December 11th, 2014
Blog for Dec 7, 2014
Why We Have Decided to Treat Obstructive Sleep Apnea (OSA)
Quite simply, because many lives have been cut short because of this disorder. We have not stopped treating dental disease, placing implants and restoring form and function to our patients. Cosmetic dentistry is still a huge part of our practice. However, we have dedicated another part of our facility to the treatment of OSA. We call it the Center for Dental Sleep Medicine at Ariel Dental Care. Our commitment was reinforced when the engineer driving the ill fated Metro North Train fell asleep and many were killed and injured. I have been recognizing the need for treatment for more than 20 years. It began with my interest in TMJ therapy in 1993 when I felt there was some connection between bruxism and TMJ disorders. But something didn't make sense to me. That was, why would the body do that? There had to be a very important reason. For those of you unfamiliar with TMJ, it stands for temporomandibular joint. That's the joint that allows you to open and close your mouth and chew your food and speak. So the question was, why? Why do people grind and clench their teeth as well as wear down their teeth . We used to believe it was a stress issue, then briefly a hormonal issue since it affected more women than men. Well that turned out to be more of a reason for daytime grinding and clenching. Our thinking as a profession has changed greatly in the ensuing 20 years. We now believe that night time grinding and clenching is really our brain's way of trying to get more oxygen for itself by moving the lower jaw more forward in order to make space in the back of the throat for air to pass in greater volume. Gravity works and when we lay down, muscles and surrounding soft tissue tend to collapse a bit. Just enough to narrow the breathing space significantly. Enough to deprive the brain of needed oxygen. This causes the brain to panic and it sends out a signal to the hormone generating systems in the body to go to war. To do what it requires to survive. You've all heard of the fight or flight response. It's what our body does when our brain determines there is a threat. These hormones are extremely powerful. Remember, the brain determines this is a threat to our body's very survival. The result is every organ system in the body is affected including the heart and its blood vessels, This increases the risk for heart problems and stroke. There is a significant increase in the release of inflammatory chemicals which as you now know are responsible for many health problems such as plaque accumulation in blood vessels which has a global effect on all body systems by depriving them of the ability to function properly on a cellular level. But the effect of the chronic release of these hormones go much further. Along with the nightly interruption of restorative sleep, there are cognitive and behavioral losses. The person with obstructive sleep apnea is tired, doesn't perform at peak levels, and tends to feel depressed or moody. And in the worse case, may fall asleep behind the wheel of a the vehicle of which he or she is supposed to be in control. The space here doesn't permit inclusion of all the consequences, but you now have a greater appreciation for what we are trying to accomplish. So what do we recommend? Firstly, snoring is often a sign of OSA, but not all people who have OSA snore. I'd like to give you some signs to look for. Now remember, if you experience excessive daytime sleepiness, that's a clear sign to be evaluated. But here are some more subtle signs.
- Excessive tooth wear
- A large tongue
- Narrow arches (I'm not referring to your feet, but you upper and lower jaws)
- Scalloped appearance on the side of the tongue
- Bony ledges on the insides of your lower teeth or the outside of the upper teeth below the junction of your teeth and gums.
- A chin that appears to be set back
- A narrow and high vaulted palate
- Difficult to control high blood pressure, diabetes, erectile dysfunction
- restless legs during sleep
- frequent night time trips to the bathroom
- choking or gasping that wakes you up ( not so subtle)
Let's take a few moments to discuss what can be done. First, come and see us if you have yet to be evaluated. We will examine you and recommend a visit with a sleep specialist. The sleep specialist will then determine if in fact there is enough evidence to send you for a sleep study. A sleep study is performed often times overnight in a special sleep lab. Don't let this deter you from doing so. It could be the most important thing you have done for yourself in a very long time. And you will be able to sleep long enough for the physician to get enough data in order to quantify and understand the specifics of your problem. Depending on the level of OSA you exhibit, your doctor will make recommendations as to treatment. This will range from utilization of CPAP to oral appliance therapy, to possibly just some life style changes. Should you find that you cannot tolerate the CPAP, oral appliance therapy can be very successful. We have treated many men and women who were unable to acclimate to it's use or had mild or moderate OSA and couldn't see themselves using a CPAP. These are custom fabricated appliances, chosen from a fairly wide range of different types based on the a patient's particular mouth form and symptoms. However, never lose sight of the big picture. That is the goal of becoming healthier, feeling better and living longer. In the next blog, I'll discuss the signs and symptoms of OSA in children.