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Dentistry’s Role in Sleep Apnea

Obstructive sleep apnea is very common and potentially life-threatening medical disorder that prevents airflow during sleep. More than 18 million Americans have sleep apnea, and many are not receiving treatment. Sleep apnea occurs when tissue in the back of the throat collapses and blocks the airway, reducing the amount of oxygen delivered to all of your organs including your heart and brain. People with sleep apnea may snore loudly and stop breathing for short periods of time. When the blood-oxygen level drops low enough, the body momentarily wakes up. It can happen so fast that you may not be aware you woke up. This can happen hundreds of times a night, and you may wake up in the morning feeling unrefreshed. In addition to snoring and excessive daytime sleepiness, sleep apnea can cause memory loss, morning headaches, irritability, depression, decreased sex drive and impaired concentration. Sleep apnea patients have a much higher risk of stroke and heart problems, such as heart attack, congestive heart failure and hypertension. Sleep apnea patients are also more likely to be involved in an accident at the workplace or while driving.

Sleep apnea patients are often older, obese and have thick necks, but men and women of any age or body type can have sleep apnea. The sleep disorder progressively worsens with age and weight gain. Some common signs of sleep apnea include unintentionally falling asleep during the day, general daytime sleepiness, unrefreshed sleep, fatigue, insomnia, waking from sleep with a choking sound or gasping for breath and loud snoring.

Treating OSA may require a combination of approaches such as behavioral changes, upper airway surgery, weight loss, C-PAP, or oral appliance therapy. The gold standard for treating sleep apnea is a C-PAP, which is a machine that creates positive air pressure to keep the airway open and force oxygen in the lungs. The problem with a C-PAP is a patient’s compliance in using the device. It is said that between 30 and 50 percent of those with C-PAPs do not utilize them, so they are not treating this life threatening condition.

One of the treatment options for treating sleep apnea is an oral appliance. Oral appliances are a front-line treatment for snoring and mild to moderate obstructive sleep apnea. This small plastic device fits in the mouth during sleep like a sports mouth guard or orthodontic retainer. Oral appliances help prevent the collapse of the tongue and soft tissues in the back of the throat, keeping the airway open during sleep and promoting adequate air intake. Oral appliances may be used alone or in combination with other treatments for sleep-related breathing disorders, such as weight management, surgery or C-PAP.

Oral appliance therapy involves the selection, fitting and use of a specially designed oral appliance that maintains an open, unobstructed airway in the throat when worn during sleep. Custom-made oral appliances are proven to be more effective than over-the-counter devices, which are not recommended as a screening tool or as a therapeutic option. Dentists with training in oral appliance therapy are familiar with the various designs of appliances and can help determine which is best suited for your specific needs. The initial evaluation phase of oral appliance therapy can take several weeks to complete. This includes examination, evaluation to determine the most appropriate oral appliance, fitting, maximizing adaptation of the appliance and the function. Ongoing care, including short- and long-term follow-up is an essential step in the treatment of snoring and Obstructive Sleep Apnea with Oral Appliance Therapy. Follow-up care serves to assess the treatment of your sleep disorder, the condition of your appliance, your physical response to your appliance, and to ensure that it is comfortable and effective.

Some of the advantages of oral appliance therapy include: oral appliances are comfortable and easy to wear; most people find that it only takes a couple of weeks to become acclimated to wearing the appliance; oral appliances are small and convenient, making them easy to carry when traveling; and treatment with oral appliances is reversible and non-invasive.

If you or someone you know thinks they have sleep apnea, it is vital they receive a proper diagnosis and treatment. If you have already been diagnosed and are using (or not using) your C-PAP, look for these other solutions. It may even save your life. FBN

By Bryan Shanahan, DDS



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