Dental Sleep Medicine.
Dental Sleep Medicine is an area of practice that focuses on the management of sleep-related breathing disorders including snoring and obstructive sleep apnea through the use of oral appliance therapy and upper airway surgery.
Snoring is extremely common and, in many cases, relatively harmless. Nearly everyone snores at one time or another. Occasional light snoring, at worst, is a minor annoyance. Loud and habitual snoring can disrupt your sleep and may be a sign of a much more serious sleep disorder – obstructive sleep apnea.
Snoring is a sound that occurs in the upper airway as you breathe in air. The unmistakable sound is a sign that your airway is partially blocked, usually by soft tissue in your throat. The flow of air causes the soft tissue to vibrate, generating the noise, which comes out of your nose, mouth or both.
The volume of snoring depends on the person. You may snore so loudly you wake yourself up. Snoring may also cause you to have a dry mouth or to wake up with a dry mouth and a sore throat.
• Snoring can affect almost anyone.
• Habitual snoring has been found in an estimated 24 percent of adult women and 40 percent of adult men.
• Both men and women are more likely to snore as they age. Men become less likely to snore after the age of 70.
• Alcohol, drugs, muscle relaxers and tobacco products contribute to snoring for both men and women.
• Obese or overweight people tend to snore because there is more fat tissue in the back of their throats.
• Pregnancy can increase a woman’s change of snoring.
• An estimated 10 to 12 percent of children snore.
• Snoring appears to run in families
Is it Snoring or Obstructive Sleep Apnea?
Obstructive sleep apnea frequently goes undiagnosed because people often mistaken the serious sleep disorder for snoring. About half of loud snorers have some form of sleep apnea.
Snoring and obstructive sleep apnea have similar causes. Sleep apnea happens when the tissue in the upper-airway blocks the entire airway, causing a pause in your breathing. The blockage keeps oxygen from reaching your organs including your heart and brain. When the blood-oxygen level drops low enough, the body momentarily wakes up. It can happen so fast that you may not be aware you woke up.
Snorers who suffer from sleep may make gasping, choking or snorting sounds as they try to breathe and feel drained of energy during the day.
Obstructive Sleep Apnea.
Sleep apnea is a potentially life-threatening medical disorder that causes your body to stop breathing during sleep. The muscles in your throat relax and the tongue may fall back and block the airway as you sleep, reducing the amount of oxygen delivered to all of your organs including your heart and brain. People with sleep apnea may snore loudly and stop breathing for short periods of time. The breathing pauses from sleep cause your body to briefly wake while you remain unaware. This can happen hundreds of times per night, and you may wake up feeling unrefreshed.
In addition to snoring and excessive daytime sleepiness, sleep apnea can cause memory loss, morning headaches, irritability, depression, decreased sex drive and impaired concentration. When left untreated, sleep apnea can lead to hypertension, stroke, heart attack and sudden death while asleep.
Sleep apnea patient are often older, obese and have thick necks, but men and women of any age or body type can have sleep apnea. The sleep disorder progressively worsens with age and weight gain.
Oral appliances (OA) are a front-line treatment for patients with mild to moderate Obstructive Sleep Apnea (OSA) who prefer OAs to continuous positive airway pressure (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. This small plastic device fits in the mouth during sleep like a sports mouth guard or orthodontic retainer. Oral appliances help prevent the collapse of the tongue and soft tissues in the back of the throat, keeping the airway open during sleep and promoting adequate air intake. Oral appliances may be used alone or in combination with other treatments for sleep-related breathing disorders, such as weight management, surgery or CPAP.
Standards of Care.
• 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 moderate to severe OSA should have an initial trial of nasal CPAP, due to greater effectiveness with the use of oral appliances.
• Patients with moderate to severe OSA who are intolerant of or refuse treatment with nasal CPAP. Oral appliances are also indicated for patients who refuse treatment, or are not candidates for tonsillectomy andadenoidectomy, cranofacial operations, or tracheostomy.
Oral Appliance Therapy.
Oral appliance therapy involves the selection, fitting and use of a specially designed oral appliance that maintains an open, unobstructed airway in the throat when worn during sleep. Custom-made oral appliances are proven to be more effective than over-the-counter devices, which are not recommended as a screening tool nor as a therapeutic option.
Dentists with training in oral appliance therapy are familiar with the various designs of appliances and can help determine which is best suited for your specific needs. A board certified sleep medicine physician must first provide a diagnosis and recommend the most effective treatment approach. A dental sleep medicine specialist may then provide treatment and follow-up.
The initial evaluation phase of oral appliance therapy can take several weeks or months to complete. This includes examination, evaluation to determine the most appropriate oral appliance, fitting, maximizing adaptation of the appliance, and the function.
Ongoing care, including short- and long-term follow-up is an essential step in the treatment of snoring and Obstructive Sleep Apnea with Oral Appliance Therapy. Follow-up care serves to assess the treatment of your sleep disorder, the condition of your appliance, your physical response to your appliance, and to ensure that it is comfortable and effective.
Advantages of Oral Appliance Therapy.
• Oral appliances are comfortable and easy to wear. Most people find that it only takes a couple of weeks to become acclimated to wearing the appliance.
• Oral appliances are small and convenient making them easy to carry when traveling.
• Treatment with oral appliances is reversible and non-invasive
How Oral Appliances Work.
• Re-positioning the lower jaw, tongue, soft palate and uvula
• Stabilizing the lower jaw and tongue
• Increasing the muscle tone of the tongue
Types of Oral Appliances.
With so many different oral appliances available, selection of a specific appliance may appear somewhat overwhelming. Nearly all appliances fall into one of two categories. The diverse variety is simply a variation of a few major themes. Oral appliances can be classified by mode of action or design variation.
Tongue Retaining Appliances.
Tongue retaining appliances hold the tongue in a forward position using 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 Re-positioning Appliances.
Mandibular repositioning appliances reposition and maintain the lower jaw in a protruded position during sleep. The device serves to open the airway by indirectly pulling the tongue forward, stimulating activity of the muscles in the tongue and making it more rigid. The device also holds the lower jaw and other structures in a stable position to prevent the mouth from opening.