1. Snoring, why is it a problem? Snoring, as opposed to sleep apnea, is a social problem. Sleep apnea is basically a medical problem in which the body is deprived of the proper amount of oxygen due to blockage of the airway whereas snoring is a vibration generally of the uvula, or the soft tissue that hangs down in the back of your mouth.
The solution for both problems is to increase the capacity of the airway. This can be done utilizing continuous, positive air pressure flowing through a mask or can be helped, in about 30% of the cases, by a surgical procedure where the uvula is removed or shortened.
Another simpler and more comfortable solution is a dental device that brings the jaw forward and opens the airway, much as is done in CPR training. When you bring the jaw forward it carries the base of the tongue with it and opens the airway so that the path of air in and out of the lungs is unobstructed and the uvula no longer is vibrated due to closure of the airway.
Snoring can have significant effects in a marriage relationship as one spouse that snores often is found sleeping in a separate bedroom or the spouse that is kept awake through the night can become aggravated and angry over this consistent interruption.
Even in the general population, the snorer usually finds the reactions of others antagonistic toward him.
2. Why see a dentist for snoring? A dentist is uniquely trained in the fabrication of appliances for the mouth and has knowledge of the anatomy and function of the jaws and consequently the treatment to eliminate snoring. You should seek a dentist who has a strong background in the treatment and diagnosis of temporomandibular joint problems as this is the area that is under stress using an appliance to prevent snoring.
Of all the obstructive sleep apnea statistics, the most alarming is that 80-90% of the sufferers go undiagnosed according to the American College of Physicians. While dentists only act as part of the team, they can play a critical role in screening, diagnosing and treating obstructive sleep apnea. The dentist may be able to recognize the problem and direct sleep apnea sufferers in the right direction to help them discover they have a problem that they may not have known existed.
Surgeries to remove the uvula are often done but then fail if the level of obstruction is lower down in the pharyngeal airspace and not in the oral cavity. This often occurs when the tongue relaxes and the base of the tongue blocks the airway in the pharynx. There are currently more than 80 oral sleep appliances on the market. All these appliances have the same effect which is to pull the jaw forward and keep the airway open. The real issue is how far forward they pull the jaw and how predictable and comfortable they are for the patient.
3. Do I have to have a sleep study at the hospital to see if I can utilize this appliance? If you suspect that you have sleep apnea, a sleep study under controlled situations is certainly appropriate. However, if you feel that snoring is your main problem, an appliance can be made and by utilizing a take-home pulse oximeter which measures the oxygenation of your body through the night, we can screen you for sleep apnea at home. If it appears that you have an apnea problem, then you will be referred to a sleep study specialist for a more thorough evaluation.
4. There are seemingly many products. Why do you recommend a TAP appliance? For many years dentists have used various techniques to bring the mandible forward to open the airway and in essence these are arbitrary, hit or miss appliances. The TAP appliance is the first fully adjustable mandibular repositioning appliance that can be altered by the patient at home until the desired effect is reached. It also allows for some freedom of movement while it is being worn so the jaw is not in a fixed position all through the night.
The advantage to the TAP appliance is that it is adjustable on the basis of 1/4 to 1/2 millimeter at a time using a simple screw device. This allows the patient to get a personal and exact measurement of their needed position.
5. Can a dental snoring appliance change my bite? In rare cases the use of this appliance can alter the patient’s bite. It is necessary to be seen routinely so that if any changes occur, they can be intercepted at an early stage. If you wear a pull-forward appliance for any length of time, you should have regular check-ups every six months.
6. How much does this cost? The appliance is less than the cost of two regular crowns done by your dentist. It is less costly than a complete sleep study and a continuous positive air pressure appliance.
7. Where should I start? Contact our office. After finishing the initial screening exam, a thorough dental examination of both the dental structures and the temporomandibular joints is performed and the patient is given a home test pulse oximeter to use overnight to rule out severe sleep apnea. If severe sleep apnea is detected, the patient will be referred to appropriate physicians for a complete sleep study.
The appliance is then fabricated and inserted and the patient adjusts the appliance to the desired and effective position. Again, a take-home pulse oximeter study is conducted to verify the effectiveness of the oral appliance.
8. What are some of the side effects? Some of the side effects experienced include tooth and jaw tenderness after the initial delivery or after an adjustment, however this usually subsides in a few days. A temporary bite change can occur in almost all patients which lasts for an average of 15-30 minutes each morning immediately after removing the appliance. The patient is provided with an exercise to utilize each morning to reduce the occurrence of the bite change and resume normal muscle activity. Approximately 3% of patients will generate a permanent change in their dentition which can be eliminated with occlusal adjustment.
9. Sleep disorders, what are they? There are primarily two basic sleep disorders. One that we will deal with using a dental appliance is snoring. Snoring is the vibration of the uvula, or posterior flap in the back of your mouth, as air passes through it. This is largely a social problem, however if it is obstructive and blocks your airway, it can become a significant medical problem.
A more serious medical problem is sleep apnea. This is where the airway is blocked at times during the night and the patient is deprived of oxygen. This has an impact on coronary disease, stroke and general well being. When patients have a blockage of the airway during sleep, their level of carbon dioxide in the blood builds up as the oxygen that is carried by the red blood cells is transported to the tissues in need. A mechanism in the branch of the carotid artery called the carotid body senses this increased level of C02 and arouses the patient. This can happen 10, 15, 20 times an hour and the patient never gets restful, renewing sleep. People with sleep apnea tend to fall asleep easier and whenever they have a chance to rest will find themselves nodding off to try and regain the sleep they missed the night before.
The American College of Physicians states that symptoms to look for in sleep apnea include restless sleep, daytime sleepiness, poor memory and concentration, loud snoring, depression, mood swings or personality changes, morning headaches, irritability and dry throat.
Untreated the disorder can lead to cardiovascular disease, hypertension and auto accidents caused by falling asleep at the wheel.
10. What is the treatment for sleep apnea? The cold standard for sleep apnea was a C-PAP. A continuous positive air pressure machine that delivers a continuous flow of air by means of a mask that fits over the mouth and nose. This positive pressure is adjusted so the airway is maintained in an open position during the night. A C-PAP, while an effective treatment for sleep apnea, is found to have non-compliance of use in over 50% of the patients. If a C-PAP is not used continuously, it is not helpful.
An alternative treatment is a dental appliance that brings the jaw forward and opens the airway by carrying the base of the tongue forward with the jaw. This can be followed with a sleep study to be sure that it is an effective treatment for the patient. However, moderate to mild sleep apnea and snoring can all be effectively treated with the dental appliance.
11. What causes sleep disorders? Blockage of the airway can be caused by enlarged tonsils and adenoids, lack of adequate space for the tongue, obesity, or the use of alcohol or drugs.
12. Will weight control alone eliminate sleep apnea? Often weight control will greatly improve the prognosis of sleep apnea, however if you have an anatomic blockage, weight control alone will not eliminate snoring or sleep apnea.