Sleep apnea (SA) is a condition that causes continuous stopping and starting of breathing while asleep. During this time, the brain keeps you awake just sufficiently to enable you to breathe, although you experience sleep disorders in the process. If not managed early, sleep apnea can result in significant health problems. Unfortunately, most of these causes are concealed and untreated. However, a dentist can notice the symptoms of the illness during an annual oral examination, help you manage the symptoms, and refer you to a physician for specialized care when necessary.
At The Hawthorne Dentist, we partner with sleep experts and physicians, enabling us to refer diagnosed patients for long-term and specialized care. Also, we can develop dental appliances that prevent airway blockage.
Sleep Apnea at a Glance
Sleep apnea causes breathing difficulties while asleep. Usually, the disorder stops and restarts breathing. The term apnea is the Greek word for breathless. The condition happens in three primary ways. The first sleep apnea type is obstructive, abbreviated as OSA. It occurs when your throat muscles relax excessively while asleep, blocking the airways and allowing air to enter and leave the lungs.
Another kind of SA is the central one, abbreviated as CSA. Although less prevalent, it happens when the brain cannot control breathing because of failure to transmit signals or cues to the muscles regulating breathing. When you suffer from CSA, you will experience breathing pauses because of the physical blockage of the airways.
The final SA type is the treatment-emergent CSA. It happens when undergoing OSA treatment and, in the process, developing CSA.
When your airways block during sleep due to collapse of the throat or failure by breathing muscles to control breathing because of failure by the brain to send signals, your lungs are deprived of oxygen. The oxygen shortage activates or triggers the survival reflex, waking you sufficiently to breathe. While the reflexive awakening keeps you alive, it interrupts your sleep pattern, denying you restful sleep. If you do not manage the condition early, it could result in increased heart stress, putting your life at risk.
According to the National Library of Medicine, around one billion people aged between 39 and 60 years around the globe suffer from OSA. CSA is not as widespread, although a few individuals suffer from the condition.
People with obesity, hypertension, or cardiovascular disease are more likely to develop the condition. Also, particular ethnic groups are more predisposed to the illness than others. Patients who have been using opioid medication to manage pain are also at an elevated risk of CSA.
Experts depend on the Apnea-Hypopnea Index (AHI) to test the gravity of your condition. AHI measures estimate the apnea or hypopnea incidents you experience every hour to gauge condition severity. The results from the test can be mild, average, or severe, so inform your health expert on the most appropriate treatment or management.
Discussed further are the three sleep apnea kinds:
- Obstructive Sleep Apnea
OSA is a prevalent type of SA, affecting approximately one billion people. It occurs due to the collapse of the throat. The relaxation of the head and throat muscles causes the collapse. When the throat collapses, the tissues surrounding it compress the windpipe, preventing lung oxygen flow. This is the source of the breathing difficulties you experience while sleeping.
- Central Sleep Apnea (CSA)
CSA stems from brain failure to transmit signals to breathing muscles, particularly during sleep, pausing breathing. Many factors contribute to the development of this condition, like heart failure, reduced oxygen levels in the blood, and damage to the nervous system in the spinal cord, interfering with signal transmission from the brain to other body parts. OSA therapy can also increase the chances of developing CSA.
- The Complex of Mixed Sleep Apnea Disorder
Also called treatment-emergent CSA, complex SA develops when undergoing Positive Air Pressure (PAP) treatment, which leads to CSA in OSA treatment.
Mixed SA develops due to elevated ventilation during PAP therapy, air leakage on the PAP mask leading to a drop in carbon dioxide levels, or an adjustment in your body’s response to breathing. People at an elevated risk of developing complex SA are:
- The male gender
- Senior citizens
- Individuals who sleep on their backs
- Individuals on opioid medication for pain management
- Persons with advanced OSA
- People living in higher altitude
- Persons undergoing PAP treatment
You can tell if you have mixed sleep apnea if you experience these symptoms at night:
- Daytime fatigue
- Feeling sleepy or exhausted when waking up
- Problems concentrating
- Chest pains
- Mood swings
- Repeated waking at night
- Poor quality of sleep
You should know that stertoring is not one of the symptoms of mixed SA. Your dentist or physician will recommend continuous positive airway pressure (CPAP) treatment to manage the condition. However, if there is no improvement, your medical expert will suggest more advanced treatments, like adaptive servo-ventilation. Sometimes, a bi-level PAP will be advisable, coupled with a reinforcement rate for sufficient breathing.
Sleep Apnea Pervasiveness
Statistics show that sleep apnea affects around one billion people around the globe, with the more significant part of the demographic comprising OSA patients. 936 million people between ages 39 and sixty suffer from mild to severe OSA, while an average of 425 million people are diagnosed with average to severe OSA, according to the National Library of Medicine. Unfortunately, this number only reflects a small fraction of the population, as 80% to 90% of the conditions are undiagnosed or untreated. The US came second to China regarding countries leading with OSA prevalence. Approximately thirty million individuals are affected by OSA, with only six million diagnosed cases. The studies show that most of these conditions are undetected and thus go without treatment and are only discovered when they are severe or cause life-threatening complications.
Typically, the condition affects more men than women, with men experiencing the most severe conditions. Nevertheless, when women develop menopause, their risk of sleep apnea is elevated, and the condition tends to affect them with more symptoms than men.
Senior citizens, mainly those aged 65 or above, are twice as prone to the condition as middle-aged ones. Approximately half of the senior citizens suffer from mild symptoms, with 20% experiencing average to severe symptoms. From these statistics, aging increases the danger of sleep disorders.
Another factor that increases the threat of the condition is obesity. 40% of obese persons suffer from sleep apnea, with 20% experiencing OSA or hypopnea disorder. 15% to 20% of pregnant women suffering from obesity develop OSA.
Other contributing factors are:
- Large tonsils
- Family history of the condition due to genetic predisposition
OSA and CSA Symptoms
The symptoms common in patients suffering from CSA and OSA are:
- Loud snoring
- Episodes of posed breathing while asleep
- Air gasping as your body attempts to maintain the usual breathing
- Dry mouth is the morning caused by breathing through the mouth
- Morning headaches stemming from oxygen deprivation
- Difficulties remaining asleep
- Hypersomnia or sleepiness in the day
- Cognitive impairment of problems concentrating due to sleep deprivation
- Mood swings or irritability due to insufficient sleep
The symptoms particular to CSA are:
- Insomnia
- Poor quality of sleep
- Problems paying attention or concentrating
- Waking up in the middle of the night with breath shortness
- Chest pains that manifest at night
- Daytime tiredness
- Morning headaches
Medical Complications Stemming From Untreated SA
Most of these conditions in the US and around the globe are undiagnosed and thus go untreated. If your condition is not diagnosed early, the symptoms could go from sleep difficulties to life-threatening situations. Untreated sleep disorders increase the possibility of metabolic syndromes and heart conditions.
Research shows that you are twice as susceptible to developing heart disease as a person who does not suffer from this sleep disorder.
Sleep apnea increases the possibility of metabolic illnesses like hypertension and type 2 diabetes. Furthermore, an accelerated pulse rate and high blood pressure caused by sleep apnea can cause systemic inflammation, causing atherosclerosis, which is known to increase the threat of stroke or myocardial infarction. Chronic inflammation also damages the pancreas, elevating diabetes risk.
Other health complications you are at risk of developing because of the sleep disorder are:
- Metabolic conditions like hypertension, excessive body fat, and high blood sugar
- Heart conditions like heart attack or failure
- Pregnancy complications caused by hypertension, preeclampsia, and gestational diabetes
- Asthma
- Liver damage due to worsened symptoms of nonalcoholic fatty liver disease
- Elevated risk of brain tumors and cancer due to insufficient oxygen
- Compromised immune system
- Respiratory issues
- Anxiety and depression
- Mental confusion
Sleep apnea also leads to neurocognitive impairment due to persistent sleep deprivation. The symptoms that show you are experiencing chronic sleep deprivation are:
- Difficulties concentrating
- Challenges paying attention
- Memory loss
- Depression
- Irritability
- Sexual dysfunction
- Night sweat
- Restlessness at night
- Excess sleep during the day
- Microsleeps are brief moments of falling asleep during the day. These increase the chances of road and workplace accidents, as you could fall asleep while driving or operating heavy machinery.
Sleep Apnea Diagnosis
Diagnosing sleep apnea combines clinical evaluations, symptom evaluations, and special tests. The first phase of the process entails clinical reviews that focus on examining the symptoms you are experiencing and your sleep pattern. Your spouse, roommate, or any other person you share your bed with can attest to some of these symptoms, as they have seen them manifest while you are asleep.
Your healthcare professional will also make some inquiries regarding the following:
- Whether you feel exhausted during the day or experience microsleeps
- Whether you snore at night
- Whether your partner sees you pause or stop breathing while sleeping
- Whether you have challenges staying awake when operating a car or reading
- Whether you have a history of smoking
The diagnosis also entails a physical evaluation to establish if you have factors that elevate the threat of the condition, like hypertension, obesity, neck circumference, or other medical concerns.
Tests used to diagnose sleep apnea are:
Sleep Study
Otherwise called polysomnography, a sleep study is a test performed in a sleep laboratory to diagnose sleep apnea. The test entails detailed monitoring of the body while you are asleep in your home or sleep laboratory. During the test, your physician observes body functions like breathing, levels of oxygen in the blood, the activity in your brain, and heart rate. The results from the tests determine if you suffer from sleep apnea.
Your physician could also try the split-night sleep test, where half your night’s sleep is devoted to testing if you have the condition. If the physician discovers you have sleep apnea, the next half of the night tests whether a PAP device can manage the condition.
Home Sleep Apnea Test (HSAT)
If your physician suspects you suffer from moderate or severe OSA, they will recommend an HSAT. The test monitors your heart rate, oxygen levels in the blood, breathing pattern, and airflow but uses fewer computations than studies conducted in a lab. These tests are convenient and comfortable to use, but they could miss an existing sleep apnea condition when not performed correctly.
Dental Examination
Few dentists know dental sleep medicine. If you are lucky to have a dentist with expertise in this field, you can trust them to identify signs of illness during your regular dental examinations. The dentist usually examines the mouth and surrounding areas in these routine checks. If they discover signs of the disorder, they can conduct further evaluation. When they find a large tongue, a large and persistent tonsil, a high-arched palate, a massive neck circumference, or mandibular retrognathia, it could mean they have sleep apnea. If the dentist has the capabilities, they could manage the condition; if not, they will refer to a physician for specialized care.
The diagnostic criteria for diagnosing sleep apnea are based on sleep studies, HSAT tests, and symptom evaluation. On the other hand, the AHI test measures the severity of the condition by determining the complete air stoppage and shallow breathing rate per sleep hour.
A complete diagnosis is made after at least five full breaths per one sleep hour. The rate of events you experience within the duration determines the condition’s gravity.
Oral Appliances Treatment
If your dentist diagnoses the condition through a routine exam and has knowledge of dental sleep medicine, they could administer treatment to manage the condition without referring you to another specialist. The treatment conducted by dentists is called oral appliance therapy or training. These special dental tools fix your breathing problem, especially OSA, by keeping airways open while asleep.
- Definition of Oral Appliances
Dental appliances for OSA are devices or tools that you wear in the mouth to pull the jaw and tongue forward while asleep to enable effective breathing.
When you suffer from OSA, the tongue partially or entirely blocks the airway while asleep. The air blockage triggers survival reflexes in the brain, which slightly wakes you up to enable breathing. The restricted airflow pattern continues overnight, denying you quality sleep and rest. Dental appliances fix this condition by holding the tongue in place to ensure normal breathing.
- Oral Appliances Types
Your dentist has two oral appliance options for addressing your problem: mandibular advancement devices or splints (MADs) and tongue-stabilizing devices (TSDs).
MADs are designed to pull the lower section of your jaw or mandibular forward. When the jaw moves forward, the tongue also pushes forward, creating an opening in the airways that allows normal breathing while asleep. The device or appliance sits on the teeth and comes in two sets, one for the upper jaw and the other for the lower one. If you prefer this treatment, the dentist will help you choose the correct appliance depending on:
- Size
- The distance the appliance should move the jaw
- The contact between your teeth when you close the jaws
- Material preference, whether soft or firm
The other option for fixing sleep apnea using oral device therapy is TSDs. Instead of pulling the mandibular forward, these appliances pull the tongue using suction. The suction holds or retains the tongue to prevent it from moving backwards while asleep. The appliance’s tip then hangs on the outside of the mouth. These tools function the same way as MADs, pulling the tongue forward to open airways. TSDs are not as prevalent as MADs, although people ineligible for MADs use them to fix sleep apnea.
A practical dental appliance for fixing sleep apnea is tailored to meet your oral needs and teeth impression. You can purchase the appliance or have your dentist prepare a customized one after taking a detailed impression of your teeth. When the dentist takes the impression, they will send it to a dental lab for fabrication. When the device is ready, it will be sent back to the dentist, who will schedule another appointment for installation. Once the device is in place, the dentist will give you post-procedure instructions on how to use and care for the device for optimum results.
Wearing a TSD or MAD at first is difficult. Therefore, in the first few days, wear the device for a few hours, and as time passes, you will become used to it and wear it for longer hours. Eventually, you will start wearing the device throughout the night for maximum benefits.
- Oral Appliances Benefits
The benefits of oral appliance therapy are:
- The appliances enable you to sleep, improving your sleep quality and preventing daytime sleepiness or fatigue
- It reduces or eradicates snoring
- You experience deep sleep without disruptions
These appliances will eliminate the symptoms if you have mild to moderate OSA. If you do not see improvement, you must consider other treatments.
You should know that oral appliances are only suitable for mild or moderate OSA disorders that do not require CPAP machines. Also, if you suffer from CSA, it means the problem originates from the brain, so the dentist will refer you to a physician for specialized treatment. Besides, managing OSA at advanced stages using oral appliances is dangerous, so your dentist will recommend seeing a physician or sleep professional for advanced therapy.
Advanced Treatment Options
For severe disorders, CSA, or where oral device therapy fails, your dentist will refer you to a physician for advanced procedures like:
Hypoglossal Nerve Stimulation
You should try hypoglossal nerve stimulation to improve your sleep quality, life quality, and sleep apnea. It is a new treatment that has proved safe with no significant adverse effects.
CPAP (Continuous Positive Airway Pressure)
The gold standard for OSA treatment is CPAP. The procedures entail using machines to steadily deliver a flow of air using a mask to keep airways open. When you consistently use the machine, the airways adapt to staying open, increasing the chances of the treatment successfully managing OSA. CPAP is proven in OSA (Obstructive Sleep Apnea) management, although it is a less effective therapy for monitoring CSA.
The benefits of the procedure in OSA management include:
- It improves your cardiovascular health
- It lowers blood pressure
- Reduces nighttime arrhythmia events
- Enhances heart functions among heart failure patients
- Reduces daytime sleepiness
- Enhances your mental health by alleviating depression and anxiety symptoms
Lifestyle Changes
Adjusting your lifestyle through weight loss, modifying sleep positions and neck exercises can help manage sleep apnea. Other lifestyle modifications, like quitting alcohol or smoking, have also proven to alleviate the symptoms. Therefore, before trying any treatment, change your lifestyle to manage the condition. However, if there is no improvement after the changes, you should try treatment.
Surgery
When noninvasive treatments fail, your physician will recommend surgery. The standard surgical procedures medical experts use to fix sleep apnea are:
- Tissue extraction surgery
- Shrinkage surgeries
- Jaw repositioning operation
- Nasal operation
Your physician can even recommend a tracheotomy. Although highly invasive, the surgery is a highly effective treatment for sleep apnea. It is used as a last resort and entails an airway directly through the neck.
Another surgery is tonsillectomy, performed on adults and children to remove large tonsils blocking the airways to open up airways. The procedure is appropriate for moderate SA.
Find a Reputable Cosmetic Dentistry Service Near Me
Treating sleep apnea takes several approaches. The condition is not just a sleep disorder because, if left untreated, it leads to significant health complications like heart attack and heart disease. Dental experts commonly diagnose this condition during routine exams, and those with dental sleep medicine knowledge can help monitor and manage the symptoms. If you experience sleep apnea symptoms, consult your dentist for a diagnosis and treatment.
At The Hawthorne Dentist, we will recommend oral appliances to manage the condition. However, if the symptoms do not improve, we will refer you to a physician for advanced care. Call us at 310-775-2557 for a no-obligation consultation.
