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Sleep Apnea

Sleep apnea is a potentially life-threatening sleep disorder characterized by repeated pauses in breathing during sleep.  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 the breathing 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 wake 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 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.

Reasons 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 patients can technically “die” many times each night. Sleep apnea has been linked to a series of serious heart-related conditions, diabetes, strokes, Alzheimer's and cancer.  Because of these life events sleep concerns should be investigated by the dentist at the earliest opportunity.

What does sleep apnea treatment involve?

Many different treatment options can be offered which depend largely on the exact diagnosis and the health of the patient.

Dental devices that gently move the lower jaw forward are very effective in opening the airway.  These dental devices are gentle, easy to   wear, and often help patients avoid unwanted surgeries.

Diabetes- If you have Diabetes you are 50% more likely to have Sleep Apnea or OSA Obstructive Sleep Apnea. A 2014 study in the American Journal of Respiratory and Critical Care Medicine. When you have sleep apnea your tongue and tissues closes off your airway. This apneic event can last for few seconds up to minutes where your body is being deprived of oxygen known as hypoxia. When your body experiences the lack of oxygen the brain releases chemicals messages to the lungs and diaphragm to breathe. When the blockage remains in place the brain due to stress releases sugars in the fight or flight response to stress. Over time this constant system correction leads to elevated blood sugar levels and impaired insulin sensitivity. When left untreated unchecked insulin sensitivity leads to protracted insulin resistance, which then leads to glucose intolerance, and diabetes results.  Respiratory and Critical Care Medicine shows that for nondiabetics, 1 in 3 patients with severe OSA will also develop diabetes.

Heart Disease- People with obstructive sleep apnea are more likely to suffer heart attacks and die in the middle of the night. The cause may be low oxygen or the stress of waking up often during sleep. Stroke and atrial fibrillation- a problem with the rhythm of the heartbeat—are also associated with obstructive sleep apnea. The disrupted oxygen flow caused by sleep apnea makes it hard to your brain to regulate the flow of blood in arteries and to the brain itself.

High Blood Pressure-Obstructive sleep apnea can contribute to high blood pressure in people who have it. The frequent awakenings that plague people with sleep apnea cause hormonal system to go into overdrive, which results in high blood pressure levels at night. Low blood-oxygen levels, caused by the cutoff oxygen, may also contribute to hypertension in people with sleep apnea. The good news: Some people with high blood pressure who are treated for sleep apnea can cut back on their blood pressure medications.

Strokes-Sleep apnea can be an after effect of stroke, but can also be the cause of a first time or recurrent stroke. The condition causes low oxygen levels and high blood pressure, both of which can increase the risk of a future stroke.

Alzheimer's-Sleep is the time for the brain to clean up all the plaque. If sleep is disturbed, the brain might not get the job done, leaving an accumulation of the proteins that block up nerve cells. 

Weight Gain-Being overweight causes fatty deposits in the neck that block breathing at night. In turn, sleep apnea impairs the body’s endocrine systems, causing the release of the hormone ghrelin, which makes you crave carbohydrates and sweets. Also, people with sleep apnea who are tired and sleepy all the time may have lower metabolisms, which can also contribute to weight gain. Getting treatment for sleep apnea can make you feel better, with more energy for exercise and other activities. 

Car Accidents-Daytime grogginess can put people with sleep apnea at increased risk of falling asleep behind the wheel. People with sleep apnea are up to 5x’s more likely than normal sleepers to have traffic accidents. 

Cancer- It is believed that OSA help to promote the growth of cancers. Animal studies have suggested that oxygen deprivation fosters cancer progression. When mice with malignant tumors are put in low-oxygen environments that simulate sleep apnea effects, their cancers grow more quickly. There’s also the possibility that depriving mice of oxygen triggers the development of more blood vessels (to compensate for the lack of oxygen delivered to tissues) and that this may spur tumor growth.

“Unfortunately, sleep apnea doesn't hurt like chest pain. It doesn't bring up a specific complaint. The patient may be a little sleepy or confused. People often fail to make the correlation that the daytime sleepiness may be related to disrupted sleep at night", said Dr. Alon Avidan, a professor of neurology at the University of California, Los Angeles, and director of the UCLA Sleep Disorders Center.

Sleep Apnea Appliances

Oral Appliance Therapy (OAT) is considered a primary choice of treatment for mild to moderate OSA patients because of its treatment success rate and patient compliance.   

Most oral appliances work by repositioning the mandible in order to create a more accessible airway opening.  By opening the airway, many appliances prove to alleviate snoring and treat sleep apnea.