Sleep Apnea

Sleep apnea is a potentially life-threatening sleep disorder characterized by repeated pauses in breathing during sleep. The term sleep apnea is derived from the Greek etymology meaning “without breath”. Breathing pauses can last anywhere from several seconds to minutes, and happen as often as 30 times or more per hour. Ongoing disrupted breathing causes an imbalance between the carbon dioxide and oxygen levels in the bloodstream, as not enough carbon dioxide is exiting and not enough oxygen is entering the body.

Sensing this imbalance, the brain sends a message to the body, telling it to wake up to restart breathing the process. People with sleep apnea will partially awake as they struggle to breathe, and this is often accompanied by loud snoring or choking sensations. Because people with sleep apnea don’t always completely awake during the episodes, they are often unaware they have a sleeping disorder and it can remain undiagnosed.

There are two main types of this disorder; central sleep apnea which occurs when the brain fails to send important signals to the breathing muscles, and obstructive sleep apnea which occurs when air cannot flow through the nose or mouth even though the body is still trying to breathe. Obstructive sleep apnea is far more prevalent and easily treatable by the dentist.

Common signs of obstructive sleep apnea can include snoring, severe early morning headaches, sleepiness in the daytime, and insomnia. Fortunately, the dentist is equipped with the necessary technology and expertise to treat sleep apnea in several different ways.

Reason for treating sleep apnea

It is very important to seek medical attention if sleep apnea is suspected. A sufferer can completely stop numerous times per hour, and this can quickly turn into a deadly situation. Obstructive sleep apnea occurs when the soft tissue lying at the back of the patient’s throat collapses into the airway. The tongue then falls towards the back of the throat which tightens the blockage and prevents oxygen from entering the lungs.

The problem worsens when the chest region, diaphragm, and abdomen fight for air. The efforts they make to obtain vital oxygen only cause a further tightening of the blockage. The patient must arouse from deep sleep to tense the tongue and remove the soft tissue from the airway.

Because sleep apnea causes carbon dioxide levels to skyrocket in the blood and oxygen levels to decrease, the heart has to pump harder and faster to compensate for the lack of oxygen. Sleep apnea has been linked to a number of life threatening conditions, and should be addressed as soon as possible to prevent permanent damage to the body, or even death.  Some of these conditions include high blood pressure (which leads to an increased risk of heart attack or stroke), cardiac arrhythmias, diabetes, gastric reflux, poor healing and longer hospital stays, depression, and auto and work place accidents from falling asleep.  Studies have shown that 40% of heart attack and stroke patients have sleep apnea.  In fact, it puts people at greater risk than smoking!  Severe sleep apnea has even been shown in a recent study to cause permanent brain damage.  Clearly, sleep apnea is not something to be taken lightly. 

What does sleep apnea treatment involve?

The first step is to get a diagnosis, and the only way to do so is with a polysomnogram or sleep study.  This can be done in a laboratory setting, or with a home monitor.  Regardless, the patient is connected to a number of leads and bands which will measure the number of times the patient stops breathing, the blood oxygenation levels, breathing rate and depth, heart rate, brain waves, and a number of other items.  From these readings a diagnosis will be made - either no apnea, mild apnea, moderate apnea, or severe apnea.  The treatment will be based on this diagnosis, and consultation a physician, dentist, or both.

The "gold standard" for treatment of sleep apnea for many years has been the CPAP machine.  This machine includes a mask that fits over the patients mouth and nose, and pushes air into the lungs, keeping the airway open, and preventing the apnea episodes.  When tolerated by the patient it is a very effective treatment.  The problem is that about 50% of patients cannot tolerate and sleep with the bulky equipment on, so they don't use it.

An alternative treatment is an oral appliance made by a dentist.  There is a number of appliances out there that work on the same principle - hold the lower jaw forward, which opens the airway and allows better oxygenation of the blood.  These appliances are very effective in treating sleep apnea, and tend to be much better tolerated than the CPAP machine.  The patient wears plastic guards (like a thick retainer that covers the teeth) on the upper and lower teeth, with something built in that prevents the lower jaw from dropping back and blocking the airway.  In some cases medical insurance will cover this appliance.

A third option for treating sleep apnea is surgery.  There are a number of surgeries that can be done, some relatively simple, some very invasive.  The simple surgeries and fairly well tolerated, but don't have a great long term record of success.  In other words, the apnea may improve initially, but in a few years, it may be back where it started from.  The more involved surgeries (usually splitting the lower jaw and moving it forward) can be very successful, but is very invasive, has a long recovery time, and can permanently change the shape and appearance of the face.  In general, this is considered a last resort if other options have failed, and the health risks of the patient are serious.

The treatment of sleep apnea has a team approach, including the patient, the primary care physician, a sleep specialist, a dentist, and possibly a sleep laboratory, with communication amongst the team members essential.  Dr. Moore has extensive training in this area.  Please feel free contact him for any questions - often a phone consultation can be invaluable in learning about sleep apnea, and what can be done about it.