Posts for tag: sleep apnea
We all know how much better we feel after a good night’s sleep: refreshed, energized and ready to handle — even excel at — our day-to-day responsibilities. Yet millions of people, young and old, are robbed of a good night’s rest by sleep-related breathing disorders such as sleep apnea, in which the soft tissues in the back of the throat block the airway during sleep. This temporarily disrupts airflow, causing numerous “micro-arousals” (sleep interruptions) that we may not even be aware of. A lack of sleep can make us drowsy, irritable and unfocused. In children, these typical symptoms of sleep apnea can lead to mistaken diagnoses of Attention Deficit Hyperactivity Disorder (ADHD).
The relationship between sleep apnea and behavioral problems has been highlighted in several recent scientific journal articles, including a major study published several years ago in Pediatrics, the official journal of the American Academy of Pediatrics. The lead author, Dr. Karen Bonuck, said at the time: “We found that children with sleep-disordered breathing were from 40 to 100 percent more likely to develop neurobehavioral problems by age 7, compared with children without breathing problems. The biggest increase was in hyperactivity, but we saw significant increases across [other] behavioral measures.” Therefore, an accurate diagnosis of a child’s behavioral problems — leading to the right treatment — is crucial. While sleep apnea must be diagnosed by a physician, treatment for the condition is often provided by a dentist.
What can be done for children suffering from sleep apnea? The most common treatment is surgical removal of the tonsils or adenoids. This treatment can sometimes be performed by an oral and maxillofacial surgeon, a dentist who has received several years of post-graduate surgical training. There are several other procedures oral surgeons can perform to open the airway, depending on what anatomical structures are blocking it.
Sometimes a child with sleep apnea can benefit from a procedure to expand the palate (roof of the mouth) to enlarge the airway. This is not a surgical treatment but rather an orthodontic one. An orthodontist (a dentist who specializes in moving teeth) will fit the child with a palatal expander, a butterfly-shaped device that gradually separates the two bones that form the upper jaw and roof of the mouth. This is often done to prevent crowding of teeth and other bite problems, but has been shown in some cases to improve airflow.
There is another dental approach used to treat adults and older children, whose jaw growth is complete. It’s called oral appliance therapy, and it involves wearing a custom-made device during sleep that resembles a sports mouthguard or orthodontic retainer. An oral appliance can maintain an opened, unobstructed, upper airway during sleep in various ways, including: repositioning the lower jaw, tongue, soft palate and uvula; stabilizing the lower jaw and tongue; increasing the muscle tone of the tongue.
If your child has been diagnosed with sleep apnea, we can help you find the best treatment approach. For more information, please contact us or schedule an appointment for a consultation. You can also learn more by reading the Dear Doctor magazine articles “Sleep Disorders & Dentistry” and “Snoring & Sleep Apnea.”
Q: What is sleep apnea, and how common is it?
A: Obstructive sleep apnea is a type of sleep-related breathing disorder (SRBD) in which the airflow to the lungs is restricted — or even cut off completely — during sleep. This condition is usually caused by the collapse of soft tissues in the back of the throat, and is potentially deadly. Sleep disorders, including SRBD, are thought to affect tens of millions of people in the United States. They have been blamed for several catastrophic accidents, including the 2014 Metro-North train crash in New York, and the 1989 Exxon Valdez oil spill in Alaska.
Q: How can I tell if I might have sleep apnea?
A: Everyone has trouble sleeping sometimes. But if you constantly snore, wake up feeling irritable, and experience sleepiness and diminished performance during the day, it may mean you suffer from this condition. After a while, SRBDs can trigger depression, confusion, memory loss, and other personality changes. Medical professionals note that a person with SRBD tends to be obese; to show enlargement of the tongue, tonsils, or uvula; to have nasal polyps or congestion; and possibly, to exhibit other signs.
Q: How is sleep apnea treated?
A: There are various treatments for sleep apnea, depending on the severity of the problem and its likely cause. These include oral appliance therapy (wearing a retainer-like device in the mouth at night); orthodontic treatment and/or oral surgery; and using a CPAP (constant positive airway pressure) machine to help facilitate breathing at night. Each has advantages and disadvantages that should be discussed with a healthcare provider who has experience in the area of sleep disorders.
Q: What does all this have to do with dentistry?
A: Dentists are, of course, extremely familiar with the anatomy of the mouth. We sometimes notice signs of potential sleep problems before they become life-threatening. What’s more, we may be able to successfully treat the problem with oral appliance therapy. We can properly fabricate, fit and adjust an oral device that helps keep your airway open at night. Because it is inexpensive, removable, and relatively comfortable, an oral appliance may be a good remedy to try before moving on to more complex treatments, such as a CPAP machine or surgery. So if you think you might have SRBD, maybe it’s time to make an appointment and talk to us about it.
You may think snoring is a minor problem, but it can be a lot more than that. Just ask hoops star Shaquille O'Neal, whose rambunctious snoring bothered his girlfriend enough for her to suspect a health problem. Her observations eventually led to Shaq's diagnosis of moderate Obstructive Sleep Apnea (OSA), which occurs when the soft tissue structures at the back of a person's throat, including the tongue, partially close off the upper airway and prevent air from moving into the lungs during sleep. Sometimes airflow can be blocked completely for 10 or more seconds.
When air flow is reduced, blood oxygen levels drop. This leads to brief waking episodes known as “micro-arousals,” which can happen sometimes more than 50 times an hour. The sleeper might not even be aware of this, even while gasping for air. Micro-arousals prevent the person from ever reaching deep, restful sleep.
Besides suffering from excessive daytime sleepiness, studies show sleep apnea patients are at higher risks of heart attacks, congestive heart failure, high blood pressure, brain damage and strokes. People with sleep apnea also have a higher incidence of work and driving-related accidents.
OSA can be treated in a few different ways. On the advice of his doctor, Shaq opted for a Continuous Positive Airway Pressure (CPAP) machine, which generates pressurized air delivered through a face mask worn while sleeping. The force of the pressurized air opens the airway (windpipe) in the same way as blowing into a balloon does.
For people with milder OSA, or who find they can't tolerate wearing a mask during sleep, an oral appliance supplied by a dental professional might be the answer. Oral appliances are worn in the mouth and are designed to gently reposition the jaw and move the tongue forward away from the back of the throat. Success rates of 80% or more have been reported using oral appliances, depending on the severity of the OSA.
If you would like more information on sleep apnea, please contact us or schedule an appointment for a consultation. You can learn more about sleep apnea by reading the Dear Doctor magazine article “Snoring & Sleep Apnea.” Dear Doctor also has more on “Sleep Disorders & Dentistry.”