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, MAGD