The field of dentistry has changed a lot in the years that I have been a dentist. Many of these changes have been very exciting and offer greater care for my patients. One such expansion of care for dental patients is in the field of sleep dentistry. Since the mouth is the gateway to the rest of the body, many symptoms that cause conditions such as Obstructive Sleep Apnea are more likely to be noticed by dental professionals.
Obstructive Sleep Apnea (OSA) is a disorder marked by interruptions and pauses in breathing during sleep caused from the physical obstruction of the airway. This is usually caused by the soft tissue at the back of the tongue. A true apnea event is the total cessation of breathing that lasts over ten seconds or as long as a couple minutes. Many people average thirty seconds per event. Every time you stop breathing for that long, the oxygen level in your blood will drop. This can cause many serious health problems, including death.
A short list of these problems includes but is not limited to:
- Hormone imbalance
- Memory problems
- Depression
- Liver problems
- Heart disease
- Diabetes
- High Blood Pressure
- Stroke
One of the side effects of sleep apnea is a change in the metabolic rate. This can cause weight gain which can in turn cause all of the other health problems associated with weight gain.
When you think about how important it is to breathe, it’s no wonder that involuntarily holding your breath while you sleep, over and over again, every night, is very bad for your health. Anyone who has slept in the same room with someone who has severe sleep apnea can tell you that it’s quite disconcerting when that person stops snoring only to cease breathing altogether, and then to be aroused a minute or two later gasping for breath. I personally have spent a sleepless night sharing a hotel room with such a person. Each time he stopped breathing, I imagined that I would be performing CPR if it continued.
The incredible part of this whole thing is that most of these people are completely unaware that they have this deadly condition. However, they may be aware of other symptoms caused by their sleep apnea.
These symptoms include:
- Sleepiness during daytime activities
- Inability to focus or concentrate
- Falling asleep while watching TV or a movie
- Irritability and/or personality changes
- Difficulty staying asleep
- Frequent urinating at night
- Night time grinding or clenching of teeth
- Snoring
- Awakening with a very dry or sore throat
- Presence of Gastro-Esophageal-Reflux Disease (GERD)
- Frequent morning headaches
- Depression and or mood changes
People are well aware of these symptoms but probably don’t associate them with Obstructive Sleep Apnea (OSA). This makes OSA a very silent killer.
One of the conditions I see in my dental office that may be caused by OSA is the wearing down of the front teeth. Wear on the front teeth is usually only possible if the patient moves their lower jaw forward. For most people, closing their jaw in its normal position results in the front teeth overlapping and not touching. The only way for them to be worn down is to advance the lower jaw so that the bottom teeth can touch the top teeth.
The reason that this is associated with OSA is because while the person is asleep and breathing stops, the brain will arouse the person just enough for them to move the jaw forward to make it possible to breath. Moving the jaw like this can cause wear on the edges of the front teeth. This also brings up another problem with having OSA.
As the brain falls asleep, it goes through five different stages. Most people have heard of REM sleep which is also known as Rapid Eye Movement. This is the last stage of sleep. Deep sleep is the third and fourth stage of sleep. This is where you get the most restorative sleep and this is where the brain rejuvenates itself. Deep sleep also reduces the drive to sleep. Without deep sleep, the brain will be in need of more sleep and cause daytime drowsiness.
In order to get to deep sleep, the brain has to go through the first two stages of sleep. This takes some time, which is why a short nap during the day will not diminish the ability to fall asleep but a long nap will. During a long nap, the brain goes into deep sleep and so the drive to sleep is reduced.
These stages of sleep can present a big problem for those with OSA, depending on which stage the apnea occurs. Apnea tends to cause an arousal which brings the brain out of deep sleep. Due to the sleep cycle, this means that patients with OSA spend less time in deep sleep. Also, there is recent research which suggests that many patients experience apnea events in REM sleep, which can in turn have an effect on short term memory (NYU Langone Medical Center, 2015).
Since there is less time spent in the deep sleep cycles in people with sleep apnea, they will experience daytime drowsiness. This can cause some serious problems with occupational accidents, productivity and being able to enjoy leisure activities. The National Highway Traffic Safety Administration estimated in 2013 that drowsy driving was responsible for 72,000 crashes, 44,000 injuries, and 800 deaths. This is just another way that OSA can kill.
Because OSA is a big health problem, there’s a significant need to increase awareness and treatment. Being aware of the symptoms is a start. If you experience multiple symptoms of OSA, then you should have a sleep test done. There are different kinds of sleep tests that can be performed. Many sleep tests are done in sleep centers and these tests can monitor brain waves and determine how much time is spent in the different sleep cycles. A more basic and less expensive test can be performed at home that will monitor the number of apnea events per hour along with how well the body is receiving oxygen. This home test can screen for OSA and in many cases is a good place to start. If the test shows that there are significant problems then the patient should get a definitive diagnosis by visiting a sleep physician along with further testing at a sleep center.
As a health care provider, I see many people who are afraid of a diagnosis to the point that they don’t want to be seen. It’s like the proverbial ostrich with its head in the sand thinking that it’s successfully avoiding a predator because it can’t see it. All this does is to allow the predator to easily attack the ostrich without being detected and without the ostrich doing anything to save itself. If there is a problem, finding it and treating it is much better than not finding it and allowing it to get worse. Many people feel this way about OSA because they don’t want to be told that they might need to wear a CPAP machine. Studies have shown that people with untreated severe sleep apnea have a much higher mortality rate. Further studies need to be done, but because most people with sleep apnea aren’t even aware they have it, this could be a tip of a very big iceberg.
Luckily, there are treatment options that work. The Continuous Positive Airway Pressure (CPAP) machine, and the Bilevel Positive Airway Pressure (BPAP) machine while being a little cumbersome and inconvenient, works very well to improve blood oxygenation and in reducing sleep apnea events. This treatment has changed many people’s lives as it has reduced the daytime sleepiness and other more serious symptoms that people with OSA suffer from. For these people, the inconvenience of a CPAP or a BPAP machine is worth it for them to feel better.
But there are other options if a patient doesn’t want to or can’t use a machine to sleep with. Dental appliances made to advance the mandible forward are very effective at opening the airway and reducing apneas for people with OSA. These appliances aren’t as cumbersome and have the added benefit of being able to be used while traveling or even camping with much greater convenience. We offer such appliances at Ridge Park Dental.
If you think you might have OSA, then you have nothing to lose by taking a home test. This will arm you with information and could change your life or even save it.
Ng, A. K., & Guan, C. (2012). Impact of obstructive sleep apnea on sleep-wake stage ratio. 2012 Annual International Conference of the IEEE Engineering in Medicine and Biology Society. doi:10.1109/embc.2012.6347006
NYU Langone Medical Center. (2015, October 06). Sleep apnea affects REM sleep and memory. Retrieved April 04, 2018, from https://psychcentral.com/news/2014/10/31/sleep-apnea-affects-rem-sleep-and-memory/76798.html
Marshall NS; Wong KKH; Liu PY; Cullen SRJ; Knuiman MW; Grunstein RR. Sleep apnea as an independent risk factor for all-cause mortality: The Busselton Health Study. SLEEP 2008;31(8):1079-1085.
American Academy of Sleep Medicine. Study shows that people with sleep apnea have high risk of death. (2017, November 08). Retrieved April 05, 2018, from https://aasm.org/study-shows-that-people-with-sleep-apnea-have-a-high-risk-of-death/