Sleep Medicine in Dentistry
Airway & Sleep apnea
If you are not feeling rested in the morning, snore heavily, or frequently get headaches in the morning, it’s possible that you may be suffering from a sleep-related breathing disorder (SRBD). Approximately 50-70 million people in the United States suffer from one or multiple sleep disorders. This can contribute to other health conditions and impair daily functioning activities and thus affect the overall quality of life.
Sleep disorders are not exclusive to the adult population. Children and adolescents may suffer from sleep disorders, too. Because sleep disorders are not easily recognized in the younger patients, they are frequently undiagnosed.
At All Day Smile, Dr. Hang Pham has the proper knowledge and training to recognize and identify patients that are at high risk for sleep disorders. After proper screening, she will make the appropriate referrals so that patients can get a definitive diagnosis by a specially trained medical doctor in sleep medicine. Once a proper diagnosis is made, Dr.Pham and the sleep doctor will custom tailor treatment options to help control and possibly resolve your conditions permanently.
Our ultimate goal is to help guide all our patients towards relief from the symptoms of a sleep disorder so that they can have more restful night’s sleep and thus improve the overall quality of your health and your life. To learn more about sleep apnea, schedule an appointment or get in touch today!
What Is Sleep Apnea?
THE BASICS OF SLEEP RELATED BREATHING DISORDERS
Apnea, by definition, is the cessation of breathing and sleep apnea refers to the disruption of breathing on a daily basis during sleep. The two most common sleep-related breathing disorders are Central Sleep Apnea and Obstructive Sleep Apnea. Central sleep apnea (CSA) is characterized by the absence of airflow and the effort to breath is not present. Studies suggest that this disorder is related to a central nervous system dysfunction. It is relatively uncommon, but can be very dangerous to your health. This disorder is typically treated with a CPAP (continuous positive airway pressure) machine.
The more common type of sleep apnea is Obstructive Sleep Apnea (OSA). Obstructive sleep apnea is characterized by repetitive episodes of complete (apnea) or partial (hypopnea) obstruction of the upper airway during sleep. These episodes last for at least 10 seconds and are measured with a home sleep test (HST) or an in-lab polysomnography (PSG) test. These frequent interruptions in proper breathing result in poor blood oxygenation and can ultimately contribute to a wide range of adverse health consequences including hypertension, cardiovascular diseases, metabolic disorders (such as diabetes), gastric disorders (such as gastroesophageal reflux diseases), respiratory disorders (such as asthma), emotional and psychological disorders, and increased mortality rates.
Common symptoms of OSA include loud snoring, often accompanied by choking or gasping noises, poor quality sleep, abrupt awakenings in the middle of the night, and excessive daytime sleepiness. You may also notice issues like a sore or dry throat upon waking, morning headaches, or difficulty concentrating throughout the day. Without proper care, OSA can be a life-threatening condition.
Why is my child snoring?
Understanding Sleep Disorders in Children
Between 20 and 50% of the pediatric and adolescent population may have a sleep disorder. Unfortunately, these disorders are often not often recognized at an early stage and therefore go undiagnosed. Sleep disorders may lead to poor quality of sleep and have a direct impact on behavioral, physical, and mental growth and development.
Snoring is a very common complaint from parents and is believed to affect about 3-12%of children. Snoring is caused by the vibration of the soft palate and the pillars of the orpharyngeal inlet. Children who snore at night are typically suffering from some form of obstruction, mainly enlarged tonsils and adenoids. Screening of these anatomical structures can be done by Dr. Pham and a proper referral can be made to an Ear Nose and Throat specialist for further evaluation and treatment, if needed.
Understanding the Symptoms
What Causes Obstructive Sleep Apnea?
There are a number of factors that contribute to OSA. In most patients, several of these factors are present and are the root cause of their sleep apnea. Hence a strong knowledge base is needed to fully understand the proper screening and treatment for this disease.
Obesity has been linked to many patients suffering from sleep apnea. The increased girth of the waist and the extra soft tissue around the neck area increases the collapsibility of the airway. Weight loss through a controlled diet and exercise can help reduce the risk of OSA caused by obesity. Other causes of OSA include enlarged tonsils and adenoids, which can partially obstruct the airway. Some genetic anatomical features, such as narrow dental arches, large neck circumference, and deviations in nasal anatomy are associated with sleep apnea, and can contribute to OSA.
Because of the nature of the complexity of sleep apnea, a broad range of specialist is needed to partake in an interdisciplinary treatment plan. Dr. Pham understands the challenging role of being the quarterback but is confident that by doing so, she can have a huge impact on the patients in her community.
Know What to Expect
Sleep Apnea Screenings
Sleep apnea screenings are typically done by doctors or sleep specialists, often using a questionnaire such as STOP-BANG (Snoring, Tiredness, Observed apnea, bloodPressure, Body mass index, Age, Neck circumference, and Gender). You’ll simply answer a few questions about yourself and your sleeping habits, and your doctor can determine if you may have sleep apnea. In some cases, you may need a sleep study.
A sleep study will use specialized tools to gather information about your sleeping habits, and may record your breathing, heart rate, neurological activity, and other metrics to determine if you have apnea. Sleep studies are often administered overnight by sleep doctors at their clinics (polysomnography or PSG), but some sleep doctors can provide you with special equipment that you can use to conduct the sleep study at home (home sleep test orHST).
Know Your Options
How Do You Treat Sleep Apnea?
The most common therapy for sleep apnea is positive airway pressure (PAP). The PAP device produces a pressurized airflow that is delivered to the patient via a mask. The airflow subsequently creates a positive distension of the upper airway which allows for airway patency, or proper function and engagement of the muscles and tissues. There are several types of PAP modes but the most common one is continuous positive airway pressure (CPAP). While PAP machines have proven to be effective in treating sleep apnea, they can be inconvenient to use. As such, a significant challenge to both patients and health care practitioners is compliance to PAP therapy.
For this reason, oral appliance (OA) therapy is becoming more prevalent for the management of sleep-related breathing disorder and is currently recognized by the American Academy of Sleep Medicine as a medical device option for treatment. OA is designed to reposition or advance the mandible to improve the upper airway patency. Because there are a lot of factors that must go into place when designing an appropriate appliance for each patient, proper screening and collaboration is needed between your dentist and the sleep physician.
Oral appliances are small, portable, require no power, and do not restrict your sleeping positions, so they are very versatile and a good option for patients with mild-to-moderate OSA. However, they are not usually recommended for patients with severeOSA, or central sleep apnea (CSA).