How Do Dentists Spot Sleep Apnea?

Do you often wake in the morning feeling like you didn’t sleep well? Even after being in bed for 8+ hours, do you experience morning grogginess and exhaustion? A bad night’s sleep can be caused by any number of things: eating too late, stress, and a bad mattress. However, chronic sleep problems are often attributed to sleep apnea. Dentists can often spot its symptoms in their patients, which makes regular checkups a must.

Sleep apnea is often either ignored or left untreated. However, it is a huge health concern and it can be treated relatively easily. Nearly one-third of adults report having sleep apnea symptoms, yet few of them seek treatment. This is particularly astonishing when we consider about 5.4 million Canadian adults have been diagnosed with this disorder, or are at high risk of developing it.

Not Just “Snoring”

Although people with sleep apnea often make snoring noises, the problem goes much deeper than sound. In Obstructed Sleep Apnea Syndrome (OSAS) snores are accompanied by moments when you completely stop breathing. Even though you may feel you are asleep, you’re actually waking each time the body tries to get oxygen.

Despite how “common” it may be, sleep apnea is a serious disorder that should be treated by medical professionals. Apneas (or “breathing pauses”) can last from 10 to 30 seconds until the brain senses the problem and signals the throat muscles to tighten to restore normal airflow. With each sleep apnea episode, the level of oxygen in the blood is reduced (hypoxia). This results in sleep disturbances as the sleeper wakes briefly to resume breathing. Pauses in breathing can occur several times throughout the night and the sleeping person may have no memory of waking.

Sleep disturbances and hypoxia may lead to daytime sleepiness, memory problems, and poor concentration, which can reduce quality of life. It also puts stress on the heart and has been linked to hypertension and high blood pressure.

Types of Sleep Apnea

There are three kinds of the disorder. We’ve listed them in order of severity:

• Obstructive: The most common form of apnea, which occurs when the muscles in the throat relax during sleep.
• Central: This happens when your brain “forgets” to send signals to the muscles that control breathing. It is a more rare form of apnea.
• Complex sleep apnea syndrome: This term is used when a person exhibits symptoms of both obstructive and central sleep apnea. This is also referred to as treatment-emergement central sleep apnea and is the rarest type of this sleeping disorder.

Causes of Breathing Pauses

The causes of sleep apnea are varied. The problem usually occurs when soft tissues behind the throat start to collapse and close during the sleep. A narrow airway, relaxed throat muscles, small jaw, and large tongue can cause airway obstruction.

Here are the known causes of a collapsed or blocked airway:

• Physical Obstructions – Fat or thickened tissue around the airway can obstruct the normal airflow. When air is squeezed, it can cause loud snoring (associated with Obstructive Sleep Apnea, or OSA).
• Muscular Changes – When sleeping, the tongue and the muscles responsible for keeping the airway open become relaxed. This causes the airway to narrow. For those who do not have sleep apnea, airflow is not obstructed and breathing continues normally.
• Brain Function – Central sleep apnea (CSA) occurs when the brain causes the rhythm and control of breathing to malfunction. CSA can be associated with certain health factors (e.g. heart disease, stroke, use of pain medications).

Other sleep apnea risks include:

• Excess Weight – Obesity is a common risk factor for breathing pauses. Fats can build around the upper airway and obstruct breathing.
• Gender – Men are 2-3 times more likely to experience sleep apnea than women.
• Age – The risk of apnea is more significant among older adults.
• Family History – It is possible that sleep apnea can be inherited through your genetic structure.
• Smoking – OSA is three times more common among people who smoke. Smoking can cause fluid retention and inflame the upper airway.
• Alcohol Use – Drinking alcohol causes the throat muscles to relax, worsening OSA.
• Nasal Congestion – People who have difficulty breathing through their nose may be likely to develop sleep apnea.
• Narcotic Pain Relievers – Taking long-acting opioid medications (like methadone) is likely to increase the risk of CSA.
• Stroke – The risk of CSA or “treatment-emergent” CSA is higher for stroke patients.

What are the Risks?

As mentioned before, sleep disturbances may affect both physical and mental health. The Canadian Community Health Survey reported that the risk of high blood pressure is almost two times higher in Canadian adults with sleep apnea. In addition, sleep apnea patients are over two times more likely to have heart problems and mood disorders (e.g. depression, manic episodes, dysthymia, and bipolar disorder).

Untreated sleep apnea can also lead to chronic fatigue, which increases the risk of injuries. Sleep apnea patients have been reported to have more incidents of workplace and motor vehicle accidents. Fatigue may cause irritability and behavioural problems.

The Link Between Sleep Apnea and Your Dentist

Family dentists are often the first healthcare professionals to detect the early signs of this disorder. The reason is patients see them more often than their general physician. Also, one of the first signs associated with sleep apnea is bruxism (tooth grinding). The dentist may also notice other signs (e.g. small jaw, dry mouth, redness of the throat caused by excessive snoring, tongue with scalloped edges). It’s important to report to your dentist if you experience morning headaches or frequent migraines.

If your dentist notices sleep apnea symptoms, s/he may ask about:

• Your typical sleeping schedule
• Time it takes to fall asleep
• Sleeping environment
• If you use sleep medication
• Hours of sleep you get each night
• If anyone noticed you snoring
• Waking up gasping for air
• Family members with sleep apnea

It may be recommended that you see a sleep medicine specialist for a “sleep test” to further assess your condition. The overnight sleep study is conducted using “polysomnography.” This test measures various body functions, including blood oxygen level, heart rate, and the number of breathing interruptions during sleep.

If you’re diagnosed with sleep apnea, both your physician and dentist can work together to determine the right treatment and implement appropriate treatment therapies to prevent apnea.

What are my Options?

Fortunately, there is hope! Depending on its severity, there are a number of ways you can address sleep apnea and reduce its symptoms. It may be recommended that you use one of these appliances while sleeping:

• Continuous Positive Airway Pressure (CPAP) – CPAP is considered the leading treatment for sleep apnea. Patients wear this mask to prevent breathing pauses during sleep. It is connected to a pump that supplies a steady flow of air down the throat and keeps the airway open. It helps reduce snoring, alleviates daytime sleepiness, and lowers blood pressure. Although these machines were once quite noisy, many are virtually silent.
• Mandibular repositioning device (MRD) – This dental appliance resembles a retainer. It helps treat OSA and snoring by pushing the jaw and tongue forward, making the airway larger. It also prevents the soft tissues of the throat from collapsing, which can narrow the airway.
• Tongue Retaining Device (TRD) – TRDs control and keep the tongue in a forward position. While some patients may feel uncomfortable wearing TRDs, it has fewer therapeutic complications than MRDs.

Even if your dentist doesn’t specialize in sleep apnea, a knowledgeable oral health team will be interested in your overall health. If you’re experiencing symptoms, sleepiness, or pain, make sure to discuss these issues with your dentist.

Whether related to sleep apnea or not, tooth grinding while sleeping can cause tooth damage, gum recession, decay, loose teeth, and sensitivity. Call a dentist if you are concerned about bruxism. In Oshawa, call Clearbrook Dental at (905) 434-4244.