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Snoring & Sleep Apnea PDF Print E-mail
Snoring is no laughing matter. In fact, 75 million people in the U.S. suffer from snoring. Of these, 18 million are undiagnosed sleep apnea sufferers. For many, snoring does not involve a serious medical disorder. However, snoring can be a warning sign of a serious health problem where the airway closes during sleep and may even become life-threatening. The tongue plays a major role in snoring and obstructive sleep apnea (OSA) because the tongue has a tendency to relapse into the airway when sleeping. Indications of poor sleep include:
  • Daytime sleepiness
  • Headache or TM jaw soreness upon awakening
  • Restless or fragmented sleep; gasping for air
  • Dozing easily when reading, sitting or driving
  • Anxiety with breathlessness
  • Loss of interest in sex
Causes

A few of the medical and dental conditions that can lead to snoring can be evaluated such as a small, retruded jaw, allergies or an airway obstruction. Lifestyle changes are recommended such as exercise, weight loss, limiting alcohol and nicotine.

Diagnoses

To determine if you are a sleep appliance candidate, our office performs a complete dental history, screening exam and diagnostic tests as well as referring you to a sleep specialist for a medical assessment and a sleep study when indicated. Our exam may also include:
  • Evaluation of the head, neck, facial area and supporting structures
  • Checking the upper airway for obstruction, the vault of the palate, the oropharyngeal airway space, hypopharygeal airway space, size of the tongue, and the position of the mandible
  • TMJ disorder/occlusal evaluation to establish the ideal jaw position to increase the airway
  • Intra-oral habit assessment and gag reflex
  • Diagnostic models
  • Overnight sleep screening – not all patients are sent for a sleep study/assessment.
We have special training, qualifications and experience in treating TMD, snoring and mild to moderate sleep apnea. If you or someone you love experiences TMD or sleep problems, we can help. Ask the doctor or any new member of our staff for more information.

Facts About Oral Airway Appliances-The Dentist’s Role in Providing an Effective Alternative or Adjunct to CPAP and Surgery

Sleep disordered breathing encompasses several sleep disorders associated with varying degrees of airway blockage due to large tonsils, long soft palate or uvula, excessive fleshy tissue, or excessive relaxation of the tongue. In our dental sleep practice, we see some of the conditions that lead to snoring such as a small or retruded jaw and airway obstruction. While patients can perform some self-help measures toward overcoming the problem, many times it takes multidisciplinary care to treat the problem effectively.

Dentistry is an integral part of sleep medicine. Working together with physicians, a trained sleep dentist is a valuable member of the SLEEP TEAM. With the intense, special education we have acquired in our practice, we provide an alternative, or an adjunct to surgery and CPAP.

Patients with Mild or Moderate OSA

When our office suspects a patient is experiencing apneic episodes, they are referred to an ENT, pulmonologist or sleep specialist for a complete medical assessment and usually overnight polysomnogram (as directed by a physician). Our office evaluates, "red flags" such as:
  • Snoring
  • Daytime sleepiness
  • Awakening headache
  • TMJ soreness on awakening
  • Fatigue
  • Restless/Fragmented sleep; gasping
  • Anxiety with breathlessness
  • Dozing when reading or sitting
Screening

Our complete SCREENING to identify physiologic and behavioral predisposing factors includes:
  • Complete medical/dental history
  • Intraoral exam and evaluation of the head, neck and facial area, teeth, and supporting structures.
    • Checking the upper airway for obstruction, the vault of the palate, the oropharyngeal airway space, hypopharyngeal airwary space, size of the tongue, the position of the mandible, etc.
    • Upper and lower dental impressions
    • Specialized x-rays to assess whether or not the patient is a sleep appliance candidate; Lateral cephalographs and x-rays of the upper and lower dental arches for study of the jaw position and airway potential
    • TMJ disorder/occlusal exam – because the lower jaw moves in multiple directions, it is important to establish the best position to increase the airway
    • Sometimes an instrument is used to measure throat and nasal airway
Oral Appliance Therapy

Oral appliance therapy is being taught to dentists in postgraduate courses. This special training helps us choose the most appropriate appliance for each patient.

OSA appliances often look similar to orthodontic retainers and TMJ appliances. They are usually made from clear acrylics, and may have adjustment features.

All appliances attempt to dilate or open the airway by altering the position of the lower jaw. Benefits include:
  • Excellent patient acceptance and compliance
  • Non-invasive, conservative treatment
  • Repositioning the soft palate and stabilizing the lower jaw, tongue, soft palate, and uvula
  • Moderate cost – compared to other treatments
  • Increased muscle tone, pharyngeal and genioglossus muscle activity.
The efficacy of oral appliance therapy is clear in the scientific literature and has been common since the 1980’s. An increasing awareness in the dental profession is evident with the growing International Snoring Association and the Academy of Dental Sleep Medicine.

Oral appliance therapy has been recommended by the American Academy of Sleep Medicine and the National Institutes of Health for the treatment of mild to moderate obstructive sleep apnea, and in all cases of CPAP intolerance. As such, most insurance companies cover the cost of oral appliance therapy.

When is an oral sleep appliance the answer?

Clinical trials show that oral appliances are very effective in treating simple snoring and mild to moderate OSA. Many sleep appliances eliminate the need for surgery, medications and other therapies. They are especially effective for those patients who:
  • Cannot handle or will not comply with CPAP
  • Will not consent to a surgical procedure
  • Need the appliance in conjunction with surgery or CPAP treatment
Frequently, we refer these patients back to the sleep physician for a follow-up polysomnogram to evaluate the effectiveness of the sleep appliance.

When is CPAP the answer?

While CPAP is certainly the most recognized treatment, patients may feel claustrophobic and some find the equipment to be aggravating. Compliance is often a struggle. The strap and head gear required to keep the face mask on during sleep may cause discomfort and pressure on the face. However, there have been and continue to be, many improvements with CPAP and BiPAP. These therapies should be thoroughly considered with all patients who have OSA. If a patient can tolerate CPAP and it is adjusted correctly, it provides the most predictable results of the non-surgical therapies.

When is surgery the answer?

Sometimes surgery cannot be avoided. Surgeons can correct abnormalities such as nasal polyps, enlarged tonsils and deviated septum or jaw malformation. However, when an invasive surgical solution fails, patients can become frustrated and often devastated with their soft tissue changes. Statistics show surgical success only ranges between 30-50%. In addition, a number of complications can emerge over time. Many ENT physicians will encourage their patients to try oral appliance therapy prior to surgery.

Because many other medical conditions can be associated with OSA, our office knows the importance of a "team" approach with sleep centers and physicians. This team approach provides you with the best possible care and long-term success. We look forward to establishing a relationship with you and assisting with this serious medical problem.

Source: TMData Resources
 


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