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Sleep is a crucial part of our daily routine where we spend about one-third of our time. Interrupted sleep can have a negative impact on the pathways in our brain that allow for learning and creating new memories. When we don’t get high quality sleep, it can make it harder for us to concentrate and respond quickly [1].

There have been several accidents both large and small that have been linked to over-tiredness, the Exxon-Valdez oil spill and the Chernobyl nuclear accidents just to name a few [2]. Every year, up to 100,000 car accidents and 1,550 deaths are caused by tired drivers. Some experts claim that driving drowsy from poor sleep can impair your alertness and reaction time, just as much as someone who is driving drunk [2].

Recent studies have shown that a chronic lack of quality sleep can increase a person’s risk for disorders such as high blood pressure, heart disease, cardiac arrhythmias, diabetes, depression, obesity, stroke, metabolic syndrome (also known as syndrome X), and non-alcoholic fatty liver disease [1]. It is important to visit with your physician if you are feeling sleepy or tired even after getting adequate sleep, repeatedly waking in the middle of the night, or have symptoms of a sleep disorder such as snoring or gasping for air [3].

Sleep disordered breathing is described by Dr. Avram Gold as “every form of pharyngeal collapse during sleep [4]." It is broken down into three categories:

  1. Snoring

  2. Upper Airway Resistance Syndrome (UARS)

  3. Obstructive Sleep Apnea (OSA)


Snoring

Snoring occurs when the muscles in the back of our throat relax and the airway narrows. As we inhale and exhale, the moving air causes the tissue to flutter creating noise. It affects 57% of men and 40% of women [5]. Risk of snoring increases with obesity, alcohol consumption, use of sedatives, nasal congestion, large tonsils, tongue or soft palate, deviated septum, jaw that is small, or pregnancy [6].


Upper Airway Resistance Syndrome (UARS)

UARS is the repetitive partial collapse of the muscles in the back of your throat during sleep. It is an intermediate disorder between snoring and OSA.4 UARS is linked to increased clenching of the teeth (bruxism), headaches and jaw joint pain (also known as temporomandibular disorder) [7].


Obstructive Sleep Apnea (OSA)

OSA occurs when the muscles in the back of your throat relax so much so that it causes the upper airway to become obstructed. Because of your inability to breathe, the oxygen level in your blood drops. Your brain then senses this obstruction and will briefly wake you from your sleep so that you can reopen your airway. Typically this awakening is in the form of a snort, choke or gasp. This pattern can repeat itself five to 30 times or more per hour, all night, which can impair your ability to reach a deep, restorative sleep [5]. Depending on your sleep study from a sleep medicine specialist, they will categorize your OSA as being mild, moderate or severe. Mild cases can be managed with lifestyle changes such as weight loss, exercise, avoiding alcohol and certain medications, and quitting smoking [5]. However, moderate-severe OSA is managed either via 1) the use of a continuous positive airway pressure (CPAP) machine, 2) oral appliance or 3) surgery. Surgery is typically a last resort option when the other two treatments have failed.

The CPAP delivers air pressure through a mask while you sleep. It is considered the "gold standard" of treatment for patients who suffer from OSA [7]. However, the majority of my patients find this type of treatment uncomfortable and some have found that they even remove it subconsciously in their sleep. Several patients lose hope and become ‘non-compliant’ with their CPAP. Furthermore, patients who wear dentures find their CPAP does not help because their airway is collapsed even more so when they remove their dentures at night prior to wearing their mask, so the forced air into an already collapsed airway does not help alleviate their apnea.

Depending on the type of sleep disordered breathing a person is diagnosed with, your dental specialist can work with you to make an oral appliance customized for you that will help with your snoring, whether it be to treat simple snoring to more complex OSA. These devices are designed to open your airway by bringing your jaw forward. The American Association of Sleep Medicine found that in 87% of patients with OSA, oral appliances were just as effective as a CPAP in reducing a patient’s apneic episodes. The appliance is custom made to either fit the patient’s natural teeth or dentures. Several recall visits are necessary to ensure a proper fit and to reassess your symptoms. However, not all dentists understand how to carry our this type of therapy. In a survey of dental practitioners, 40% know little or nothing about oral appliance therapy [8], so it is important to visit with a specialist who will understand your needs.


References:


1. National Institutes of Health. (2019, August 13). Brain Basics: Understanding Sleep. National Institute of Neurological Disorders and Stroke. Retrieved from

https://www.ninds.nih.gov/Disorders/Patient-Caregiver-Education/understanding- Sleep


2. Berger, F., Zieve, D., & Conway, B. (2020, August 4). Sleep and Your Health. MedLine Plus. Retrieved from

https://medlineplus.gov/ency/patientinstructions/000871.htm


3. National Center for Chronic Disease Prevention and Health Promotion, Division of Population Health. (2020, March 20). Are You Getting Enough Sleep? Centers for Disease Control and Prevention. Retrieved from

https://www.cdc.gov/sleep/features/getting-enough-sleep.html


4. Gold A. Functional somatic syndromes, anxiety disorders and the upper airway: A matter of paradigms. Sleep Med Reviews 2010; 1-13.


5. Schwab, R. J. (2020, June). Merck Manual Professional Version: Snoring. Retrieved from

https://www.merckmanuals.com/professional/neurologic-disorders/sleep-and-wakefulness-disorders/snoring


6. A.D.A.M. Medical Encyclopedia [Internet]. Atlanta (GA): A.D.A.M., Inc.; c1997-2019. Snoring - adults. Updated July 2, 2020. Retrieved from

https://medlineplus.gov/ency/patientinstructions/000720.htm


7. A.E. Sanders et al. Sleep Apnea Symptoms and Risk of Temporomandibular Disorder: OPPERA Cohort. J Dent Res 2013; 92:70S-77S


8. Bian H. Knowledge, opinions, and clinical experience of general practice dentists towards obstructive sleep apnea and oral appliances. Sleep Breath 2004; 8:85-90

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