• Everything You Need to Know About Sleep Apnea

    Whether you’re here because your partner has finally decided that they can’t put up with your snoring anymore, or you find yourself waking up multiple times through the night gasping for air, there’s a chance that what you may be suffering from is a disorder known as sleep apnea. Affecting more than 20 million Americans and with a diagnosis rate as low as 20% in moderate to severe obstructive cases, sleep apnea is a lot more common than you may think.

    Not to be confused with narcolepsy, which is a sleep disorder that causes episodes of overwhelming drowsiness throughout the day, sleep apnea (also known as sleep apnoea) only affects you when you’re sleeping. Now, you may be wondering to yourself, what does this have to do with my oral health? While we will be answering this question more in detail later, believe it or not, it’s quite common for dentists to diagnose sleep disorders first.

    In this article, we’re going to be taking an in-depth look at sleep apnea symptoms, causes, complications, and treatments so you can stay ahead of the curve and take appropriate action.

What is Sleep Apnea?

Sleep apnea is a common sleeping disorder in which a person’s breathing is repeatedly interrupted throughout the night. As scary as that may sound, once your body has been deprived of fresh oxygen for a long enough period of time, the brain will automatically send a signal that restarts the body’s normal breathing pattern.

Depending on the individual and length of breathing interruption, someone suffering from sleep apnea may simply snort and take a deep breath when their natural breathing resumes, or, in more extreme cases, wake up gasping for air, feeling as though they were being smothered in their sleep. This involuntary breathing interruption is typically caused by one of two things, each warranting its own respective sleep apnea classification.

Obstructive Sleep Apnea (OSA)

Obstructive Sleep Apnea (OSA), is the most common form and happens when, as the name suggests, a person’s airway becomes blocked while asleep. Generally, OSA is caused when the tongue and throat muscles enter a relaxed state, allowing them to essentially collapse inward on the airway.

Central Sleep Apnea (OSA)

The other, less common form of sleep apnea is known as Central Sleep Apnea (CSA). With CSA, breathing interruption occurs as the result of a signaling problem between the brain and lungs. Rather than the airway being blocked, there’s simply no signal stimulating the lungs to take in fresh air.

Regardless of the kind of sleep apnea, what makes it such a troublesome sleep disorder is the fact that individuals can suffer anywhere from just a few to hundreds of episodes each night, leading to a poor quality of sleep. In addition to dramatically impacting the natural sleep cycle, both OSA and CSA lead to reduced blood oxygen levels, placing further stress on the body during its time of recovery.

Common Sleep Apnea Symptoms

One of the biggest reasons sufferers of sleep apnea can often go years without getting properly diagnosed is because the symptoms can easily be attributed to a number of different problems and causes. Below, we’ve outlined some of the most common sleep apnea symptoms so you know what to look out for in yourself, family, and friends.

Snoring

Not sure what we mean yet? Ever tried sleeping in the same room as someone with a disruptively loud snoring problem? Often observed by your partner first, snoring is one of the most common sleep apnea symptoms. However, just because you snore doesn’t mean you have sleep apnea. Snoring is most commonly linked when followed by breathing pauses, and then gasps or choking sounds.

Daytime Drowsiness

Another common symptom of sleep apnea is daytime drowsiness or an overall feeling of being fatigued. As we touched on above, sleep apnea disrupts your normal sleep cycle, which ultimately prevents your body from entering a deep state of recuperative REM sleep.

Whether you’re awoken from each episode or not (sometimes, you may not even remember waking up), your body and mind are constantly getting roused, never truly allowing you to achieve restful sleep. Drowsiness or fatigue can often be brushed off as “I just need some coffee” or “maybe I’m getting sick” until the problem has finally gone on long enough to warrant further action.

Dry Mouth & Sore Throat

Have you ever woken up with a mouth so dry that all you could think about is downing a glass of cold water as fast as possible? Having a dry mouth or sore throat when you wake up are also common symptoms of sleep apnea. Even though both of these can be caused by allergies or the common cold, all signs point back to mouth breathing as the culprit.

When breathing through the mouth rather than the nose, not only do you increase your chances of snoring, but, because the air you’re breathing doesn’t get warmed by the nasal passages, it can also dry out soft tissue. Between both the snoring and increased dryness, it’s much easier for the airway to “collapse” and create a breathing interruption.

Nocturia

Even though you would never think that frequent trips to the bathroom during the night may be linked to sleep apnea, as it turns out, they are. Also called nocturia, which most commonly occurs when overconsuming large amounts of fluid right before bed and when taking a diuretic medication, sleep apnea can contribute in a large, unexpected way.

When we sleep at night, the body naturally releases a steady supply of anti-diuretic hormone (ADH) to prevent us from having to use the bathroom during the night. However, because sleep apnea interrupts our normal sleep cycle, the natural supply of ADH also becomes fragmented, leading to more frequent bathroom trips.

It’s also believed that, due to the inability to reach a state of deep sleep, the mind is more susceptible to signals from the bladder.

Psychological & Physiological Stress

In addition to excessive daytime drowsiness, sleep apnea can also affect your mental state, leading to a lack of concentration, irritability, and even depression in some circumstances. Just as the body needs time to recover after a long day, so too does the mind, which typically happens during sleep.

When repeatedly woken up from sleep apnea episodes, your brain is prevented from performing the needed recuperative maintenance that’s supposed to occur. As a result, you may feel like you have a severe case of “brain fog” throughout the day, or even experience some irritability since your brain is telling you it needs more rest.

If allowed to go on for a prolonged period of time, sleep apnea can eventually lead to depression due to the level of psychological stress your brain is undergoing.

Grinding Your Teeth

Finally getting to some dentally related subject matter, grinding your teeth is also another common symptom of sleep apnea. Also known as bruxism, teeth grinding is fairly common and assumed to affect as much as 10% of the population. Even if you don’t do it during the day, at night, it can happen subconsciously as a defense mechanism of sorts, acting to prevent your muscles from relaxing enough to block the airway.

Because the tongue and jaw are the most common culprits of OSA, teeth grinding is believed to reduce the occurrence of sleep apnea episodes through the night. While all of that may sound good, grinding your teeth can cause a number of issues such as permanent enamel damage, TMJ, and even headaches.

Causes of Sleep Apnea

As we touched on earlier, the two primary types of sleep apnea have very different causes. Now that you have a better understanding of sleep apnea as a whole, in this section, we’re going to be taking a detailed look at these causes, as well as risk factors.

OSA Causes & Risk Factors

With Obstructive Sleep Apnea, breathing gets interrupted when the airway becomes blocked by muscle or soft tissue. Depending on the individual, OSA typically occurs for one of two reasons.

The first reason is linked to muscles that support the soft palate which include the uvula, tongue, tonsils, and side walls of the throat. During the day, because these muscles are constantly stimulated and in use, they’re unable to block the airway and impede breathing.

However, at night, when sleeping in the prone position, much like the rest of the body, these muscles enter a relaxed state. Typically, soft palate muscles will not relax to the point that they obstruct the airway, but in individuals with sleep apnea, it can cause more than 40 episodes each hour.

The second cause of OSA occurs in individuals that are overweight or have excessive fat stores around the neck. In fact, more than 50% of individuals that suffer from Obstructive Sleep Apnea are either overweight or obese. In further support of this, the medical community has found that excess weight is the number one risk factor associated with sleep apnea, showing evidence that a 10% gain in weight can increase the odds of developing severe OSA by as much as 600%.

Having a thick neck, even though it doesn’t have to be directly associated with being overweight, is also a cause of OSA. This includes men with a neck circumference of 17 inches or more, and 15 inches or more for women. The increased muscle tissue and potential for fat stores raise the odds that an individual will develop Obstructive Sleep Apnea.

Other OSA Causes & Risk Factors

Smoking

Not only is smoking bad for your body and health in more ways than you count, but, as it turns out, smoking can also increase your chances of developing OSA. In fact, smokers are 3 times more likely to have Obstructive Sleep Apnea than people who have never smoked. Researchers believe this is linked to inflammation of the upper airway, leading to fluid retention and an overall higher likelihood of breathing through the mouth when sleeping.

Alcohol & Medications

Segwaying off our last point, the use of alcohol, sedatives, and tranquilizers can also cause sleep apnea. Serving as muscle relaxants, using these substances can also affect muscles in the soft palate, leading to the development or worsening of OSA.

Age & Gender

Age and gender are a few factors outside of your control that can also increase the chances of developing OSA at some point. While men are between two to three times more likely to have Obstructive Sleep Apnea, women have a higher risk when overweight and after menopause.

Childhood OSA

Of course, OSA isn’t exclusive to adults. Due to the various developmental stages children go through in regards to their oral health, there’s a number of potential risk factors that increase the odds of getting childhood Obstructive Sleep Apnea. Enlarged tonsils, adenoids, and even dental conditions such as a deep overbite have all been attributed to childhood OSA. When left untreated, childhood OSA has been linked to behavioral problems, cognitive issues, and hyperactivity.

CSA Causes & Risk Factors

Though not nearly as common as OSA, Central Sleep Apnea still affects millions of people around the world. With CSA, rather than having the inability to breathe as the result of a collapsed airway, the sufferer is simply receiving no stimuli from the brain to breathe.

Because CSA is neurological, it’s generally only seen in people that are older or those that have a medical condition. For instance, individuals that have had a stroke or suffer from heart failure are at a higher risk of developing Central Sleep Apnea than those that are perfectly healthy. Neurological diseases such as Parkinson’s, Alzheimer’s, and ALS have also been known to cause CSA as they get progressively worse.

Medical conditions aside, research has shown that males are more likely to have CSA that females, with men over the age of 65 having the highest risk. Lastly, the use of narcotic-based pain medication has also been linked to an increased risk of developing Central Sleep Apnea. Generally going hand in hand with other conditions, in some cases, CSA can occur in tandem with OSA.

Sleep Apnea Complications

At first, sleep apnea may just sound like more of an annoyance than a serious sleep disorder. However, now that we’ve covered the various causes and risk factors of the two primary types of sleep apnea, let’s take a look at the different ways it can negatively impact your health.

Daytime Fatigue

Think about the last time you got a terrible night’s sleep. How did you feel the next morning? Ready to tackle the day with a smile, or ready to snap on the first person that rubbed you the wrong way? As you can imagine, being unable to get the restorative sleep that’s so crucial can have crippling effects on both your mind and body.

Even though it may feel like you got a good night’s sleep, chronic sleep apnea slowly saps your energy, leading to severe daytime drowsiness, difficulty concentrating, and even irritability. This can have a negative impact on your work and personal life while also dramatically affecting your ability to drive.

In fact, motor vehicle accidents are some of the most common symptoms that finally push people to go see a doctor about their chronic daytime fatigue

Blood Pressure & Heart Complications

Because sleep apnea causes sudden drops in your blood oxygen levels, increases in blood pressure and the level of cardiovascular strain while asleep have been observed. This is especially true with Obstructive Sleep Apnea, which has been shown increase the risk of developing hypertension.

To further support the link, research suggests that as much as 50% of the hypertensive population also suffers from sleep apnea. As with most conditions that negatively impact blood pressure, the heart can also be affected by untreated sleep apnea.

Studies have found that sleep apnea can increase the risk of recurrent heart attacks and strokes, while also contributing to dangerous abnormal heartbeats. Multiple episodes of sleep apnea in a heart disease victim have the potential to induce life-threatening irregular heartbeats that can ultimately cause sudden death.

Increased Risk of Dental Complications

Bruxism is commonly one of the first signs of sleep apnea, which is why dentists are often the first medical professionals to suspect a sleep disorder. While grinding your teeth may not sound all that dangerous, when done for a prolonged period of time, it can lead to permanent enamel damage, reduce the structural integrity of the teeth, and even cause cracks or chips.

All of this only makes it easier for cavity-causing bacteria to settle in and begin wreaking havoc on your teeth and gums. Spikes in dental caries, as well as inflamed, sensitive gums despite an otherwise thorough routine, may point to bruxism.

Sleep Apnea Treatment

Once it’s been determined that you suffer from sleep apnea, don’t panic. While we’ve spent this whole time talking about how bad sleep apnea can be for your health, there are numerous treatment options available.

Mandibular Repositioning Device (MRD)

For mild to moderate cases of Obstructive Sleep Apnea, oral devices are a popular option because they’re easy to use, hardly noticeable, and place far fewer limitations on sleep position. These custom-made oral devices are designed to keep the jaw in a forward position while you sleep, preventing soft tissue and muscle from obstructing the airway.

By expanding the airway during sleep, MRDs are also highly effective at treating snoring. While there are over-the-counter oral devices such as night guard that can help protect against grinding, they’re typically not as effective at keeping the jaw in a neutral position and addressing the sleep apnea issue and are not approved by the FDA.

Many over the counter devices are not using approved hinges that help the body titrate to the new appliance which causes even more issues. In fact, insurance companies, including Medicare, have strict requirements with regard to the types of appliances used as well as the qualifications of those who administer treatment.

Your primary care physician or sleep specialist must write a prescription for the oral appliance. The dentist cannot make that election for you. Your physicians are interpreting your sleep study as well as monitoring all your overall health concerns; the dentist’s role is to assist in managing the obstructive sleep apnea while monitoring your oral health along the way. Those providers communicate about your progress and determine if a follow-up sleep study is necessary to confirm efficacy of treatment.

Continuous Positive Airway Pressure (CPAP)

CPAP machines are commonly used in moderate to severe cases of sleep apnea or those in which oral devices aren’t providing effective treatment. When in use, the CPAP machine delivers a steady stream of air, creating a pressurized environment that’s just enough to keep your airway open, eliminating both snoring and apnea episodes.

Consisting of a mask and connecting tube that are secured to your face before sleep, the CPAP can feel a bit complex. At first glance, the machine may seem like something straight out of a Sci-Fi film, but it serves as one of the best treatment options for those suffering from severe sleep apnea, often referred to as the gold standard of treatment options.

With a little practice and communication with your doctor to find a mask that best suits your comfort and positional requirements, the CPAP machine has helped millions achieve a more restful sleep. Many of the modern machines have a variety of fitting options and customizable air delivery, such as adding moisture, to ensure the most effective treatment possible.

Surgery

Serving as a last resort for patients that had little to no success with oral devices or the CPAP machine, there’s a number of surgical options that can help treat sleep apnea. The most common procedures involve removing excess soft tissue that blocks the airway during sleep and enlarged tonsil removal.

For more severe cases, patients can elect complex procedures such as structural adjustment of the nose, jaw, and facial bones. Weight loss surgery is also an option for obese patients that have conditions or limitations that prevent them from losing weight through lifestyle changes. Depending on the kind of surgery that needs to be carried out, it can either be done at your doctor’s office or a hospital setting.

Lifestyle Changes

In addition to the above treatment options, one of the most effective ways to combat sleep apnea is by making some lifestyle changes. For some, this may include smoking and alcohol cessation, and for others, weight loss or allergy management.

Because being overweight is such a strong factor in sleep apnea cases, many patients experience natural relief by simply changing up their diet and implementing a healthy exercise routine. In other cases, sleep apnea may be the result of the position in which you sleep. Most commonly occurring in the supine position (on your back), some patients find relief by training themselves to sleep on their side.

We Are Here to Help

No matter what treatment options works best for you, the important piece of the equation is that you address your obstructive sleep apnea. We offer complimentary consultations so that you can see demonstration devices, talk Dr. Goyer who is a Diplomate with the American Academy of Dental Sleep Medicine, and so that we can make sure an oral appliance is an option based on your oral health. Many of our patients over the years have experience amazing results which has made real impacts on their day-to-day lives.

Another aspect of your treatment plan involves working with your insurance. This can be a tricky benefit to garner reimbursement. It is a medical benefit, meaning that it is not billed to your dental insurance but rather your medical insurance. Many medical insurance companies do not contract with dental offices, which makes utilizing in-network benefits challenging. Over many years we have assembled a toolkit of strategies to work with your medical insurance company to ensure that your benefits are being utilized as efficiently as possible. We will discuss all of this before we start treatment so you can make a decision based on your needs as it relates to your overall health as well as your financial well-being.