CONNECTIONS

– Dr. Rob Veis, Dentist, Lecturer and
CEO, Appliance Therapy Group

In today’s information age, you can’t read a paper, listen to the radio or watch television without learning something about the latest device, herbal medicine, nasal strip, surgical technique or dental appliance being used to treat SNORING.

If you snore loudly and often, you are no doubt accustomed to middle-of-the- night elbow thrusts, occasional forced exile to the living room sofa (or the garage) and lots of bad jokes. But snoring is no laughing matter.

That log sawing animal noise that keeps everyone awake and contemplating murder (yours) comes from foiled attempts (also yours) to force air through an airway that is not fully “open-air.”

Truth be told, perhaps ten percent of adults snore. And although for most of those afflicted, snoring has no serious medical consequences, for an estimated one percent, habitual snoring is the first indication of a potentially life-threatening disorder called Obstructive Sleep Apnea.

• • • •

Snoring and Apnea: Not the Same Thing

Snoring and Apnea are not the same thing. Snoring – the result of a change in air flow through nasal and pharyngeal tissues — is only a potential warning sign of Sleep Apnea. Visualize water running through a pipe. If the water flow is partially blocked, the pipe will vibrate. The same thing happens when the flow of air is obstructed. In this case, it is the tissues in the mouth and throat that vibrate.

Essentially, on one side of the obstruction spectrum, you have the benign snorer (no actual physical problems or harm). On the opposite side, the apnea sufferer. In the middle there is the snorer suffering from Upper Airway Resistance Syndrome. Those falling into this middle group may not experience apnea episodes, but their snoring is so loud, their breathing so labored, that it still wakes them up numerous time and leaves them tired and depleted in the morning.

What is Sleep Apnea?

Steadmans’ Medical Dictionary defines “apnea” as “the absence of breathing or the want of breath.” When air flow at the mouth and nose stops for more than 10 seconds, an apnea episode has occurred. If a person experiences 30 or more apnea episodes during a seven-hour sleep period, they are believed to be suffering from Sleep Apnea.

Apnea severity is usually categorized by episode frequency per hour: 5-15 is considered mild, 15-25 moderate, more than 30 is severe. Episodes can last anywhere from between 10-20 seconds each, terminating with at least partial awakening. Typically, a patient may have as many as 300 apnea episodes per night.

There are three basic classifications of sleep apnea:

Central Apnea occurs when air flow stops because breathing stops (temporarily). The airway remains open, but the chest wall muscles make no effort to create air flow. The cause is frequently encephalitis, brainstem damage, spinal cord injury or other serious debilitating conditions.

Obstructive Apnea is the stoppage of air flow due to a total airway collapse, despite a persistent effort to breathe. The obstruction can occur in one or all of three areas: the nasopharyngeal (nose-to-throat passage), oropharyngeal (tongue) and the hypopharyngeal (back of throat).

Mixed Apnea is a combination of the two previous types…usually beginning with a central episode followed by an obstructive one.

Signs & Symptoms

Because the nature of obstructive sleep apnea is multi-symptomatic and the treatment options varied, proper diagnosis and treatment are best handled with a team approach. Members of said team may include a sleep specialist, an ENT, an internist, an orthodontist, an oral surgeon and a general dentist.

Adults
Heavy Snoring
Gasping or choking during the night
Excessive daytime sleepiness
Fragmented, non-refreshed and/or restless sleep patterns
Morning headaches, dry mouth, scratchy throat and/or nausea
Irritability, anxiety, depression
Clouded memory and/or intellectual deterioration
Poor job performance and/or occupational accidents
Decreased sex drive and/or impotence
Teeth grinding
Hypertension

Children

Yes children can have Sleep Apnea, too. Typically they suffer from growth and developmental problems. Often they are highly allergic — with airway blockage due to enlarged tonsils. IMPORTANT: If they are already having snoring and breathing problems, do not ignore them.

Hyperactivity
Poor concentration
Developmental delay
High nasal voice quality
Noisy breathing
Nocturnal mouth breathing
Snoring
Frequent upper airway infections
Earaches
Bedwetting
Restless Sleep
Nightmares or night terrors
Headaches
Chronic runny nose
Obesity

What To Do?

If you suspect that someone maybe experiencing apnea episodes, refer them to a sleep specialist immediately for a complete medical workup and sleep test. I want to place special emphasis on “sleep specialist” here. The sad fact is, the majority of physicians have received less than one hour of training in sleep medicine as part of their medical education.

Even after a thorough evaluation by a dentist and/or sleep specialist, a definitive diagnosis can only be arrived at after a sleep test – a polysomnogram (PSG). As the patient sleeps, the PSG measures ventilation, gas exchange, cardiac rhythm, number and length of breathing stoppages, sleep stages and arousals.

Most major medical insurers will require patients to undergo a full PSG study in a sleep lab before paying out for treatment. In recent years however, ambulatory (mobile) sleep study devices have entered the dental market and are beginning to play an important in proper treatment. Patients with a high insurance deductible (or no medical insurance at all) may prefer the low cost of diagnosis via ambulatory means.

What’s most important here is don’t wait. Don’t put off treatment. Don’t avoid dealing with a problem that you see exists. Sleep Apnea can lead to heart failure, seizures, and even sudden death.

Next time: A Good Night’s Sleep — What are My Options?
A detailed discussion of treatment approaches, appliances and procedures.

Dr. Rob Veis is a practicing dentist, world-traveled lecturer and teacher and CEO of The Appliance Therapy Group. Headquartered in Chatsworth, CA, The Appliance Therapy Group is celebrating its 51st year of service – more than half a century of sharing innovative appliances, information and insights with dental patients and practitioners all over the world.

For more information on today’s dental treatments and technologies, visit www.TheATPA.com or call 800.423.3270

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