How Can a Dentist Treat Your Sleep Apnoea

How Can a Dentist Treat Your Sleep Apnoea

Of every 10 Australians older than 40, 7 are likely to snore at some time. Many people may not think of snoring as a sign of something potentially serious but in some people it may indicate a more serious medical condition called obstructive sleep apnoea( OSA).

During normal breathing, air is drawn through the nose and past soft tissues at the back of the throat which include the uvula (the dangly bit that hangs down at the back of the mouth), soft palate and the tongue.

During waking hours the airways are held open by the tone of the muscles around them, however during sleep these muscles relax. In some people they may relax too much and even collapse, leading to obstruction of the airways. The obstruction to airflow may be partial or complete and the term apnoea is applied if airflow is interrupted by at least 50% for more than 10 seconds. This will lower the level of oxygen in your blood and cause a buildup of carbon-dioxide. Your brain senses this impaired breathing and briefly rouses you from sleep so that you can reopen your airway. Most of the time the person does not wake and usually has no awareness of these brief episodes, but finds their sleep is not refreshing. Occasionally, sufferers may awake and make a snorting, choking or gasping sound. This pattern can repeat itself 5 to 30 times or more each hour, all night long, which means the ability to reach the desired deep, restful phases of sleep is impaired, and you’ll probably feel sleepy during your waking hours.

1. So what should you look out for?

People with OSA almost always snore loudly and can have other symptoms, including:

Tiredness on waking
Excessive daytime sleepiness
Choking or gasping during sleep
Morning headache
Poor concentration
Memory deterioration
Decreased sex drive or impotence
Personality changes that may include irritability
Decrease in job performance
Anxiety or depression

Anyone can develop OSA, however certain factors put you at increased risk. These may include:

Excess weight. While anyone can develop this disorder excess weight can lead to fat deposits around the upper airway which can in turn obstruct breathing.
A narrowed airway which may be inherited. This group includes those with enlarged tonsils and adenoids, which may all lead to blockage of the airways
High blood pressure (hypertension)
Smoking
Diabetes
Gender. Men are twice as likely as premenstrual women to have OSA. However, the frequency of OSA increases in women after menopause
Family history of OSA
Asthma

2. Why should you be concerned with OSA?

OSA is considered a serious medical condition with several systemic complications:

Daytime fatigue and sleepiness. Sufferers may have difficulty concentrating and find themselves falling asleep at work, while watching TV or even when driving. Children with OSA may perform poorly in school and commonly have attention and behaviour problems.
Cardiovascular problems: Sudden drops in blood oxygen levels that occur during OSA increase blood pressure and strain the cardiovascular system. Many people with OSA develop high blood pressure which can increase the risk of heart disease. The more severe the OSA, the greater the risk of coronary artery disease, heart attack, heart failure and stroke.

Complications with medications and surgery. OSA is a concern with certain medications, sedation procedures and general anaesthesia. Drugs such as sedatives, analgesics and general anaesthetics relax your upper airway and may worsen OSA.

Sleep-deprived partners. Loud snoring can keep those around you from getting good rest and eventually disrupt your relationships. In extreme cases, partners may choose to sleep in another room.

3. When should I consult my dentist/doctor:

Diagnosis of the cause of sleep apnoea is crucial so that the most effective treatment can be offered. OSA may have a multifactorial cause and so assessment may involve specialists with expertise in various areas including dentistry, respiratory medicine, ear-nose-throat surgery and neurology. A likely first step once a thorough medical and social history is taken and signs/symptoms evaluated is for you to be referred to a sleep disorder clinic to monitor sleep patterns overnight in a study known as Polysomnography. During the sleep study, you’re hooked up to equipment that monitors your heart, lung and brain activity, breathing patterns, arm and leg movements and blood oxygen levels while you sleep.

It’s time to see a doctor if you experience or if your partner observes the following:
Snoring loud enough to disturb your sleep or that of others
Waking up gasping or choking
Intermittent pauses in your breathing during sleep
Excessive daytime sleepiness

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4. What are my treatment options?:

Snoring and OSA may be treated using oral appliances, nasal continuous positive airway pressure (nasal CPAP) or surgery, although alterations in lifestyle factors may also be helpful. Your doctor may suggest losing weight, exercising regularly, moderating your intake of alcohol (especially before bed) and to quit smoking. The use of a nasal decongestant or allergy medications and avoidance of certain sedative medications such as anti-anxiety drugs or sleeping pills (e.g. Valium) may help. Sleeping on your side is preferable to sleeping on your back.

CPAP involves wearing a mask over the nose at night that delivers air under pressure via a quiet pump, with the effect of keeping the upper airway passages open. Although regarded as the most consistently successful method of treating OSA some people find the mask cumbersome, uncomfortable or loud. They are best suited to patients with severe OSA or a history of heart disease, high blood pressure or diabetes.

Oral appliances are a safe, painless and effective alternative for people with mild to moderate OSA and snorers. Worn during sleep, oral appliances have helped many people who snore or have OSA. In fact, for every 100 snorers, about 95 will have a decrease in the noise level they make during sleep. And for every 100 people with mild to moderate sleep apnoea, about 80 will either have good or excellent results while using the appliance.

The appliances aid in keeping the airway open by:

Bringing the lower jaw forward and/or,
Lifting up the soft palate and/or,
Holding the tongue forward.

The appliances are easy to wear as they are small and light, they are easy to carry during travel, an obvious disadvantage over the CPAP machines. If it is cleaned and stored correctly, it should last for years.

Dentists require training and experience in oral appliance therapy to be able to correctly determine the right appliance to suit your needs and following a thorough assessment of your mouth and teeth, utilising x-ray imaging and accurate dental moulds, will be able to fit you with an appliance that you are able to wear at home. It is important that the whole process is undertaken in conjunction with and following consultation from a respiratory or sleep physician.

There are a few contraindications such as:

Having a pre-existing disorder of the jaw (Temporomandibular Joint Disorder or TMJ)
Severe untreated gum disease or dental decay
Full upper and lower dentures

The following possible side effects are usually minor and last only a few days and include:

Discomfort around the teeth and jaw
Dry mouth or excessive salivation
Irritation of the soft tissues of the mouth
Discomfort of the jaw joint

Longer term irregularities or changes to the bite may occur but for most people a change in bite is not annoying, is not a risk to the oral health and does not require further dental treatment. The patient should weigh up the risks of snoring and OSA against the risks of changes to the bite.

Surgical procedures may also be employed to:

Open breathing passageways in the nose
remove the tonsils/adenoids
reduce the tongue size, or
bring the upper or lower jaw forwards

As discomfort or complications may occur, careful discussion with a surgeon is necessary before a decision about surgery is made.

Talk to one of our dentists if you feel you may have risk factors or be suffering from OSA and we can help to give you the correct advice and offer treatment where appropriate to aid this potentially serious but treatable medical condition.