Sleep apnea is a sleep disorder that affects millions of people around the world. It is characterized by repetitive pauses in breathing during sleep, which can last from a few seconds to several minutes. These pauses in breathing can lead to disrupted sleep, reduced oxygen flow to the brain, and numerous health problems, including high blood pressure, heart disease, stroke, and depression. It affects approximately 25 million American adults, and about 80% of sufferers are undiagnosed. While the connection between oral care and sleep apnea is not yet well understood, your dentist can play a critical role in diagnosing and treating sleep apnea. A well-trained dentist can evaluate the airway and jaw position to determine if any physical factors contribute to the condition. Dentists can also help patients diagnosed with sleep apnea by providing custom-made oral appliances to help keep the airway open and prevent these frequent pauses in breathing. What is Sleep Apnea? Sleep apnea is a severe sleep disorder where breathing stops and repeatedly starts during sleep. Breathing must pause for 10 seconds or more to be diagnosed as sleep apnea. The interruptions in breathing cause you partially wake up dozens or even hundreds of times throughout the night. This will prevent a deep, restful sleep cycle. People with sleep apnea are typically unaware of these events but will feel exhaustion or drowsiness the next day. Sleep apnea symptoms include: \tDaytime fatigue \tSnoring \tExperiencing a dry mouth or sore throat upon awakening \tMorning headache \tDifficulty concentrating and forgetfulness \tChanges in mood \tHigh blood pressure \tDecreased sex drive or libido \tWaking abruptly, gasping or choking What causes sleep apnea? The actual causes of sleep apnea will vary from patient to patient. Men are much more likely to be affected by sleep apnea than women, and it most often occurs in people over 40. Sleep apnea risk factors include: \tObesity \tNasal obstructions or sinus problems \tEnlarged tonsils \tLarge tongue or large neck \tSmall jawbone \tFamily history of sleep apnea Sleep apnea comes in three forms: obstructive sleep apnea, central sleep apnea, or complex sleep apnea. Obstructive Sleep Apnea (OSA) is the most common form of sleep apnea. OSA accounts for over 80% of cases in the United States. OSA occurs when the muscles that support the soft tissues in your throat, such as the tongue and soft palate, relax too much, narrowing your airway. The causes of OSA can range from sinus and allergy issues to obesity. Central Sleep Apnea: Central sleep apnea is a neurologic issue in which the brain fails to activate respiratory muscles during sleep. Central sleep apnea is typically associated with a neurological disorder like a stroke or Parkinson's disease. Complex Sleep Apnea: A combination of central and obstructive sleep apnea. This type of sleep apnea means breathing problems persist even after airway obstruction is treated. Sleep Apnea and Oral Health A dentist is often the first medical provider to notice and diagnose sleep apnea. A variety of factors can cause sleep apnea's most common symptoms. Below are a few signs your dentist can use to diagnose sleep apnea: Bruxism (Teeth Grinding) Teeth grinding while sleeping can cause headaches or neck and jaw pain. Recent research has shown that approximately 13% of adults grind their teeth while sleeping, and more than 80% do not even realize they are doing it. Dentists can note teeth grinding based on the wear on your teeth. Bruxism can be considered one of the body's natural defense reactions to obstructive sleep apnea. Research has shown that when your throat begins to relax before apnea, the jaw reflexively closes to prevent the airway from being blocked. Bruxism and OSA appear to be related to certain sleep positions. Certain custom mouthguards called mandibular advancement devices can reduce bruxism and OSA. Temporomandibular Joint (TMJ) Disorders Temporomandibular joint (TMJ) disorders are often reported along with obstructive sleep apnea. The TMJ connects the lower and upper jaw with two joints. When the joint or the muscles surrounding it are damaged or misaligned, patients can experience neck stiffness, headaches, ear pain, and popping or clicking noises when their jaw moves. While the specific connection between TMJ disorders and sleep apnea has not been fully discovered, both involve dysfunction with the muscles surrounding and inside the mouth. Some research has found that people with OSA were twice as likely to have TMJ disorders than those without sleep apnea. Tooth Decay Patients who suffer from sleep apnea often are mouth breathers at night because the airways leading to the nose are narrower and more easily obstructed. Breathing through the mouth for prolonged periods will lead to mouth dryness. This dryness contributes significantly to plaque, gingivitis, and progressive periodontal disease. Saliva helps to wash the surface of the teeth, clearing away bacteria and debris. While gingivitis and tooth decay alone is not a clear diagnosis of sleep apnea, taken along with other factors, they can help point towards a sleep apnea diagnosis. How Can Your Dentist Help With A Sleep Apnea Dental Appliance? An official sleep apnea diagnosis is needed and must come from a medical doctor with the possibility of a visit to a sleep center. A dentist can fabricate a sleep apnea dental appliance used to reposition the tongue and lower jaw forward during sleep to maintain the open airway. Usually, a sleep apnea dental appliance is recommended for mild to moderate obstructive sleep apnea patients. A sleep apnea dental appliance can also be utilized in severe obstructive sleep apnea patients who cannot tolerate using a CPAP machine. The standard medical treatment right now is using a CPAP (called Continuous Positive Airway Pressure). Approximately 25%-50% of sleep apnea patients do not regularly use or tolerate CPAP machines. Some recent clinical studies have shown that a sleep apnea dental appliance is the most effective in treating snoring and mild to moderate obstructive sleep apnea. Types Of Sleep Apnea Dental Appliance Mandibular advancement device (also called MAD). This is the most popular sleep apnea dental appliance prescribed for obstructive sleep apnea patients. This sleep apnea dental device is very similar in appearance to an athletic mouthguard. A hinge between the upper and lower part of the sleep apnea dental appliance allows the lower jaw to be eased forward. The Thornton Adjustable Positioner (TAP) is a sleep apnea dental appliance that allows further adjustments than most. This TAP sleep apnea dental appliance controls the degree of lower jaw advancement for even more comfort and control of obstructive sleep apnea. Tongue Retaining Device (TRD). More popular than the sleep apnea dental appliance above. This device works by holding the tongue in place, keeping the airway open. Ask your dentist which sleeps apnea dental appliance is right for your particular case of obstructive sleep apnea. Sleep Apnea Dental Appliance Conclusion The best course of treatment for obstructive sleep apnea depends on many factors. These factors include the severity of your obstructive sleep apnea, the physical anatomical structure of your upper airway, other medical issues you may have, and a patient's personal preferences. Choosing the correct sleep apnea dental appliance is a very personalized decision. Speak to Dr. Marielaina Perrone about which sleep apnea dental appliance is right for you. There are proven scientific links between a lack of a good night's sleep and many problematic symptoms, including depression, memory loss, hypertension, and weight gain. With the help of your dentist and a sleep apnea dental appliance, you can improve your sleep and overall health!