Sleep apnea, a severe sleep disorder, occurs when breathing stops during sleep. Different types arise from airway blockages. Signs include snoring, fatigue, dry mouth, and restlessness. If untreated, it can lead to high blood pressure and heart issues. It may also affect oral health, causing problems like bruxism and TMJ disorder.
Treatment ranges from lifestyle changes to dental devices or surgery. If you have symptoms, consult a skilled dentist. At Washington Dental, we evaluate your condition and provide the right treatment. If oral appliances suit you, we will create a custom device. We are here to help you if you are in Lomita.
An Overview of Sleep Apnea
Sleep apnea is a sleep disorder that affects millions of people, often without them even realizing it. It's a condition where your breathing repeatedly starts and stops while you're asleep and can happen multiple times throughout the night. This disruption in breathing can lead to various health problems and a reduced quality of life.
The most common form is obstructive sleep apnea (OSA). When you sleep, the muscles in the back of your throat relax. This relaxation is a natural part of the sleep cycle. In some individuals, these relaxed throat muscles can collapse and wholly or partially block your airway. This blockage is what characterizes OSA.
When your airway is blocked, your brain detects the drop in oxygen levels and the struggle to breathe. In response, it briefly wakes you from deep sleep to reopen your airway. This awakening is so brief that you might not even remember it. This cycle can repeat itself multiple times an hour throughout the night. These frequent disruptions to your sleep prevent you from reaching the deeper, more restorative phases of sleep.
Causes of Sleep Apnea
- Excess Weight. Excess fat in the upper body can accumulate fat deposits around the upper airway, increasing the likelihood of airway obstruction during sleep.
- Older Age. As you age, the risk of obstructive sleep apnea rises. This risk levels off after reaching the 60s and 70s. Age-related changes in muscle tone and fat distribution can contribute to the development of sleep apnea.
- Narrowed Airway. Some individuals have naturally narrow airways, a trait that can be passed down through their family. This inherent narrowness can make them more susceptible to airway obstruction during sleep.
- High Blood Pressure (Hypertension). Obstructive sleep apnea is relatively common in individuals with hypertension, highlighting the intricate relationship between sleep apnea and cardiovascular health.
- Chronic Nasal Congestion. Consistent nasal congestion at night, regardless of the cause, can increase the risk of obstructive sleep apnea. The blockage in the nasal passages can force individuals to breathe through their mouths, further contributing to the condition.
- Smoking. The chemicals in cigarette smoke can irritate and inflame the upper airway, making it more prone to collapse during sleep.
- Diabetes. Research has identified a connection between diabetes and the risk of obstructive sleep apnea. Managing both conditions is essential for overall health.
- Male Sex. Generally, men are 2 to 3 times more likely than premenopausal women to have obstructive sleep apnea. However, the risk increases in women after menopause.
- Family History. A family history of sleep apnea can increase an individual's risk. If close relatives have been diagnosed with sleep apnea, it's essential to remain vigilant and consider evaluation.
- Asthma. Studies have found an association between asthma and the risk of obstructive sleep apnea. Managing asthma effectively is essential for minimizing this risk.
Common Symptoms of Sleep Apnea
Sleep apnea can manifest through various symptoms, including:
- Reduced and absent breathing.
- Frequent and loud snoring.
- Gasping for air during sleep.
- Daytime sleepiness and fatigue.
- Decreases in attention and concentration.
- Dry mouth and headaches upon waking.
- Nocturia (waking up often during the night to urinate).
- Sexual dysfunction and reduced libido.
The Connection Between Sleep Apnea and Oral Health
Experts assert that good sleep keeps you healthy. For example, it prevents gum/ periodontal diseases, mouth ulcers, and bad breath. Examples of dental issues linked to sleep apnea could include mouth breathing, bruxism, and temporomandibular joint (TMJ) disorders.
Temporomandibular Joint (TMJ)
TMJ disorders and sleep apnea share a closer relationship than one might expect. The temporomandibular joint connects the lower jaw to the upper jaw, playing a pivotal role in various essential functions, including chewing and speaking. However, the association with sleep apnea goes beyond these functions.
Symptoms of TMJ Disorders Include:
- Jaw pain.
- Pain throughout the head, neck, and shoulders.
- Problems with chewing.
- Clicking or grinding sounds in the jaw joints.
- Episodes of a locked jaw, where opening or closing the mouth becomes difficult.
A 2013 study found that individuals at a higher risk of sleep apnea were three times more likely to suffer from a TMJ disorder. Also, those displaying two or more signs of sleep apnea had a staggering 73% higher risk of developing a TMJ disorder. Factors that could contribute to the association include:
- Sleep apnea often leads to increased muscle tension in the jaw, which can exacerbate TMJ symptoms.
- Bruxism. Grinding or clenching the teeth during sleep, a common feature of sleep apnea can directly affect the TMJ.
- Sleep apnea can cause individuals to change their sleeping positions, affecting jaw alignment and TMJ function.
Bruxism, the habit of grinding teeth or clenching the jaw, is also connected to sleep
apnea. While it can occur at any time, it frequently manifests during sleep, further complicating the already disrupted rest of individuals with sleep apnea. Symptoms of bruxism could include:
- Teeth grinding sounds during sleep, often noticed by a bed partner.
- Worn-down tooth enamel.
- Tooth sensitivity.
- Jaw pain or tightness.
- Headaches, particularly in the morning.
- Disrupted sleep patterns.
Research has shown that bruxism may affect up to 31% of adults. Remarkably, at least a quarter of these individuals may also have sleep apnea. Bruxism is classified as a sleep-related disorder due to its uncontrollable and involuntary nature, primarily occurring during sleep.
Detecting bruxism can be challenging for those who experience it, as it often goes unnoticed. Dentists may notice bruxism during routine dental exams, such as loose teeth, eroded tooth surfaces, or cracked and broken teeth. When combined with complaints of muscular pain in the head, neck, and jaw and dryness of the lips, mouth, and throat upon waking, these signs can imply you suffer from bruxism.
Factors that contribute to the sleep apnea and bruxism connection are:
- Sleep apnea episodes, characterized by pauses in breathing during sleep, can lead to brief awakenings. These awakenings may trigger bruxism episodes, causing teeth to grind or clench.
- Both sleep apnea and bruxism can be exacerbated by stress and anxiety. The tension from these emotions may manifest as teeth grinding during sleep, particularly in individuals with sleep apnea.
- Shared neurological mechanisms may underlie both conditions, influencing the likelihood of their co-occurrence.
Sleep apnea frequently leads to mouth breathing, and this seemingly innocuous habit can significantly affect oral health. Mouth breathing during sleep results in dry mouth, leading to dental issues, including tooth decay.
A study reported that periodontal disease affects a striking 62.3% of people with sleep apnea. Additionally, gingivitis, a precursor to more severe gum disease, accounts for 34.1% of individuals with sleep apnea. These statistics demonstrate the importance of comprehensively addressing sleep apnea and its associated oral health concerns.
Mouth breathing and sleep apnea are intricately linked through the following:
- Airway Obstruction - Chronic mouth breathing can contribute to airway obstruction, a hallmark of sleep apnea. The mouth's open position during breathing can lead to instability in the throat and airway, increasing the risk of apnea episodes.
- Reduced Airflow Control - Breathing through the nose provides better control over airflow, allowing for smoother and more regulated breathing. Mouth breathing, on the other hand, can result in erratic airflow patterns during sleep.
- Increased Apnea Severity - Studies have suggested that individuals who primarily breathe through their mouths during sleep may experience more severe sleep apnea symptoms. The combination of mouth breathing and apnea can lead to loud snoring, frequent awakenings, and daytime fatigue.
Types Of Sleep Apnea
Obstructive Sleep Apnea
Obstructive Sleep Apnea (OSA) is a prevalent sleep disorder characterized by recurrent episodes of interrupted breathing during sleep. These interruptions occur due to a physical blockage in the upper airway, preventing the free flow of air to the lungs.
The hallmark of OSA is the obstruction of the upper airway. This blockage is often the result of relaxed throat muscles and tissues collapsing during sleep. When these muscles slacken excessively, the airway narrows or closes, impeding air passage. Consequently, the brain senses a lack of oxygen and briefly wakes you up to reopen the airway, often so briefly that you may not even realize you've awakened.
Identifying OSA can be challenging because interruptions in breathing typically occur while you're asleep. However, there are several signs and symptoms, including:
- Loud snoring.
- Pauses in breathing.
- Excessive daytime sleepiness.
- Morning headaches.
- Difficulty concentrating.
Central Sleep Apnea
Central Sleep Apnea (CSA) is a less common but equally disruptive sleep disorder characterized by interruptions in breathing during sleep. Unlike Obstructive Sleep Apnea (OSA), where the airway is physically blocked, CSA is primarily driven by a malfunction in the brain's respiratory control center.
In CSA, the problem originates in the brain's inability to transmit proper signals to the muscles responsible for controlling breathing. Unlike OSA, there isn't a physical blockage in the airway. Instead, the brain momentarily "forgets" to send the signals needed to maintain regular breathing patterns.
CSA can be more challenging to diagnose due to its less conspicuous symptoms. Common indicators include:
- Frequent awakenings.
- Shortness of breath.
- Difficulty staying asleep.
- Cheyne-stokes respiration.
Complex Sleep Apnea Syndrome
Complex Sleep Apnea Syndrome (CSAS), also known as Treatment-Emergent Central Sleep Apnea, is a relatively rare sleep disorder that shares characteristics with both Obstructive Sleep Apnea (OSA) and Central Sleep Apnea (CSA). CSAS is a distinct type of sleep apnea characterized by a combination of obstructive and central apneas during sleep.
Unlike pure OSA, where airway blockages are the primary issue, and pure CSA, which stems from brain signaling problems, CSAS presents a unique challenge because it involves both components.
Diagnosing CSAS can be complex due to its mixed nature. Healthcare professionals typically use a sleep study (polysomnography) to monitor and analyze an individual's sleep patterns and respiratory activity. CSAS is usually diagnosed when the following criteria are met:
- Initial OSA Diagnosis - Patients initially present with OSA and are treated with continuous positive airway pressure (CPAP) therapy.
- Emergence of Central Apneas - Despite effective OSA treatment, central apneas appear or worsen during CPAP therapy.
The Effects of Sleep Apnea on Your Body
Sleep apnea can have far-reaching consequences for your overall health and well-being. Here are some of the effects of sleep apnea on your body:
- Hypertension (High Blood Pressure) - The recurrent interruption of oxygen flow during apneas can trigger a stress response, leading to elevated blood pressure levels.
- Heart Disease - Individuals with untreated sleep apnea are at a higher risk of developing heart conditions such as coronary artery disease, arrhythmias, and even heart attacks.
- Stroke - Sleep apnea can increase the risk of stroke due to its impact on blood pressure and the potential for blood clot formation.
- Daytime fatigue and cognitive impairment.
- Excessive daytime sleepiness.
- Type 2 Diabetes.
- Weight gain - Sleep apnea can disrupt the balance of hunger-regulating hormones, potentially leading to weight gain and obesity.
Relationship and Social Impact
- Snoring and relationship Stress - Loud snoring, a common symptom of sleep apnea, can strain relationships due to sleep disruptions for the affected individual and their partner.
- Social implications - Daytime fatigue can limit social activities and participation in events.
- Nonalcoholic Fatty Liver Disease (NAFLD) - Evidence suggests a link between sleep apnea and NAFLD, a condition characterized by the accumulation of fat in the liver.
Treating Sleep Apnea
Sleep apnea is a treatable condition; several approaches can help alleviate its symptoms and improve your overall health.
Continuous Positive Airway Pressure (CPAP) Machines
CPAP (Continuous Positive Airway Pressure) machines are widely considered the gold standard for treating sleep apnea, particularly obstructive sleep apnea (OSA). These machines deliver a continuous stream of air pressure through a mask that keeps your airway open during sleep.
CPAP machines work on a straightforward principle: they deliver a continuous stream of pressurized air to keep your airway open during sleep. The CPAP machine generates a constant flow of air, which can be adjusted to the prescribed pressure level set by your healthcare provider.
You wear a mask that covers your nose, both your nose and mouth, or, in some cases, only your nostrils. The choice of mask depends on your comfort and the recommendation of your healthcare professional. The pressurized air from the machine is delivered to your airway via the mask.
This positive air pressure acts as a splint, preventing your airway from collapsing or becoming obstructed during sleep. By maintaining an open and unobstructed airway, CPAP therapy allows you to breathe normally throughout the night, reducing or eliminating apnea events.
Modern CPAP machines come with various features to enhance comfort and compliance:
- The ramp feature allows the machine to start with lower pressure and gradually increase it over a set period, making it more comfortable as you fall asleep.
- Some CPAP machines have built-in humidifiers to prevent dryness in the airway and alleviate discomfort.
- Many CPAP machines can record data on your sleep patterns, mask fit, and the effectiveness of therapy, which can be useful for healthcare providers in adjusting treatment.
Successful CPAP therapy requires compliance and regular follow-up with your healthcare provider. They will monitor your progress, adjust the pressure settings, and ensure the equipment is functioning correctly.
Sleep Apnea Dental Appliances
Sleep apnea dental appliances, or mandibular advancement devices (MADs) or oral appliances, are an alternative treatment option for obstructive sleep apnea (OSA). These appliances are designed to help alleviate the symptoms of sleep apnea and improve the quality of sleep.
Sleep apnea dental appliances work by repositioning the tongue and lower jaw and maintaining an open airway when sleeping. A sleep dentist or dental specialist custom-fits the appliance for the patient. This involves taking impressions of the teeth to create a personalized device.
The appliance is worn in the mouth during sleep. It consists of upper and lower trays that fit over the teeth. The lower tray is adjustable and can be moved forward to advance the lower jaw. By repositioning the lower jaw slightly forward, the appliance helps prevent the collapse of the upper airway, which is a common occurrence in OSA. With the airway kept open, airflow is improved, reducing or eliminating apnea events and snoring.
There are various types of sleep apnea dental appliances, including:
- Mandibular Advancement Devices (MADs). These reposition the lower jaw forward to keep the airway open.
- Tongue Retaining Devices (TRDs). These hold the tongue forward to keep it from blocking the airway.
Proper use and fit of the dental appliance are crucial for its effectiveness. Patients should have regular follow-up appointments with their sleep dentist to ensure that the appliance is working correctly and that they are making the necessary adjustments.
Surgical interventions are considered when other treatments for sleep apnea, such as lifestyle changes, CPAP therapy, or dental appliances, have not been effective or when the severity of the condition warrants more aggressive treatment. Below are some common surgical procedures used to treat sleep apnea:
UPPP is a surgical procedure that removes excess tissue from the throat and palate. It involves:
- Removal of the Uvula, the small, hanging structure at the back of the throat, is partially or completely removed.
- Tonsillectomy: If the tonsils are enlarged, they may be removed during the procedure.
- Pharyngeal Wall Reshaping: The surgeon may trim excess tissue from the pharyngeal walls to widen the airway.
UPPP is typically performed under general anesthesia and may effectively reduce snoring and mild to moderate obstructive sleep apnea. However, its success rate varies from person to person.
Genioglossus Advancement (GA)
GA is a surgical procedure that repositions the tongue to prevent it from collapsing backward during sleep. It involves:
- Repositioning the Genioglossus Muscle: The genioglossus muscle, which attaches to the tongue and the lower jaw, is repositioned to prevent airway collapse.
- Strengthening the Airway: This procedure aims to strengthen and stabilize the airway, reducing the risk of obstruction.
GA is often recommended for individuals with anatomical issues contributing to sleep apnea. It may be performed alone or in combination with other surgical procedures.
Maxillomandibular Advancement (MMA)
MMA is a more extensive surgical procedure that involves repositioning the upper and lower jaws to enlarge the airway. It includes:
- Repositioning the Upper and Lower Jaws: The surgeon moves the upper and lower jaws forward to increase the space at the back of the throat.
- Stabilizing the Jaws: The jaws are secured in new positions using plates, screws, or other fixation techniques.
MMA is typically recommended for individuals with severe obstructive sleep apnea or those who have not responded well to other treatments. It is a highly effective procedure, but it is also more invasive.
Inspire therapy is a newer approach involving a small device to stimulate the
hypoglossal nerve during sleep. This stimulation helps keep the airway open by preventing the tongue from collapsing backward.
The device is implanted under the skin of the chest, and a remote control is used to turn it on before sleep and off upon waking. Inspire therapy is suitable for individuals with moderate to severe obstructive sleep apnea who cannot tolerate or benefit from other treatments.
Benefits of Sleep Apnea Oral Appliances
Sleep apnea oral appliances, or mandibular advancement devices (MADs), offer several advantages as a treatment option for obstructive sleep apnea (OSA) and snoring. These benefits include:
One of the primary benefits of oral appliances is that they are non-invasive. Unlike surgical procedures, which may involve significant recovery time and potential risks, oral appliances are custom-fitted devices worn in the mouth during sleep. They do not require surgery or a mask or machine-like continuous positive airway pressure (CPAP) therapy.
Many individuals find oral appliances more comfortable to use than CPAP machines. The custom-fit design ensures a snug yet comfortable fit in the mouth. This can lead to better compliance with treatment, as individuals are more likely to use the appliance consistently.
Portability and Travel-Friendly
Oral appliances are compact and easily portable. They do not require electricity or special equipment, making them convenient for travel. This portability allows individuals to maintain their sleep apnea treatment regimen even when away from home.
Oral appliances are silent compared to the audible noise generated by CPAP machines. This can be particularly beneficial for individuals who share a bedroom with a partner, as it eliminates the noise associated with using a CPAP device.
Improved Sleep Quality
By effectively reducing or eliminating obstructive events during sleep, oral appliances can improve sleep quality. Better sleep can increase daytime alertness, improve mood, and enhance overall well-being.
Find a Dentist Near Me
Patients often underestimate the link between risk factors and sleep apnea. Surprisingly, your dentist can assist in alleviating this condition. Snoring, insomnia, and interrupted breathing during sleep are telltale signs. Sleep apnea can exacerbate oral health issues, and dental problems can contribute to it. The connection between sleep apnea and oral health is substantial.
At Washington Dental, we can help if you are dealing with sleep apnea and seek evaluation and assistance in Lomita. Contact us at 310-326-5183 to discover how we can help you improve your sleep and oral health.