Dental Sleep Medicine: Treating Snoring and Sleep Apnea

Dental Sleep Medicine: Treating Snoring and Sleep Apnea

Why do we need to sleep anyways?

People often think of sleeping as a time when our body shuts down and our mind stops working. This is absolutely not the case!  On the contrary, sleep is a time when our body is active not only in restoring, rejuvenating and strengthening itself, but also of processing the events of the day and consolidating our memories1.  Research has proven that our bodies require long periods of undisturbed sleep in order to synthesize and regulate hormones, to grow and repair muscle and tissues, and to enhance mental function.  It’s fair to say that sleep impacts every aspect of our health and daily life!

 

Why do we snore?  What is Obstructive Sleep Apnea?

Snoring is a sound that occurs during sleep when soft tissue at the back of our throat vibrates as we breathe. Snoring is extremely common in men, but also occurs frequently in women, especially during pregnancy and after menopause. Age, obesity, nasal obstruction, alcohol and smoking all increase the risk of snoring, as does a narrow airway or misaligned jaws2. Snoring can occur in younger, physically fit people as well.  Snoring is often a sign of sleep apnea.

When the muscles at the back of our throat relax too much, the soft tissue surrounding our airway doesn’t simply vibrate, but it collapses and blocks the flow of air into and out of our lungs.  As a result, repeated breathing pauses occur, which often reduces our oxygen levels. These breathing pauses are followed by brief awakenings that disturb our sleep.  We call these episodes of arrested breathing apnea.  Nearly thirty million adults in the US suffer from Obstructive Sleep Apnea (OSA)3.

 

Is Treating OSA Important?

Treating obstructive sleep apnea and other types of sleep disordered breathing is incredibly important to your health. Untreated sleep apnea often causes excessive daytime sleepiness or fatigue, as well as morning headaches and memory loss.  Accidents at work as well as an increased risk of motor vehicle collisions occur in people with untreated OSA. Untreated sleep apnea raises the risk of other physiological problems including:

  • High blood pressure
  • Stroke
  • Heart disease
  • Diabetes
  • Chronic acid reflux
  • Erectile dysfunction
  • Clenching/grinding and TMJ problems

Severe, untreated sleep apnea even increases your risk of death. 3

 

How is Snoring and OSA Treated?

There are basically 3 options for the treatment of sleep apnea and snoring.  These include continuous positive airway pressure (CPAP) therapy, oral appliance therapy (OAT/MAD) and surgery.

  • CPAP therapy involves wearing a face mask connected by tubing to a constantly running machine.  This machine blows a continuous stream of air into the throat to hold open the airway as a person sleeps and breaths
  • Oral appliance therapy uses a mouth guard-like device (worn only during sleep) to position the lower jaw forward and maintain an open, unobstructed airway.
  • Surgical options vary and are largely dependent upon the anatomical conditions and limitations of the individual.

*All treatment modalities have varying side effects and rates of success.

 

Oral Appliance Therapy (OAT) / Mandibular Advancement Devices (MAD)

Mandibular Advancement Devices (MADs) are fabricated to fit in the mouth just like an orthodontic appliance or a custom-made mouthguard.  The mandibular advancement device works by moving the jaw and tongue forward at night.  Because the tongue and soft-tissue at the back of the throat is to a large degree attached to the inside of the chin, by moving the lower jaw (mandible) forward it is possible to open the airway and stabilize it.  MAD’s also improve the strength and rigidity of the airway by increasing the muscle activity of the tongue and other airway muscles.
There are currently over 100 different types of custom made oral appliances available to reposition the jaw and treat snoring and sleep apnea. Given this knowledge, how does one decide on which appliance to choose, or even if an appliance will work?  Dr. Cichon and his team at Southport Dental Care have partnered with local sleep specialist Dr. John E. Remmers and his team of researchers at Zephyr medical to incorporate the MATRx plus Home Sleep Test system into their sleep medicine program.  Dr. Remmers is a pioneer in sleep medicine, having invented the auto-titrating CPAP, and is a world-renowned expert in the field of snoring and OSA.

 

The MATRx plus device removes the guesswork when deciding which sleep apnea patients will respond to OAT.  During a 2-night home sleep test, MATRx plus uses a computer-controlled mandibular positioner, which is connected to temporary dental trays, to gently move the patient’s lower jaw through a range of positions in an attempt to both ascertain if the patient will be a responder to OAT and also to identify the optimal jaw position to reduce air flow impedance.  After the test is complete, our office will generate a report for you with the following information:

  • A binary prediction of therapeutic outcome (i.e. is the patient a responder or non-responder to OAT)
  • An efficacious protrusive position for the responder’s custom oral appliance

 

The ability to verify effectiveness prior to fabricating a custom oral appliance is particularly helpful when dealing with those OSA patients who are intolerant to, or refuse, CPAP. In addition, OSA patients are looking for CPAP alternatives. Oral Appliance Therapy has been proven to be an effective treatment option for OSA and snoring.  If you or a loved one struggles with obstructive sleep apnea or snoring, or if you have any questions about the management of sleep disordered breathing, please let Dr. Cichon and his team at Southport Dental Care help you out.

Links:

http://www.aadsm.org/PatientResources.aspx

https://sleepfoundation.org/sleep-disorders-problems

https://www.zephyrsleep.com/resources/videos-for-patients/

Reference:

 

  1. https://sleepfoundation.org/excessivesleepiness/content/why-do-we-need-sleep
  2. http://www.aadsm.org/snoring.aspx
  3. http://www.aadsm.org/sleepapnea.aspx