Treatment of Sleep Apnea

  

 

 

Snoring & Sleep Apnea - Nuisance Or Disease Continuum?
Two-thirds of partnered adults say their other half snores, while six out of 10 of all adults (59%) say they snore. Sleep apnea may be present in 20-40% of the adult population that experience snoring.

According to the U.S. Department of Health and Human Services, more than 45 million Americans suffer from sleep apnea, a disorder that causes a person to briefly and repeatedly stop breathing during sleep. Obstructive Sleep Apnea (OSA) is a debilitating, often life-threatening  sleep disorder; an estimated 800,000 patients are diagnosed with OSA each year in the U.S. and approximately 10% are being treated.

Primary care practices are not actively screening patients for OSA which leaves a large void in the number of patients being identified with this killer disease. OSA has directly been linked through numerous research papers to stroke, heart disease, hypertension, impotence, and diabetes. For those patients who have been diagnosed and have had Continuous Positive Airway Pressure (CPAP) recommended, may be intolerant of the therapy, and are currently going without therapy.  There are millions of patients who need treatment, including those who cannot tolerate their CPAP machines and are looking for alternatives. The dental practice is a prime portal to not only screen and identify patients at risk, but to offer clinically proven therapy with oral appliances.

Dentists start the implementation process which involves asking questions, observing, communicating, initiating systems, and offering solutions. The following questions should be asked:  

• Have you been told you snore?
• Are you excessively tired during the day?
• Have you ever had a sleep study?
• Have you been diagnosed with sleep apnea?
• Do you wear a CPAP?

If any answers are “yes” to any of these questions, the dentist can look for signs in these patients, like wear facets (bruxing), periodontal disease, a large neck, obesity, scalloped large tongue, red and inflamed uvula, and enlarged tonsils.

 Risk Factors:

• Excess weight. Fat deposits around your upper airway may obstruct your breathing. However, not everyone who has sleep apnea is overweight. Thin people develop this disorder, too.
• Neck circumference. People with a thicker neck may have a narrower airway.
• A narrowed airway. You may have inherited a naturally narrow throat. Or your tonsils or adenoids may become enlarged, which can block your airway.
• Being male. Men are twice as likely to have sleep apnea. However, women increase their risk if they're overweight. Their risk also appears to rise after menopause.
• Being older. Sleep apnea occurs significantly more often in adults over 60.
• Family history. If you have family members with sleep apnea, you may be at increased risk.
• Race. In people under 35 years old, African Americans are more likely to have obstructive sleep apnea.
• Use of alcohol, sedatives or tranquilizers. These substances relax the muscles in your throat.
• Smoking. Smokers are three times more likely to have obstructive sleep apnea than are people who've never smoked. Smoking may increase the amount of inflammation and fluid retention in the upper airway. This risk likely drops after you quit smoking.
• Nasal congestion. If you have difficulty breathing through your nose -- whether it's from an anatomical problem or allergies -- you're more likely to develop obstructive sleep apnea.

Snoring is the beginning of a disease continuum that will develop into apnea if therapy is not initiated. Apnea will get worse with age, bad diet, weight gain, and an unhealthy, stressful lifestyle which these days can be so common. Unfortunately, many people do not realize that they suffer from sleep apnea unless someone else brings it to their attention. Sleep apnea is a commonly occurring condition that can be life-threatening if left untreated.  

There are three types of sleep apnea -- obstructive, central, and complex. Obstructive sleep apnea is the most common. It results when the airway is blocked by the tongue and soft palate during sleep. As the brain detects a drop in oxygen, it sends a signal to arouse an individual enough to regain the airway. The loss of oxygen in the blood, as well as the constant interruption of sleep, can contribute to hypertension, atrial fibrillation, heart disease, obesity, and overall alertness. Ample research indicates that sleep apnea has a significant impact on traffic and work related accidents due to increased levels of drowsiness for inadequate sleep.

Following the screening process, the patient is generally referred to a sleep laboratory for a Diagnostic Sleep Study known as a Polysomnogram (PSG).  Providing that the results fall within the American Academy of Sleep Medicine (AASM) guidelines for oral appliance therapy -- mild to moderate apnea with no co‐morbidity, the patient should be referred back to the dental office with a prescription for an oral appliance. Oral appliances are also recommended for severe OSA patients if they cannot tolerate their CPAP, although they should always try CPAP first.

Once the patient is diagnosed for oral appliance therapy, your dentist can do a full patient examination, evaluation, and work up including impressions and a bite registration with protrusive and vertical dimension.  Oral appliance therapy allows for improved airflow by repositioning the mandible in a downward and anterior direction. Oral appliances can be easily fabricated in a dental office through the coordinated efforts of a well-trained dentist and qualified lab.

Oral appliance therapy is generally covered by medical insurance not dental insurance. Medical billing is becoming a more common necessity in the dental practice for a variety of treatments and procedures.

Once a patient is fitted with an oral appliance, a follow up protocol is essential. You have to ensure that the appliance is adjusted to the optimum position whereby snoring is eliminated and the apnea is reduced significantly. Ultimately, when efficacy has been achieved, the patient can go back to the sleep laboratory for a sleep study (PSG). The PSG results will give the sleep physician confidence that oral appliances are proving effective and, in some cases, a good alternative to CPAP.

Oral appliance therapy can be truly life-changing for patients and being able to change the quality of someone’s life is extremely powerful and rewarding.

Dr. Edlin has completed the Certification and is a member of the American Academy of Dental Sleep Medicine (AADSM).  We have successfully treated numerous patients and look forward to helping many more.  Additionally, we are happy to get pre-approval from your medical insurance and also file your claim for you once you have been fitted for your appliance.  Please call us at 314.863.2222 for more information.