What is sleep apnea?

Sleep apnea is a common condition where the muscles in your neck and face relax during sleep, leading to the gradual closure of your airway. This makes breathing difficult and in severe cases, can cause you to stop breathing altogether. The body has to wake up to tighten the muscles and reopen the airway. This cycle repeats throughout the night, resulting in various levels of sleep apnea severity.

There are different levels of sleep apnea, ranging from very light with practically no symptoms to very severe where you may stop breathing for several minutes, leading to poor sleep quality and noticeable symptoms like morning headaches, feeling unrested upon waking up, fatigue throughout the day, and moments of drowsiness while driving or watching a movie. Sleep apnea is increasingly common, and it's crucial to recognize and address it, especially if you experience these symptoms.

Who is at risk for sleep apnea?

Certain factors can indicate a higher likelihood, such as being male, having a larger neck circumference (common in males), struggling with obesity, or smoking. The larger and more obstructed the airway, the higher the risk. However, it's noteworthy that even slender, athletic females can have sleep apnea. Thus, it's essential to consider various factors beyond the stereotypical ones, as sleep apnea can affect individuals with diverse characteristics.

How does sleep apnea affect oral health?

When you come in for a new patient exam at Integrity Dental, or for your periodic exams, we specifically look for indicators that could suggest potential airway concerns. One prominent sign is mouth breathing during sleep. Ideally, breathing should occur through the nose while sleeping, as it aids in filtering the air, reducing allergies, and promoting higher-quality sleep.

Unfortunately, if you tend to open your mouth while sleeping, it can lead to a drier environment in the mouth. Bacteria thrive in dry conditions, and this increased dryness puts you at a higher risk for cavities and gum diseases such as gingivitis and periodontitis. These two factors, increased risk of cavities and gum disease, are immediate considerations during our examinations.

Moreover, if you exhibit signs of clenching and grinding your teeth, this can result in worn-down or fractured teeth over time. Beyond the aesthetic concerns, we are always keen to identify the underlying cause. If sleep apnea is suspected, addressing it becomes a priority.

Sleep apnea can also manifest in jaw movements during sleep. As your body subconsciously tries to open a closed airway, your lower jaw may jut forward. This movement can lead to wear and tear on your teeth, causing them to rub against each other and potentially chip. Recognizing specific wear patterns on your teeth can be a valuable clue indicating the possibility of sleep apnea.

Additionally, clenching and grinding can contribute to muscle pain in the jaws and issues with the temporomandibular joint due to the constant wear and tear. Dry mouth, resulting from sleep-related factors, can create an environment where bacteria and certain types of yeast thrive, leading to mouth sores.

How can a dentist diagnose sleep apnea?

As a dentist, I feel privileged to screen for sleep apnea. While I may not always be the one to provide treatment, I consistently assess these indicators during every new patient exam and periodic check-up. Examining the soft tissues of the cheeks and lips, evaluating neck circumference, and assessing the airway through tongue protrusion are part of the initial examination. Moreover, we examine the size of the tongue and jaws, as well as the presence of any obstructions like tonsillar issues. Dentists are uniquely positioned to identify potential sleep apnea concerns through a comprehensive evaluation that includes both dental and soft tissue factors. This holistic approach allows us to contribute valuable insights when collaborating with medical professionals to address sleep-related breathing issues.

Do you wake up with headaches? Do you struggle with morning fatigue? Those kinds of things all tip us off to a conversation that we can have with you regarding sleep apnea. That is just the beginning. As a dentist, I often don't treat sleep apnea. I'm not the person who will actually help you get this treated if you need it, but I can coordinate the care. So the first thing that I'll often do when I'm suspicious of sleep apnea is make a recommendation that the patient would see a physician or a sleep medicine doctor to have it thoroughly evaluated. Thankfully, we have a very good team here in Pueblo that we refer to often, and they are very good about getting our patients in, being evaluated, and discussing the treatment options for sleep apnea.

So most of the time, I won't be the one to actually help treat the sleep apnea, but I can very much help coordinate evaluation, diagnosis, and then from there, the physicians can treat it.

What are the treatments for sleep apnea?

Most of the time, sleep apnea is treated with what's called CPAP therapy. CPAP is a mask either over your full face or over your nose that forces air into your airway to help maintain its openness. Even if the musculature relaxes and tries to close down the airway, the forced air from the CPAP helps keep it open, allowing you to breathe well throughout the night. While CPAP is considered the standard of care for sleep apnea treatment, it can be challenging to tolerate for some patients. Alternative treatments, including surgical options, may be discussed by your physician.

For those who find CPAP difficult to tolerate or have mild to moderate sleep apnea, oral appliances provided by dentists can be an effective solution. These appliances are worn while sleeping and help maintain the lower jaw in a forward position, preventing the collapse of the airway. Dentists can make various types of oral appliances tailored to the patient's needs, providing a more comfortable alternative to CPAP. Oral appliances can also include guards to protect teeth and joints from grinding during sleep.

As a dentist, involvement in sleep apnea care primarily includes evaluation, referral coordination, and, in specific cases, providing oral appliances. Evaluation starts with identifying symptoms such as headaches and morning fatigue, which can indicate a potential sleep apnea concern. If sleep apnea is suspected, the dentist may recommend a thorough evaluation by a physician or a sleep medicine doctor.

The physician will determine the best course of action, which may include CPAP therapy, surgery, or oral appliances. Dentists can play a crucial role in making and fitting oral appliances, especially for patients who cannot tolerate CPAP or have mild to moderate sleep apnea. The goal is to find the most suitable treatment that ensures the patient's comfort and effectively addresses the sleep apnea condition.

What treatment options would a dentist recommend for sleep apnea?

The first thing, of course, is it must be evaluated. Patients will sometimes come in saying, "I snore. Can you make a snore guard?" Well, that's fine, but unfortunately, snoring can be indicative, actually in 80% of the cases, patients that snore do have some amount of sleep apnea. So I'm not usually willing to make a snore guard until we've ruled out sleep apnea because that could be there. The first thing a dentist would do is evaluate.

The second thing a dentist would do is coordinate appropriate referral and evaluation with the physician. The physician gets to determine what is the best course of action for sleep apnea. In certain cases, the best course of action is an oral appliance, in which case a dentist can go over it if you have healthy enough teeth and gums for an oral appliance. The next question would be what type of oral appliance should be used, as there are different types, each with their own risks and benefits.

Then we jump into oral appliance therapy. Oral surgery can help in certain cases, like say you have really inflamed large tonsils. Sometimes removing the tonsils, a tonsillectomy working with an ENT doctor is enough, and that solves it. Sometimes the tongue is an issue. Sometimes the actual physical size of the airway opening itself can be expanded.

There are certain oral surgery options that do help with sleep apnea. We briefly touched on a device that goes implanted in the soft tissue and helps maintain the tone of the muscles to keep that airway open. So sometimes surgery is the right option, and your physician should go over that with you after appropriate evaluation.

Appliances that dentists will often recommend in appropriate cases for sleep apnea are very simple. They're called oral appliances or mandibular advancement devices, another word that's used, or continuous open airway therapy. A lot of different words are thrown around, but basically, an oral appliance is something that you would wear while you sleep.

An upper member clicks in or adheres to your upper jaw and a lower one clicks in or adheres to your lower jaw with a rubber band or different devices that'll hold them together and maintain that lower jaw forward. A dentist, potentially, would make for you what's called an oral appliance, which would help keep that lower jaw forward in a healthy position to prevent the collapse of the airway while you sleep.

How can I schedule an appointment for a sleep apnea evaluation?

If you believe you may have sleep apnea and want to schedule an appointment, please call us at (719) 745-5565. We take a comprehensive approach to evaluate your condition and discuss the best treatment options for you.