Dental Sleep Medicine
Obstructive Sleep Apnea (OSA)
Obstructive Sleep Apnea occurs when the tongue and soft palate collapse onto the back of the throat. This blocks the upper airway causing air flow to stop. When the oxygen level drops low enough, the brain moves out of deep sleep and the individual partially awakens. The airway then contracts and opens causing the obstruction in the throat to clear. The flow of air starts again usually with a loud gasp.
When the air flow starts again, the individual then moves back into a deep sleep. The airway muscles collapse, as the individual awakens with a gasp. The airway clears once again as the process repeats itself. This scenario may occur many times during the night. The combination of low oxygen levels and fragmented sleep are major contributors to many of the ill effects that the sleep apnea patient suffers. In addition to excessive daytime sleepiness, studies show that sleep apnea patients are also much more likely to suffer from heart problems (heart attack, congestive heart failure, hypertension), strokes, and a higher incidence of work-related and driving-related accidents.
Diagnosis of Obstructive Sleep Apnea
Since OSA is a serious medical condition, it must be diagnosed by a physician. Diagnosis is based on the results of an overnight sleep study called a Polysomnogram (PSG). Patient evaluations and history are also critical for diagnosing OSA.
Good sleep hygiene, weight loss, and exercise are some helpful OSA treatments a patient can practice on their own. However, medical and dental treatment include Continuous Positive Airway Pressure (CPAP), Oral Appliance Therapy, and surgery.
Oral Appliance Therapy
Oral appliances are worn in the mouth to treat snoring and OSA. These devices are similar to orthodontic retainers or sports mouth guards. Oral Appliance Therapy involves the selection, design, fitting, and use of a custom designed oral appliance to be worn during sleep. This appliance then attempts to maintain an opened, unobstructed airway in the throat. There are many different oral appliances available and approved by the FDA for the treatment of snoring and/or sleep apnea. Oral appliances may be used alone or in combination with other means of treating OSA. These means include general health, weight management, surgery, or CPAP.
Oral appliances work in several ways:
- Repositioning the lower jaw, tongue, soft palate and uvula.
- Stabilizing the lower jaw and tongue.
- Increasing the muscle tone of the tongue.
- Dentists who’ve been trained in Oral Appliance Therapy are familiar with the designs of a variety of appliances. Dr. Rainwater can help determine which one is best suited for your specific needs. He will work with your physician as part of your medical team to guide your diagnosis, treatment, and on-going care.
Determination of proper therapy can only be made by joint consultation of your dentist and physician. Initiation of oral appliance therapy can take several weeks to several months to complete. Dr. Rainwater will continue to monitor your treatment and evaluate the response of your teeth and jaws.
Medical Conditions Associated with OSA
- Hypertension – uncontrolled or fluctuating, controlled with medication
- Insulin resistance
- Metabolic syndrome
- GERD or night time reflux
- Periodic Limb Movement or Restless Leg Syndrome
- Nasal blockage during sleep or upon waking
- Depression or anxiety
- Chronic fatigue
- Irritability or short temper
- Impaired concentration
- Headaches in the morning
- Drowsy Driving
- Past heart attack
- Past stroke
Sleep Problems Associated with OSA
- Witnessed apneas (bed partner says you stop breathing)
- Partner complains that you keep them up
- Fatigue upon waking or unrefreshed feeling
- Excessive daytime sleepiness (could nap if had time)
- Frequent waking at night
- Wake yourself choking or gasping
- Drooling while sleeping
- Dry mouth upon waking
- Bed wetting
- Sweating in sleep
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