Sleep Disorders

Sleep problems have many causes:

It could be a problem with your airway and/or your breathing, such as snoring and obstructive sleep apnea. It could be a problem with the way signals travel to and from your brain, such as narcolepsy. It could be a condition that causes uncontrollable leg movements at night – that is, restless legs syndrome. Or it could be one of the many problems that lead to insomnia, such as stress.

Sleep disorders are common among patients who suffer from allergies, ulcers, arthritis, heart disease, asthma, hyperthyroidism, kidney disease, Parkinson’s disease, and Alzheimer’s disease.

If you or someone you love is suffering from a lack of restful sleep, a smart first step is to discuss your concerns with a dentist who is trained in dental sleep medicine. He or she will review your dental and medical history, evaluate your airway and nasal passages using state-of-the-art technology and, if warranted, recommend treatment or refer you to the right kind of sleep specialist.

When the muscles of the jaws, soft palate and the tongue become too relaxed during sleep, they can sag and partially or completely block your airway. As you struggle to breathe, your body becomes distressed and you become partially awake, nearly every time this event occurs. These episodes can occur hundreds of times each night, keeping you from reaching the deep, restorative sleep your body requires and putting a great deal of stress on your heart. Since this can have serious consequences, we urge anyone who is concerned about the quality of their sleep to contact their physician or a dental professional with advanced training in dental sleep medicine.

At a minimum, your dental sleep exam should include:

In addition to studying your medical and dental histories, we will examine the soft tissues in your mouth, throat, neck and nose. The purpose of this clinical evaluation is to:

Since sleep-disordered breathing can also occur as a result of improper alignment of the jaw and structures within the mouth, we also examine the temporomandibular joint (TMJ) as an important part of every sleep patient evaluation.

Depending on the complexity and severity of your sleep concern, we may also recommend that you seek a referral to an overnight sleep lab for a diagnostic polysomnogram (i.e., a sleep study) in order to confirm your diagnosis. If that should be necessary, we will assist you in the process by providing you with names of sleep physicians and sleep laboratories.

Anyone who suffers from non-restful sleep will benefit from a thorough exam and, if indicated, treatment by a dentist with advanced training in dental sleep medicine. Today, 70 million Americans suffer from sleep disorders according to Carl E. Hunt, director of the National Center on Sleep Disorders Research. Sleep disorders are most common in middle-aged men and, in particular, those who are over weight. However, women and children can suffer from sleep-disordered breathing, too. Early Diagnosis is the Key. If sleep disorders go undiagnosed and untreated, their effects on health can be far more serious than simply feeling tired and irritable.

Most hospitals have sleep diagnostic centers which are being run by sleep technicians working with physicians. Sleep centers have sophisticated equipment in an adjoining room where an intercom and video camera allow communication between the technician and the patient. The patient comes in at night and is hooked up to a number of machines, which are used to monitor the activities of the brain, the eyes and the muscles. The recordings are done in a private room and there is no discomfort to the patient. Recordings are done during the night in a seven-hour sleep period and the patient is discharged in the morning. This type of testing is called a POLYSOMNOGRAM.

The purpose of a polysomnogram is to evaluate the individual sleep architecture including the stages and cycles of sleep as well as to record the electrical activity of the brain, the eyes, muscles and heart by utilizing

It also uses a finger or ear oximeter to measure the amount of oxyhemoglobin (oxygen saturation) in the blood. Patients suffering from OSA have a decreased amount of oxygen in the system.

The Watch PAT_100 can screen for OSA by measuring Peripheral Arterial Tone through a finger-mounted optoneumatic probe. It also incorporates pulse oximetry and an actigraph which give information such as blood oxygen desaturation, pulse rate to detect respiratory disturbances and sleep/wake state detection. The W100 is worn on the wrist and the patient is able to undergo the test comfortably, in a familiar setting, at home. I would like to stress again that this does NOT replace PSG testing, but is an invaluable testing tool when testing with PSG is restricted.

Watch-PAT 100 is FDA approved.

After a thorough examination of the airway and nasal passages, if the problem is found to be in the nasal passages or adenoids and tonsils a referral will be given to an otolaryngologist (ENT) with the testing results for the ENT to be able to determine the degree of obstruction and necessity for surgery.

However if SDB is due to a malformation of the teeth and jaw then we will be able to evaluate the child for oral appliance therapy. With oral appliance therapy we can correct structural problems such as recessed jaw, narrow arches that may be leading to airway narrowing or collapsing.

A CPAP (continuous positive airway pressure) is a machine that delivers lightly pressurized air through a hose to a small nose mask. The flow of the air acts like an “air splint” to keep the upper airway open and prevent apnea (i.e., shortness of breath). CPAP machines have 99% efficiency in restoring normal breathing during sleep. They have also undergone many improvements since an Australian invented the first one from a vacuum cleaner and a length of hose. However, the rate of patient compliance with CPAP is less than 50%.

Thanks to advances in dental sleep medicine, qualified dentists can effectively treat many patients who suffer from snoring, obstructive sleep apnea, upper airway resistance syndrome and other sleep-disordered breathing problems using oral appliance therapy.

An oral sleep appliance is similar in appearance to an athletic mouthguard, and it is worn during sleep to maintain airway patency. Oral sleep appliances are safe, less expensive vs. CPAP or surgery, and easy to use.

There are also few, if any, side effects. However, one size does not fit all. There are currently six (6) different FDA-approved oral appliances we can use to treat sleep-disordered breathing. Regardless of the appliance selected, to be effective, it must be properly customized and precision fit for each patient. For some patients, an oral sleep appliance can eliminate the need for CPAP or surgery. For patients with more severe sleep problems, an oral appliance can be an effective and convenient adjunct therapy.

Children can also snore and suffer from obstructive sleep apnea. Often they are highly allergic and their airway is blocked due to enlarged adenoids, tonsils or swollen nasal mucosa. The snoring or labored breathing can also be due to structural problems of the jaw and teeth. Sleep Disordered Breathing ranges in severity, from snoring to different digrees of airway obstruction. This is why it is important to have a dentist trained in SDB to evaluate the situation.

Restful sleep is essential to your child’s health.

Undiagnosed and untreated pediatric sleep disorders have been linked to a spectrum of health and behavioral issues, including

Mild to moderate sleep apnea patients are among largest groups of patients that are not screened. However, dentists with advanced training in dental sleep medicine can be patients’ first-line of defense against the potentially devastating cardiovascular, neurologic and interpersonal consequences of undiagnosed and untreated sleep-disordered breathing problems.

In our office, we use a state-of-the-art pharyngometer/rhinometer to measure your airway volume, determine whether or not your airway collapses, and evaluate your nasal turbinates (small, bony structures covered by mucous membranes that protrude into the nasal airway and help to warm, humidify and cleanse air as it is inhaled and before it reaches the lungs). Enlarged turbinates and nasal congestion can contribute to headaches and sleep disorders such as snoring and obstructive sleep apnea, as the nasal airway is the normal breathing route during sleep.

In addition to screening for sleep disorders, qualified dentists can provide dental sleep medicine therapies to patients that suffer from snoring, sleep apnea and other sleep-disordered breathing problems. These therapies can often enable sleep patients to find effective alternative or adjunct therapies to traditional treatments for sleep disorders, including CPAP or surgery.

Snoring is no laughing matter. Although often depicted comically, snoring should be taken seriously. It can disrupt your sleep as well as your partner’s sleep. Snoring can also lead to sleep apnea by changing the structure of tissues. However, not everyone who snores has sleep apnea.

If you’ve been told that you snore, or you suffer from excessive daytime sleepiness or shortness of breath upon awakening, consult your doctor. Today, patients with mild to moderate sleep apnea are among the largest groups of patients not screened. That said, the only way to determine with certainty if you have sleep apnea is by referral to an overnight sleep lab for a diagnostic polysomnographic (sleep) study. We are happy to you with names of sleep physicians and sleep labs that we work with upon request.

For simple snoring and mild to moderate obstructive sleep apnea (OSA), oral appliance therapy is an excellent alternative to CPAP and/or surgery. Both the American Academy of Sleep Medicine and the Academy of Dental Sleep Medicine endorse it.

When they are well made and used as directed by a qualified health professional, dental sleep appliances can put an end to snoring in the majority of patients. However, the success of these splint-like devices for any given patient cannot be determined without a complete dental sleep examination.

In our practice, we use six (6) different FDA-approved oral appliances to successfully treat snoring as well as other types of sleep-disordered breathing problems. To achieve maximum results, each of these splint-like devices must be customized and precision-fit to each patient. One size does not fit all, which is why you should be evaluated and treated for snoring by a dentist with advanced training and expertise in dental sleep medicine.

At their annual meeting in 1995, the American Sleep Disorders Association adopted a resolution, which formally accepted dental appliance therapy for treatment of snoring and mild sleep apnea. They also extended the recommendation to include dental appliance therapy for treatment of moderate and severe cases of sleep apnea. This is especially encouraging news, since nationally only 45% of patients using CPAP machines continue to use them. We cannot determine with certainty whether or not you are a candidate for dental sleep appliance without a comprehensive sleep evaluation by our office. However, we can tell you that increasing numbers of patients are successfully using oral sleep appliances as both alternatives and adjuncts to standard therapies, including CPAP and surgery.

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