If your bed partner snores, it may be more than a mere annoyance. One of the most common causes of snoring, especially when punctuated by short periods of silence followed by loud snorts or coughs, is obstructive sleep apnea (OSA), a disorder in which the airway is obstructed during sleep. Not only does OSA prevent a good night’s sleep due to repeated breathing disruptions, it is associated with an increased risk of high blood pressure, heart attack, stroke, obesity and diabetes.
“Most sufferers do not know they have it, because they do not remember waking up all night. But it can happen hundreds of times in a night, which is why it can be very dangerous,” explains Dr. Ruth Gomes of Viva Smiles Advanced Dentistry. “Sleep apnea is caused by anything that prevents adequate airflow to the lungs. Often, the position of the jaw can affect airflow. When the jaw is positioned too far toward the patient’s skull, the esophagus can become blocked by tissue in the back of the throat.”
Gomes is one of an increasing number of dentists who work with physicians and sleep specialists to treat OSA. “If the patient’s sleep apnea has a dental cause, I position the jaw or tongue forward so that the airway will remain open when the patient is lying down. This can be done by either wearing a palliative appliance or with permanent jaw repositioning through non-invasive neuromuscular dentistry,” she says.
She notes that the collaborative aspect of diagnosis and treatment is important when assessing OSA. “Many different factors affect the airway, which is why I usually collaborate with an ENT (ear, nose and throat specialist) and allergist to make sure all contributing factors are treated. Often tonsils and adenoids or allergies can play a part,” she says.
The dental approach to OSA treatment may involve an oral appliance. “These devices are similar to retainers that patients use following orthodontic treatment and are placed in the mouth at bedtime,” says Dr. Jeffrey Rempala of Frontenac Dental Group. “They keep the lower jaw in a slightly forward position, keeping all the muscles around the airway in a forward position, which in turn keeps the airway open while the patient sleeps.”
Patients may prefer this treatment to use of continuous positive airway pressure (CPAP), the most common medical treatment for moderate to severe sleep apnea in adults. CPAP machines are connected to a mask that is placed over the mouth and/or nose. The machine gently blows air into the throat, keeping the airway open.
Rempala identifies several advantages to oral appliance therapy compared with CPAP. They include: no reliance on electricity, the ability to communicate and sip water while wearing the appliance, the ability to sleep in any position and get up during the night without needing to unhook the machine, and easy portability when traveling.
Rempala is a member of the American Academy of Dental Sleep Medicine (AADSM) and expects to be board-certified next year. The academy organizes clinical meetings on the latest ideas and establishes treatment protocol. The AADSM also works toward improving public awareness of sleep disorders and the role of the dentist in recognition and treating them.
“The most important point I can share is to take this disorder very seriously,” Rempala says. “The overall health consequences of leaving this disorder untreated are lethal. People die from the associated disorders from this disease, which include heart attack and stroke, and there is a significant decrease in the quality of a person’s life if they suffer from OSA.”
“Since sleep apnea is such a devastating disorder, dentists should be very familiar with the signs and symptoms of OSA and thoroughly question patients who seem to fit in this category,” Rempala concludes. “The health benefits of addressing this disorder are amazing.”