May 26, 2008
Snoring vs. Sleep Apnea
Hi everyone!
It's been too long since I've written in, but I've been really busy and somehow my blog ended up near the bottom of my "to-do" list. I hope you'll forgive me!
Much of my free time has been spent reading and studying about dental treatment of Obstructive Sleep Apnea(OSA). In April I attended 3 days of intensive "hands on" training in the new field of dental appliance therapy for folks with OSA. The class was given by Dr. Barry Glassman, of the Allentown Pain Center in Pennsylvania( http://www.allentownpaincenter.com/ ) who is board certified by the American Board of Dental Sleep Medicine ( http://aadsm.org/index.aspx ). We are all familiar with snoring, which is the sound of partially obstructed breathing during sleep. If the structures of the throat are formed in a certain way and our muscles relax enough during sleep to cause the airway to narrow and partially obstruct the flow of air, our throat structures will vibrate and cause the sound we know as snoring. Such factors as large tonsils, a long soft palate and uvula, certain jaw configurations, alcohol or medications, sleep posture and fat deposits contribute to the collapsibility of the airway.
Obstructive Sleep Apnea occurs when the airway completely collapses during sleep and breathing itself stops multiple times per hour. When no air can be drawn into the lungs, the oxygen level in the blood drops and the waste gas level rises and signals the brain to partially awaken in order to stimulate the troat muscles to open and clear the obstruction. This usually but not always happens with a loud gasp or choke. Once a breath is taken the arousal subsides, the muscles relax and the process continues over and over all night. People with OSA experience continally disrupted sleep and drops in oxygen levels all night. This has been associated with irregular heartbeat, hypertension (high blood pressure), heart attack, stroke, GERD (Reflux Disease), depression and mood alteration, and excessive daytime sleepiness which can play out with deadly consequences on our roadways. It has even been implicated in the tragic Exxon Valdiz oil tanker accident in Alaska.
Obstructive Sleep Apnea is typically diagnosed at a Sleep Cinic using a test called a Polysomnograph, and in the past has been treated with lifestyle changes (eg. weight loss), behavioral modification (no alcohol, changing sleep posture, etc.), surgery to enlarge the airway (painful and not as effective longterm) and CPAP or Continuous Positive Airway Pressure (a mask worn over the mouth and nose at night which pumps air into the lungs). CPAP is almost always a very effective treatment for sleep apnea, but it is fairly cumbersome, uncomfortable, and fairly "unromantic" so compliance with its use is predictably low (<40%).
The American Academy of Sleep Medicine and the FDA has recently approved dentist fabricated oral appliances for patients with mild to moderate OSA who either perfer their use to CPAP or who are not candidates or responsive to CPAP. These appliances are comparatively comfortable and non-invasive and go by names such as Oasys, TAP, and Somnomed. These appliances are what we were trained to make, use, and maintain in the course I took. I will write more on these in the near future.
By the way, in early June I will be attending an additional 3 days of training at the American Academy of Dental Sleep Medicine annual meeting in Baltimore, MD.
That's enough for now. Until next time,
Mark W Langberg, DDS, FAGD
Comments on Snoring vs. Sleep Apnea »
I am from the Flint area and I have not found a dentist who specializes in the mouth appliances. How does one determine which type is good for the individual? I have read about the TAPII and the SomnoMed, but don't know how a dentist chooses which type to use on a patient. How important is the technician who fits a patient? I am concerned that my dentist whose office was not familiar with this apparatus two days ago, now says he can make one for me.
Thank you,
Kenda Smith
Dear Kenda:
Typically, the dentist will decide which appliance is most appropriate for the patient based on the characteristics of the patient's apnea, their specific dental and anatomical requirements, and the patients preference. For instance, the TAP III (the TAP II is not made often anymore) allows a small amount of freedom of movement right and left but does not allow the patient to open wide when he/she is wearing it. It can, however, be easily adjusted (titrated) while it is being worn during a sleep study and this is an advantage. The Somnomed does allow you to open wide while wearing it and I personally found it to be much more comfortable to wear. The OASYS appliance has additional pads which help open nasal passages similar to nasal strips. Usually, however, individual dentists have their preferred appliance based on their individual experiences clinically. All these appliances position the lower jaw forward to open the airway. All have the potential to slightly move teeth over time. The various varieties of appliances are usually discussed with patients to acertain their preference but the responsibility for best choice rests with the dentist, so you shouldn't worry too much. As with all dental care delivery, the quality of the lab used and the skill of the dentist is paramount to successful treatment. Typically patients have a sleep study and diagnosis done before the appliance is made, and one done later to confirm its effectiveness.
I hope this helps! Feel free to reply on this site if you need more info or call me at my office at 248-356-8790 if you wish to speak with me directly. Thanks for reading our blog!
Mark W Langberg, DDS, FAGD