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Dental Sleep Medicine

Bringing Niceville Patients a Restful Sleep

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Snoring and Sleep Apnea

Snoring frequently accompanies sleep apnea, but is not always an indicator of whether this sleep condition is present. However, snoring can be a sign that there is a potentially obstructed airway. Getting a simple device from the Internet or even your dentist without first finding out if you have sleep apnea means you might become a quiet sleeper, but may still be having apnea (cessation of breathing). Dentist-provided devices must be the result of a sleep test. A custom oral appliance or MAD (mandibular advancement device) can keep the airway open at night by moving the lower jaw (mandible) forward. The tongue and other soft tissues are stretched off the back of the throat and the normal action of breathing is restored, allowing for proper blood oxygen and a restful nights sleep.  

It is estimated that approximately 22 million people in the U.S. alone suffer from sleep apnea, and of those 22 million, only about 20% of them will seek treatment. Furthermore, only about half of all people diagnosed with sleep apnea and are given continuous positive airway pressure (CPAP) therapy, will continue to treat their disorder. 

During an apnea event, air is blocked from making its way to the lungs by obstructions in the upper airway. These obstructions are caused when either fatty tissues in the throat collapse back into the airway, enlarged tonsils and/or adenoids block the airway, or the tongue falls back into the airway. This often leads to loud snorts and even choking sounds as the patient struggles to breathe (most often without even knowing it) followed by loud gasps. Apnea events often last for up to 10 seconds at a time before breathing resumes for a period. When blood oxygen levels in the body drop, the brain partially awakens from sleep to send signals to the respiratory system to increase breathing effort.  

Epworth Sleepiness Quiz

STOP-BANG Sleep Apnea Questionnaire

Treatment Options

There are currently three ways to treat Obstructive Sleep Apnea. Choosing the correct treatment for you should be done after appropriate testing and with the advice of a trained professional.

A.  Surgery to open the nasal airway, palatal expansion, and pharyngeal surgery and tongue reduction are a few examples. Surgery is expensive and invasive with a longer recovery period.

B.  CPAP – Continuous Positive Airway Pressure – involves wearing a mask placed over the nose and mouth while sleeping. The CPAP is attached to an air-compressing machine, which pumps air through the mask and into the airway to open up any obstructions. Use of a CPAP requires an initial consultation with a primary care physician, an overnight stay in a sleep lab for testing, purchase of cumbersome mask and machine, wearing a bulky and noisy mask every night while sleeping, follow up testing in a sleep lab overnight, financial responsibility for the maintenance of replacement parts, additional sleep lab visits with any replacement parts. While CPAP is very effective in treating sleep apnea, many people cannot tolerate the discomfort of the mask and the inconvenience of the machine.  

C.  Oral Appliance Therapy – The FDA has approved more than 100 custom fitted mandibular advancement devices, or MAD.  Most MAD are made from acrylic, some are laser printed. The advancement mechanisms are usually surgical stainless steel, but sometimes may be nylon, acrylic, or nickel-free metals. Every component used has been approved by the FDA. A MAD is designed for you to ensure unrestricted airflow during sleep. Oral appliance therapy consists of three steps: 

  1. Screening and either a home sleep test or a polysomnogram
  2. Delivery of a custom made oral appliance
  3. Easy follow up maintenance once or twice a year. 

While there are over the counter appliances you can order, these are not FDA approved for treating sleep apnea. Additionally, when not fitted properly, they may cause unwanted side effects such as jaw problems, or excessive tooth movements and could exacerbate the sleep condition leading to potentially serious complications. Obstructive sleep apnea is a condition that continues with age, therefore, your oral appliance will be a lifelong therapy.

Child Care

Did you know that a significant number of children have Sleep Disordered Breathing (SDB) now that can become the full-blown Sleep Breathing Disorders of adulthood?

Childhood breathing disorders, like snoring, can lead to behavior and attention deficit issues by ages 4-7?  Breathing disorders prevent the passage of oxygen to all parts of our body, including the brain. 

In 2002 American Academy of Pediatrics has issued guidelines on the treatment of children with SDB and Obstructive Sleep Apnea.  (see here for a copy) The shape of the face, the jaws, and the back of the nose and throat are important to allow easy, unrestricted flow of air. Even moderate-sized tonsils in a small throat can cause trouble.  Dr. Ottesenand her team are trained to screen for breathing issues in children.  Dr. Ottesen offers the Myobrace to help to eliminate harmful soft tissue habits and teaching new, better ones. The Myobrace allows for natural growth and development in children to help allow a more optimal airway.

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