Dr. William Lund and I have just completed a comprehensive dental sleep medicine course at Tufts University School of Dental Medicine. The course has consisted of 6 days of classes and hands-on workshops where we have learned how we can help diagnose and treat our patients who have sleep apnea. The lectures provided an understanding of both normal sleep and obstructive sleep apnea (OSA). We learned about the pathophysiology and medical consequences of OSA and how to screen, diagnose, and treat sleep apnea patients, both with the positive air pressure (PAP) therapy and with oral appliances. During hands-on workshops, we performed clinical examinations, took bite registrations, selected oral appliances, and fitted and adjusted these appliances.
I have told many of my patients about the classes we have been taking, and the unanimous response is, “But you’re a dentist? Don’t doctors treat sleep apnea?” Although obstructive sleep apnea is diagnosed by a sleep medicine physician, many patients with sleep apnea can be treated by a specially trained dentist. After the comprehensive course-work we have completed, Dr. William Lund and I are eligible to receive the “Qualified Dentist” designation by the American Academy of Dental Sleep Medicine. This designation provides a distinction regarding our knowledge of and commitment to dental sleep medicine. “Qualified Dentists” are the dentists of choice to provide oral appliance therapy for OSA since the successful delivery of oral appliances requires technical skill, acquired knowledge, and judgment regarding outcomes and risks of these therapies.
Going forward we are going to begin to ask all our patients 3 simple questions: 1) Have you been told that you snore? 2) Have you been told that you stop breathing when you sleep? 3) Do you often feel excessively sleepy during the day? If the answer to any of these questions is yes, additional screening is needed. For those patients we are concerned have sleep apnea, we will recommend they go for a sleep study. Only through a doctor administered sleep study will we know if a patient does suffer from OSA. Then, if a patient is diagnosed with mild to moderate obstructive sleep apnea, we can fabricate a custom oral appliance, often covered through medical insurance. It all sounds so simple, however properly fitting a patient with an oral appliance takes time and skill. The result, as any patient who uses and oral appliance will tell you, is a dramatic increase in his or her quality of life.
Who is at risk for OSA? Studies show that 17% of women and 34% of men have OSA. Risk factors include: age (40-70), gender (male), large neck, obesity (BMI > 30), central body fat distribution, craniofacial and upper airway abnormalities, genetics, smoking, menopause, nighttime nasal congestion, and alcohol use before bed time.
What is OSA, and why is it so dangerous? OSA is not simply snoring; it is when the airway closes (partially or fully) but efforts to breathe continue, resulting in a reduction of blood oxygen saturation and ending with a sleep arousal. Primary causes of upper airway obstruction are lack of muscle tone during sleep, excess tissue in the upper airway, and anatomical features of the upper airway and jaw. The person experiences apneas (reduction of airflow by 90% for 10 seconds with persistent effort to breathe), hypopneas (reduction of airﬂow by 30% with 3% arterial oxygen desaturation for 10 seconds associated with a sleep arousal), and reras (sequence of breaths lasting at least 10 seconds characterized by increasing respiratory effort leading to an arousal from sleep). From a sleep study, a person is given an Apnea Hypopnea Index, which tells you how many times your sleep is disrupted in an hour. A score of 0-5 is normal, 5-15, mild, 15-30 moderate, and over 30 severe. Anyone with severe OSA needs PAP therapy (C-PAP), however if you have mild to moderate sleep apnea you can use an oral appliance which is much more comfortable and has a higher rate of compliance.
What are oral appliances for sleep apnea? Oral appliances refer to mandibular advancement (repositioning) devices because they are the most effective and widely used in clinical practice. The function of an oral appliance is to protrude and help stabilize the mandible (lower jaw) to maintain an open airway during sleep. The oral appliance is custom fabricated and cannot be purchased from a store or online. Although not recommended for severe sleep apnea, oral appliances can be used by those who are intolerant of C-PAP rather than no treatment. Dentists with the “Qualified Dentist” certification are the recommended providers to make these oral appliances.
Why is it so important to treat OSA? Sleep loss and sleep disorders are associated with hypertension, diabetes, obesity, depression, heart attack, and stroke. Excessive daytime sleepiness leads to significant impairments in quality of life, cognitive performance, and social functioning. Almost 20% of all serious car crash injuries in the general population are associated with driver sleepiness. Treating OSA is not just about stopping you from snoring; it is about improving the quality and length of your life.
If you think you or someone you know may have obstructive sleep apnea, please call our office and reserve a complimentary consultation with either Dr. William Lund or myself Dr. Cara Lund.
Reference: Dental Sleep Medicine: A Comprehensive Introduction Course (Tufts University School of Dental Medicine Department of Continuing Education)