dental sleep therapy
What is Obstructive Sleep Apnea (OSA)?
Apnea literally means “cessation of breath”. In other words, apnea is when you stop breathing. Obstructive Sleep Apnea (OSA) is simply when your airway becomes obstructed during sleep, causing you to stop breathing. The human upper airway is surrounded by muscles. The largest of these muscles is the tongue. When we are awake we have tightness, or tonicity, in our upper airway muscles, but during sleep these muscles relax.
As we breathe during sleep, the throat and upper airway muscles relax and may begin to vibrate (this vibration is what causes snoring). Eventually these muscles relax even more and can collapse into the airway, effectively closing your throat and prohibiting air from flowing into your lungs. When you airway collapses and you stop breathing, your body responds as if you are suffocating. Your brain realizes that you are not receiving oxygen from your lungs, and arouses you from deeper stages of sleep (where rest occurs) to a lighter stage of sleep. By moving to a lighter stage of sleep your brain is able to contract your throat and upper airways muscles to open your airway and help you resume breathing. This tightening of your upper airways muscles helps force open your airway and allow air and oxygen to flow into your lungs so you do not suffocate. This cycle of suffocation (apnea) and arousal to breath can happen hundreds of times a night. In most cases you do not fully awake, so you may not even realize this is happening to you every night! Obstructive Sleep Apnea (OSA) can cause excessive daytime sleepiness, mental impairment, cardiovascular problems, heart attack, stroke, diabetes, impotence, acid reflux, and a multitude of other undesirable side effects. Obstructive Sleep Apnea is a serious and progressive condition that can lead to serious health problems and even death if left untreated.
Recent studies have shown that 1 in 4 adults in the United States (31% of all men and 21% of all women over 18) are at “high risk” for Obstructive Sleep Apnea (based on analysis of the National Sleep Foundation’s 2005 Sleep in America survey). It is estimated that the American public spends over $3 billion every year on the diagnosis and treatment of sleep apnea! This is a serious health issue affecting millions of Americans.
Obstructive Sleep Apnea (OSA) Syndrome is a life threatening disorder affecting over 18 million Americans. 40% of Americans (2 out of 5) snore and 40% of snorers have OSA with no signs or symptoms of the disease.
Serious repercussions /consequences of untreated Obstructive Sleep Apnea (OSA) include:
- Increased risk of stroke.
- Increased high blood pressure.
- Increased incidence of atrial fibrillation.
- Increased risk of diabetes.
- Poor memory and other cognitive impairments.
- Male impotence and decreased sex drive.
- Headaches and migraines.
- Increased risk of motor vehicle accidents.
- Increase in Gastrointestinal Reflux Disease (GERD).
- Increase in Attention Deficit Hyperactivity Disorder (ADHD) in children.
Signs you or someone you love may have Obstructive Sleep Apnea (OSA) and Sleep Disordered Breathing:
- Waking up due to gasping or choking.
- Excessive daytime sleepiness.
- Memory loss.
- Nighttime grinding of teeth.
- Restless or unrefreshed sleep.
- Frequent waking during sleep.
How common is Obstructive Sleep Apnea (OSA)?
- 40% of adults over 40 snore
(approx. 87 million Americans)
- 9% of men and 4% of women suffer from some form of Obstructive Sleep Apnea.
(approx. 30 million Americans)
- Less than 10% of OSA sufferers have been diagnosed
(approximately 3 million Americans)
- Of those diagnosed with Obstructive Sleep Apnea, less than 25% have been successfully treated.
Incidence of Obstructive Sleep Apnea
Obstructive Sleep Apnea Syndrome (OSA) is a serious, life threatening disorder affecting over 18 million Americans. Research estimates that up to 9% of all adult males and 4% of all adult females suffer from sleep disordered breathing, yet fewer than 10% of the people with this disease have been diagnosed. The most recent studies have shown that 1 in 4 adults in the United States (31% of all men and 21% of all women over 18) are at “high risk” for OSA (based on analysis of the National Sleep Foundation’s 2005 Sleep in America survey).
How is Obstructive Sleep Apnea (OSA) diagnosed?
For proper diagnosis of Obstructive Sleep Apnea (OSA) or other forms of sleep disordered breathing an overnight sleep test is necessary. The test consists of placing sensors on the body to measure certain body functions such as breathing, blood oxygen saturation, respiratory effort, body position, and brain activity. Different types of sleep tests use different sensors (also called channels) and the methods for obtaining sleep information differ slightly between tests.
Traditionally sleep tests have been conducted by an attended study in a sleep facility, rather than in the patient’s home. These attended studies are called Polysomnographs (PSG) and have been used for many years for the diagnosis of sleep disorder breathing, Obstructive Sleep Apnea, and other sleeping disorders. Recently home testing has become approved by the American Academy of Sleep Medicine for diagnosis of Obstructive Sleep Apnea. There is much debate in the medical community about which type of test is the most preferable, and below we discuss each type of test and the advantages and disadvantages of each:
- Polysomnograph (PSG)
- This type of sleep test has been the standard of care for many years. These tests are performed in a sleep laboratory while “attended” by medical professionals (usually sleep technicians). Typically 16 specific measurements (channels) are recorded while the patient is constantly monitored throughout the night by sleep technicians.
- The advantage to a Polysomnograph (PSG) test is that it usually measures many different bodily systems (such as EEG for brain activity), and often measures more unique body signals than Home Sleep Testing (HST). These additional measurements may give physicians more information to help with diagnosis. Since these tests are constantly monitored by technicians, if there is equipment malfunction during the night, such as a sensor coming loose ,it can be addressed immediately without having to repeat the test. Also, if CPAP is used during the PSG it can be applied and adjusted by the technicians while the patient is sleeping.
- The disadvantages to the Polysomnograph (PSG) are convenience, costs, access to care, and quality of sleep during the test. You must travel to a sleep lab to have the sleep test, and the test is often very expensive. It is obviously more desirable and easier to have a sleep test completed in the comfort of your own home. Patient’s are also more less likely to have a typical night’s sleep in a sleep lab (compared to sleeping in your own home). PSG testing can be expensive, whether or not you have medical insurance. Home Sleep Testing (HST) addresses many of the disadvantages of PSG testing.
- Home Sleep Test (HST)
- In 2009 the American Academy of Sleep Medicine (the foremost clinical group for health issues related to sleep) approved the usage of portable sleep testing for diagnosis of Obstructive Sleep Apnea (OSA) and other forms of sleep disorder breathing. According to the new clinical guideline, home sleep testing must be performed with a Level III portable sleep device that is is capable of measuring at least four different systems on the patient. The Home Sleep Test (HST) may be given to the patient by a trained technician, but diagnosis and interpretation of the results of the test must be made by a board-certified sleep physician. After instructions are given to the patient on how to attach the device, the patient takes the device home and wears it in their own home overnight. The device is returned to the sleep specialist who then interprets the results and gives a diagnosis. The home sleep recorders utilized by Dental Sleep Solutions® dentists are all clinically approved for home use, and diagnostic tests are evaluated by board-certified sleep physician.
- The advantages to Home Sleep Testing (HST) are patient convenience, easy access to care, decreased cost, and a more typical night of sleep recorded in the comfort of the patient’s home. It is obviously easier and more convenient for the patient to sleep in their own home than having to go away to a facility to obtain a sleep study. Furthermore patients are more likely to have a typical nights sleep in their own bed than in a foreign setting. Cost is greatly reduced using Home Sleep Testing (HST) and access to care is greatly improved.
- The major disadvantages to Home Sleep Testing (HST) is that they measure fewer channels than a full PSG, which could potentially result in less accurate diagnosis. Also if the home sleep device is not properly placed on the patient, or if it comes off during sleep, then the test may have to be repeated. Furthermore, CPAP adjustment is not possible with home sleep testing unless an Auto-PAP device is utilized. However, the convenience, accuracy, and low cost of Home Sleep Testing (HST) makes it an ideal choice for most patients.
The decision on which type of testing should be used for a particular patient can sometimes be a controversial issue in the medical community. One type of testing may not be appropriate for everyone. Someone who has symptoms of Obstructive Sleep Apnea (OSA) but has no other medical or sleep concerns may be accurately diagnosed with a Home Sleep Test (HST), while someone with a complicated medical and sleep history may be better suited to be test with a full Polysomnograph (PSG). Along with your physician, your Dental Sleep Solutions® dentist can help you determine which test might is best for your particular situation.
How can Dental Sleep Solutions® dentists help?
Snoring and Obstructive Sleep Apnea (OSA) are both caused by a collapse of the upper airway when the muscles relax during sleep, causing the patient to stop breathing during the night. The largest muscle, and most likely culprit for this problem of airway collapse, is the tongue. The tongue muscle is much larger than most people realize. The tongue is present in the oral cavity (mouth) but it also extends down the throat and beyond throughout most of the length of the collapsible upper airway.
Dental Sleep Solutions® dentists have obtained specialty training in oral appliance therapy, allowing us to fit custom FDA-approved dental devices (sometime called mandibular advancement devices or dental sleep devices) that help control the collapsing of the tongue into the airway, allowing patients to stop snoring and sleep and breath easier throughout the night. A dental sleep device looks similar to a sports mouth guard and can be comfortably worn in the mouth during sleep. The dental devices help prevent snoring and Obstructive Sleep Apnea (OSA).
Oral appliance therapy helps prevent the collapse of the tongue into the airway by moving the jaw forward, allowing air to flow from your mouth into your lungs so you can breathe. Opening the airway decreases snoring and Obstructive Sleep Apnea (OSA). Most people find these devices much more comfortable than CPAP (the other primary treatment for OSA and snoring) and far less invasive and more predictable than surgery. To learn about alternative methods to treat snoring and sleep apnea click here.
Dental Sleep Solutions® dentists have the specialized knowledge and training to choose and fit an oral appliance that works perfectly for you. Many dentists claim they can provide treatment for Obstructive Sleep Apnea (OSA), but only Dental Sleep Solutions® dentists have received the rigorous training necessary to ensure that you are treated properly. Don’t trust your health to a non-specialist – make sure that you receive treatment from a qualified dentist with advanced training in sleep medicine. All Dental Sleep Solutions®dentists are here to help you with the knowledge and clinical experience you deserve.
What is a dental device and how does it work?
There are many FDA approved dental sleep devices. These devices can generally be divided into the 3 categories listed below:
1) Mandibular Advancement Devices (MAD)
Mandibular advancement devices are by far the most common type of dental sleep device available
for the treatment of snoring and Obstructive Sleep Apnea (OSA). They are also sometimes called oral appliances, or dental sleep devices.
Mandibular Advancement Devices (MADs) open the airway by moving the mandible (the lower jaw) forward. The tongue is attached to the lower jaw behind the chin. As the jaw is moved forward, the collapsible part of your airway is held open by the forward movement of the tongue and other airway muscles.Mandibular Advancement Devices (MADs) also improve the strength and rigidity of the airway by increasing the muscle activity of the tongue and other muscles of the airway.
2) Tongue Retaining Devices (TRD)
Like MADs, Tongue Retaining Devices (TRDs) also work by holding the tongue in a forward position. These devices pull the tongue forward, but instead of moving the jaw forward like a Mandibular Advancement Device (MAD), TRDs directly control the tongue itself. In some cases Tongue Retaining Devices (TRDs) have decreased therapeutic complications compared to MADs, but TRDs can also be less comfortable and generally take several weeks or months to be worn comfortably.
3) Combination CPAP/Dental Sleep Device Therapy
Often the problems associated with Continuous Positive Airway Pressure (CPAP) therapy are due to high pressures and uncomfortable fit of the nose or face mask. Your Dental Sleep Solutions® dentist can work directly with your sleep physician to make a combination dental sleep device that is worn in combination with your CPAP. This custom-made dental sleep device or oral appliance will attach directly to your CPAP machine. When CPAP is combined with jaw advancement from a mandibular advancement device, the CPAP can often be used at a much lower lower pressure setting.