We must breathe and as our oxygen levels go down, a feedback mechanism in our body takes us out of a 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 rejuvenated in the morning and rested. This is sleep apnea.
Central sleep apnea or obstructive sleep apnea?
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 tissue 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 laying down.
Are snoring & 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 or all of the above can be more likely to die in their sleep as their heart disease advances, since the heart is already compromised. These are people who you hear of having a heart attack in their sleep.
Snoring is associated 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 stop light 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, ability to concentrate and make you irritable, affecting your relationships.
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.
Diagnosis (How do you know if you need apnea treatment?)
Taking the simple test below is a starting point, but 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
The Epworth Sleepiness Scale is used 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. These issues should be discussed 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 trafficwhile 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, especially if you have one or more of the conditions listed in question E, then you may be at risk for sleep apnea and should discuss this with your physician.
Note: You should always discuss sleep-related complaints with your physician before deciding on medical evaluation and treatment.
We invite you to call our expert team today at (972) 931-0090 to schedule your sleep apnea consultation, or you can use our online Request an Appointment form.