Sleep apnea is not just another annoying nighttime event that involves loud snoring or not being able to sleep peacefully due to a night of tossing and turning; it is a medical disease that causes your body to deny itself oxygen systematically and deprives you of the opportunity to enjoy restorative sleep. You may wake up feeling tired, even though you have spent eight hours lying in bed, or someone you are sleeping with may have complained that you appear to stop breathing in your sleep.
These not only indicate poor sleeping habits but also serve as warning indicators of an illness that may have far-reaching implications for your heart and overall health. As a qualified general dentist, I observe the signs of this condition in the mouth every day and recognize the importance of dental medicine in treating airway health. We realize the impact this condition can have on your overall wellness and quality of life at SoCal Dental Care. We are committed to screening, diagnosis, guidance, and offering comfortable treatment options to help you breathe freely again.
What Is Sleep Apnea?
Sleep apnea is a sleep disorder characterized by brief interruptions in breathing during sleep. The condition arises when your usual breathing pattern is disrupted, leaving your body without breathing in oxygen for a duration that varies between a few seconds and more than a minute. When these pauses take place, there is an increase in the levels of carbon dioxide in your blood, which causes a primal survival reflex in your brain. Your brain sends a signal to your body to reopen the airway and initiate breathing again, which in most cases results in a loud gasp, snort, or choking noise.
These micro awakenings, which you probably do not recall, are so short, but they draw you out of the deep, restful phases of sleep referred to as REM and deep sleep. This cycle may be repeated many times, dozens and even hundreds of times during a particular night, so that your body does not have time to repair tissues, consolidate memories, and control hormones. The result is chronic sleep deprivation and periodic hypoxia, or low blood oxygen, which puts stress on every central organ system in your body. Differentiating between the two distinct forms of sleep apnea is crucial to understanding the mechanics of your condition and the proper approach to treatment.
Obstructive Sleep Apnea (OSA)
The most common type of this disorder is obstructive sleep apnea (OSA), which is the type that is the most directly applicable to dental medicine. It is a mechanical disorder and is caused by the overrelaxation of the muscles of the back of your throat during sleep. Such muscles hold in place structures such as the soft palate, uvula, tonsils, and the tongue. The soft tissues are drawn back by the effect of gravity when you sleep, and these muscles relax, and the airway is narrowed or completely blocked.
When you try to bring air into your body through this narrowed passage, the air flows quickly, causing the tissue to vibrate, which produces a snoring sound. The airway completely folds down, and your lungs are completely blocked. The more pressure there is, the harder your diaphragm and chest muscles will have to work to open the airway. This effort of breathing with a blocked airway continues until your brain senses that there is no oxygen and wakes you to expand the throat muscles. It is at this mechanical blockage that a dentist can be particularly helpful, as the location of the jaw and the well-being of oral tissues are crucial to ensuring that the airways remain open.
Central & Complex Sleep Apnea (CSA)
Central Sleep Apnea (CSA) differs from OSA in that it is not caused by physical obstruction of the airway. Rather, CSA is a brain stem-based neurological problem. In this type of disorder, the brain fails to relay electrical signals to the muscles that regulate breathing. You never even bother to inhale after a brief period of time, since the respiratory center in your brain is not controlling your rhythm properly. The type is also commonly linked to other health issues like heart failure, stroke, or the use of some drugs like opioids.
A third condition is complex sleep apnea syndrome, also known as treatment-emergent CSA. This condition can be diagnosed in cases where you have OSA, which may transition into CSA when using a continuous positive airway pressure (CPAP) machine. In such instances, although the air pressure clears the physical obstruction, the brain remains unable to control breathing in accordance with the normal sleep cycle. Knowledge of these differences is crucial, as dental therapy is highly effective in treating OSA. At the same time, central and complex apnea typically requires the assistance of a neurologist or pulmonologist.
Identifying the Signs and Symptoms
Diagnosis of sleep apnea may not be easy, as the most characteristic symptoms may be present when you are not awake. You can spend years of your life without even noticing that you are not getting enough sleep and that your exhaustion is due to stress, aging, or a hectic schedule. The diagnosis process is often initiated not by the patient, but by a bed partner who notes some alarming behaviors at night. This can be better evaluated by splitting the symptoms into those that happen when you are asleep and those that occur when you are awake.
Nocturnal Indicators
The symptoms that appear during sleep are, in most cases, the most violent symptoms of the disorder. The most reported symptom in partners or individuals with OSA is loud, chronic snoring. In contrast to the rare snoring that can result from a cold or a glass of wine, sleep apnea snoring is often very loud and usually interferes with the sleeping patterns of others, occurring nearly every night. However, what you need to realize is that snoring does not necessarily mean you have apnea, and it does not necessarily mean you do not snore.
A more definite nocturnal symptom is the cessation of breathing. According to your partner, you might become quiet for a horrifyingly long duration, then suddenly, explosively, you gasp or choke as you struggle to breathe. This may also be accompanied by restlessness, where you toss and turn as your body tries to get a position that keeps the airway open. Others have night sweats or frequent night urination, a condition referred to as nocturia, and this is due to the straining of the heart, which leads to the release of a hormone to stimulate the kidneys to produce more urine.
Daytime Consequences
You might even sleep through the night battle, but you will definitely experience the consequences of the battle during the day. Excessive daytime sleepiness, also known as hypersomnia, is a characteristic feature of sleep apnea. You may fall asleep during silent moments, such as when reading, watching TV, or even driving, which can be very dangerous. It is not just the feeling of being tired; it is the sensation of being overwhelmed by the need to sleep because of the absence of restorative rest.
When you wake up, you may have a dry mouth or a sore throat, which are the usual consequences of mouth breathing during the night as your body tries to compensate for a nasal blockage or a blocked throat. Another common complaint is morning headaches, which are usually attributed to the low oxygen content and high carbon dioxide retention that take place during apneic events, which cause dilation of blood vessels in the brain. There is also the occurrence of cognitive impairment; you might have difficulty concentrating, experience memory lapses, or feel that your brain is foggy and therefore unproductive. The chronic insufficiency of deep sleep disrupts your emotional stability, which leads to changes in mood, such as irritability, anxiety, and depression.
Causes and Risk Factors
To understand why the airway collapses, it is necessary to analyze your anatomy and overall biological health. Although the direct cause of OSA is the loosening of muscles of the throat, there are a few underlying causes that predispose some people to the collapse. As a dentist, my special focus is on the oral cavity and the structures of the neck to detect anatomical abnormalities that predispose individuals to obstruction. Being aware of these risk factors will enable you to understand the reasons why you developed this condition and how to manage it effectively.
Anatomical and Biological Factors
The most critical risk factor of OSA is excess body weight. Deposits of fat around your upper airway may cause breathing difficulties by increasing the weight of the soft tissues in your neck, thereby narrowing the trachea and increasing its susceptibility to collapse due to gravity. The disorder, however, can also develop in thin people, especially those with certain anatomical features. A neck circumference of above 17 inches in men and 16 inches in women is highly predictive of a smaller airway.
The space of the throat may be less than it could be naturally, and the high-arched palate, which is found inside the mouth, may decrease the size of the airflow area. Enlarged tonsils or adenoids can also obstruct the airway; these are lymphatic tissues located in the throat, a condition that is most common in children but also occurs in adults. Your jaw configuration is also essential; a retrognathic mandible (or a lower jaw that is positioned back of the average) may cause the tongue to be pushed back into the throat, and it can block the airway.
Biological factors that determine susceptibility include age and gender. Sleep apnea is much more common in older adults when the muscle tone of the throat becomes weaker, and the airway becomes more compliant and collapsible. Men face two to three times greater chances of sleep apnea compared to premenopausal women, but again, women face higher chances after menopause or if they are overweight. The genetics are also related because you might be born with anatomical features, such as a narrow throat or face structure, and inherit them from your family.
The Systemic Medical Risk of Unattended Apnea
It is essential to reposition sleep apnea as not only a sleeping problem but a systemic ailment, which will cut down life expectancy unless treated. When you cease breathing, your oxygen levels in the blood decrease, which is referred to as desaturation. This causes your heart to work even harder to pump the remaining oxygen, which in turn spikes your blood pressure. This cardiovascular burden at night over the years causes a cascade of dangerous health problems that go way beyond feeling tired.
Cardiovascular and Metabolic Effect
Sleep apnea and cardiovascular disease have a strong correlation that is disturbing. The drastic changes in blood oxygen levels that occur during episodes of sleep apnea elevate blood pressure and put the cardiovascular system under stress. Having OSA, you are at a significantly increased risk of hypertension that is unresponsive to medication. The heart strain may cause frequent heart attacks, strokes, and irregular heartbeats, including atrial fibrillation. This increases inflammation and oxidative stress, which can damage the inner lining of your blood vessels due to repeated changes in oxygen and carbon dioxide levels.
Sleep apnea changes the manner in which your body processes glucose metabolically. The condition puts you at risk of insulin resistance and type 2 diabetes. A lack of proper sleep impairs the normal functioning of insulin in the body, leading to increased blood sugar levels. Also, sleep apnea tends to be connected with metabolic syndrome, a group of diseases that comprises high blood pressure, abnormal cholesterol levels, high blood sugar, and excessive waist fat, which significantly increase your chances of developing heart disease.
Safety and Lifestyle Risks
On top of what is happening internally, untreated sleep apnea is an instant danger to your safety and lifestyle. Motor vehicle accidents are far more likely to occur in cases of severe daytime drowsiness associated with the condition. Studies have shown that individuals with sleep apnea are more likely to cause road accidents than those with regular sleeping habits because of slowed reaction time and microsleeps on the road. This danger is also carried over to the workplace, where exhaustion may lead to mistakes, accidents, and reduced productivity.
This can also impair your liver functions. Abnormal liver functioning tests are more frequent in people with sleep apnea, and their livers are more likely to manifest evidence of scarring, a disease referred to as nonalcoholic fatty liver disease. The quality of life can also be compromised by chronic fatigue, which prevents one from socializing and engaging in activities they once enjoyed. The loud snoring will cause the partners to sleep in different rooms, thus putting a strain on the relationship and intimacy.
Diagnosis and Sleep Testing
Treatment of sleep apnea cannot be based solely on symptoms; a clinical diagnosis is necessary to determine the degree of obstruction and to exclude other sleep disorders. Although, as a general dentist, I can screen for the condition by assessing the presence of anatomical risk factors and discussing your symptoms, the official diagnosis should be made by a board-certified sleep physician. The diagnostic procedure involves monitoring the physiological activity of your body during sleep to obtain specific data.
In-Lab Polysomnography Vs. Home Sleep Tests
A polysomnogram is widely used to diagnose sleep apnea. In this test, you spend the night in a sleep center where you are connected to a machine that records the activity of the heart, lungs, and brain; breathing; arms and legs; and blood oxygen level during your sleep. This detailed data will enable the doctor to eliminate other sleep disorders, such as narcolepsy or restless leg syndrome, and provide you with a clear picture of your sleep structure.
A Home Sleep Apnea Test (HSAT) is a convenient and effective option for many patients. This requires the use of a portable monitor that can be used from the comfort of your own bed, recording your heart rate, blood oxygen level, airflow, and breathing patterns. Although HSATs are not as effective as in-laboratory studies in diagnosing CSA, they are very effective in diagnosing moderate to severe OSA.
The most critical number obtained from these tests is the Apnea-Hypopnea Index (AHI), which represents the number of times you stopped breathing or experienced limited breathing in a one-hour period. A score of AHI between 5 and 15 indicates mild apnea, 15-30 is moderate, and a score above 30 is considered severe. The medical necessity and kind of treatment to be given are determined by this score.
Dental Solutions and Treatment
After you have a confirmed diagnosis, the aim is to keep your airway clear at night to ensure that you have steady oxygenation, and you do not disturb your sleep patterns. Although the CPAP machine has been the medical standard for a long time, some patients are unable to tolerate it. Fortunately, dental sleep medicine provides a noninvasive alternative for patients with mild to moderate apnea or those with severe apnea who are not adherent to CPAP therapy. These are custom dental solutions your dentist could use:
Continuous Positive Airway Pressure (CPAP) Therapy
The most effective system for treating moderate to severe cases of OSA is Continuous Positive Airway Pressure (CPAP). This treatment requires a machine that provides air pressure by using a mask over your mouth or nose during sleep. The constant flow of air functions as a pneumatic splint, keeping the upper airway passages open and thus preventing apnea and snoring.
Although this is an effective method, adherence to CPAP therapy may be a significant challenge. The mask is cumbersome, uncomfortable, or claustrophobic to many patients. The sound of the machine, the feeling of forced air, and the straps on the head may make it hard to fall asleep or stay asleep. Other side effects in some patients include a dry nose, skin irritation, or abdominal bloating. This means that a significant proportion of patients do not stick to CPAP treatment, and they end up with untreated sleep apnea. Here, the issue of exploring dental alternatives becomes a critical health choice.
Oral Appliance Therapy (OAT)
Oral appliance therapy is the best option for patients who are CPAP intolerant or have mild to moderate OSA, and qualified dentists treat it. This is a therapy where you wear a specially designed item resembling a sports mouthguard or an orthodontic retainer, but it is highly advanced. The type of device used is referred to as a Mandibular Advancement Device (MAD).
The action of a mandibular advancement device is very complex but very effective. As a result, it slightly protrudes your lower jaw (mandible) forward and downward during sleep. The device pulls the tongue forward by maintaining the jaw in a forward posture, thereby tightening the soft tissues of the upper airway and preventing the backward collapse of the tongue, which would otherwise block the throat. This mechanical dilation of the airway causes a considerable decrease in snoring and apneic incidences. These gadgets are silent, portable, washable, and do not require electricity, making them a great choice for travel. Since they are shaped to fit your bite, they are comfortable to wear and are associated with high patient compliance rates.
Lifestyle Modifications & Surgery
Along with mechanical therapies, changes in your lifestyle habits are an essential ingredient in the process of managing sleep apnea. When you are overweight, one of the most effective methods of alleviating the situation is to lose weight, as it will reduce the amount of tissue that narrows the throat. Positional therapy is also helpful, as the tongue may tend to fold downwards when one lies in the back position. Knowing how to sleep on your side will keep the tongue out of the way. It is also essential to avoid alcohol and sedatives before going to sleep, since they will relax the throat muscles and aggravate the collapse.
A surgical alternative is usually the last resort when other modes of treatment have not been effective or when an abnormal anatomical condition that is fixable exists. Surgical interventions that can be performed include uvulopalatopharyngoplasty (UPPP), which entails the excision of excessive tissue on the soft palate and pharynx to enlarge the airway. Other surgeries may address nasal obstructions or involve the advancement of the jawbone itself. These, however, are invasive procedures that have varying levels of success and a more extended recovery period compared to the non-invasive nature of oral appliance therapy.
Find An Experienced General Dentist Near Me
It is a bet with your health that you cannot afford to ignore the symptoms of sleep apnea. The chronic fatigue, the overstrain on your heart, and the mental degradation that go with this disorder are not the unavoidable results of growing old but are the symptoms of a medically treatable condition. Snoring is your body’s warning system that your airways are blocked and you are not getting enough oxygen. In treating sleep apnea, you are not only enhancing your sleep, but you are also literally lowering your chance of heart attack, stroke, and diabetes, and regaining your energy and vitality.
You need not undertake this journey alone, and you do not need to endure uncomfortable treatments that you will not use. Being a dentist, I am in a unique position to assist you in the management of airway health by providing you with comfortable, custom-fitted solutions. We would be glad to have you book an appointment with SoCal Dental Care to discuss your symptoms and determine whether an oral appliance is the correct choice for your case. If you require a referral to a sleep study or you are willing to get rid of a CPAP machine, we are ready to make your life easier. Now you can take the first step towards better sleep and better health by calling us at 818-821-8308.
