Dentists have an important role in the screening and management of sleep disorders, including snoring and sleep apnoea.
Sleep-related breathing disorders (SRBD) are disorders characterised by disruptions in normal breathing patterns. SRBDs are potentially serious medical conditions caused by anatomical airway collapse and altered respiratory control mechanisms.
Common SRBDs include snoring and obstructive sleep apnea (OSA). OSA has been associated with poor sleep, high blood pressure, memory issues, cardiovascular concerns, abnormal cholesterol levels, high blood sugar and an increased waist circumference.
In children, undiagnosed and/or untreated OSA can be associated with cardiovascular problems, impaired growth and learning and behavioural problems.
Unfortunately, many people are living with some kind of sleep-disordered breathing. This means that even if they are in bed for eight hours, their bodies are not receiving the rest or the oxygen they need – and they may not realise why they feel so tired and unhealthy. Yet, many health problems are directly linked to sleep-disordered breathing (see diagrams on this page).
Snoring is a common complaint, affecting up to 45% of adults and is a sign of airway obstruction. Snoring can be a source of great frustration for people sleeping close by and can disrupt the quality of sleep of the snorer, and others, leading to excessive daytime sleepiness.
Snoring occurs when your upper airway narrows during sleep when tissues relax and drop down, partially blocking your air passage. As the air passes through the narrowed passage, it vibrates the loose tissues and causes the characteristic sounds of snoring.
To get a baseline measurement of your current snoring issues, download SnoreLab (iOS, Android), a highly rated app that listens for snoring sounds, records clips, and analyses the sounds produced.
With sleep apnoea you stop breathing several times during the night. In severe cases, these episodes can be as frequent as 80 times per hour. If you sleep in the same room as your partner or a room mate, ask them if they notice any periods in which you stop breathing.
Sleep apnea patients come in all shapes and sizes and not all sleep apnea sufferers snore, many are not obese or even overweight, and not all of them are male. You can still have sleep apnea even if you don’t notice any pauses in your breathing as you sleep.
That’s especially true if you often feel tired during the daytime. In fact, daytime fatigue is one of the main indicators that your snoring may be due to sleep apnea.
The most effective treatment for snoring is an oral appliance that keeps your airway open and tongue forward while you sleep. An oral appliance is also recommended for mild to moderate sleep apnea.
The oral appliance advances the mandible forward and reduces the collapsibility of the upper airway. For severe sleep apnea, a device called “continuous positive airway pressure,” or CPAP is recommended, but if this can’t be tolerated then an oral appliance is the next option.
Take home sleep study
An in-lab sleep study, or polysomnogram (PSG), is a comprehensive test used to diagnose sleep apnea. These tests are conducted overnight at a sleep study centre, hospital or other designated site under the direct supervision of a trained sleep technologist.
A home sleep apnea test is a modified type of sleep study that can be done in the comfort of your home but without the oversight of a sleep technologist and therefore it measures fewer parameters. Both of these tests help to confirm whether the patient has mild, moderate or severe sleep apnea.
Dr Basil uses a WatchPAT. It’s an FDA-cleared portable home sleep apnea test and diagnostic device that uses innovative technologies to ensure the accurate detection of sleep apnea. The WatchPAT device has three points of contact design – you attach the chest sensor, strap on the WatchPAT bracelet to your non-dominate hand and slip on the finger probe.
This is done at a minimum cost and is easily worn by the patient in their own bed. The device is brought back to the clinic the next day and the data is downloaded to generate a report. After assessing these results, carrying out a thorough intra-oral exam, assessing sleep questionnaires and x-rays, a course can be charted to help the patient.
Oral appliances for snoring
Oral appliances for sleep apnea are dental devices, or mouthpieces, that you wear in your mouth to keep your airway open while you sleep. With obstructive sleep apnea (OSA), your upper airway is blocked partly or completely when you’re sleeping. The reduced airflow triggers your brain to wake you up just enough to keep breathing.
The cycle of restricted airflow, waking and falling asleep again, continues throughout the night.
These episodes stop you from sleeping soundly and prevent your vital organs from getting enough oxygen. Untreated, OSA can lead to serious health conditions and is potentially fatal.
Placed over your teeth, mandibular advancement devices (MADs) work by pulling your lower jaw (mandible) forward. Moving your jaw forward also pulls your tongue forward, creating more space for airflow in the back of your throat. Most come in two parts, one for your top teeth and one for your bottom.
Treatment
Both continuous positive airway pressure (CPAP) therapy and mandibular advancement splints (MAS) are effective treatments for obstructive sleep apnoea (OSA), but they have some key differences.
Oral appliances are small, lightweight and create minimal bulk in the mouth, leaving more space for the tongue. Patients can speak, drink and achieve a lip seal. It’s portable as it fits in a small denture container and more comfortable and easier to use than CPAP machines.
CPAP therapy involves wearing a mask that delivers a steady stream of air pressure to keep the airway open during sleep. CPAP is effective in treating OSA. Patients using CPAP therapy commonly complain that therapy is uncomfortable, claustrophobic, noisy and difficult to travel with.
The 3DS Advance is an innovative dental appliance, offering a unique, custom-made dorsal wing design, that is meticulously 3D printed from nylon. It features high tensile strength and is resistant to bruxing, cracking and abrasion.
It also allows independent movement of the upper and lower components during opening and closing. This feature reduces strain on the teeth, further enhancing patient comfort and compliance.
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How Annerley Dental Can Help
Dr Basil has attended many courses by leaders in the field including Dr Steve Olmos, Dr Derek Mahoney, and Dr Harry Ball. He has personal experience in this field as he has been diagnosed with moderate sleep apnea and had nasal surgery to enhance his breathing.
If you have been diagnosed by your doctor or sleep physician with sleep apnea or just want to reduce your snoring – give us a call. If your child snores, Dr Basil will examine your child (as part of their dental examination) and check their nasal breathing, tongue, size of tonsils and shape/size of their arch and jaws. Dr Basil will point you in the right direction.
