Sleep Dentistry North York

Apnea is a term for suspension of external breathing. During apnea, there is no exchange of air in the lungs or airways.

Sleep apnea is a type of sleep disorder characterized by pauses in breathing or instances of shallow or infrequent breathing during sleep.  Each pause in breathing, called an apnea, can last from at least ten seconds to several minutes, and may occur 5 to 30 times or more an hour.

Sleep apnea usually is a chronic (ongoing) condition that disrupts your sleep. When your breathing pauses or becomes shallow, you’ll often move out of deep sleep and into light sleep.  One of the most common signs of airway obstruction is that of snoring.  When people fall asleep, their muscles relax and one of the resultant problems is that the tongue can relax into a more backwards position and resulting in a blockage of the airway.  When this blockage is partial, the movement of air though the narrowed passageway can cause noises such as whistling and other sounds commonly associated with snoring.  But when the passageway becomes completely blocked, no oxygen is getting to the lungs and brain and this causes the brain to react and wake up the snoring person.  When this occurs, the person wakes up suddenly and takes a gasp of air (sometimes it can be quite terrifying for the patient).  This constant sleep/wake cycle then causes sleep disturbances in this person. These sleep disturbances can cause these people to have on going tiredness, often to the point of falling asleep during the day.  This can be quite deadly when this person falls asleep at the wheel of a car or truck!!

There are other significant causes of airway problems and one of the most significant is that of narrowed airways in children, caused by enlarged tonsils and adenoids, allergies and repeated bouts of the common cold.  In children, long term restricted airways can have dramatically damaging effects on their ability to learn and concentrate with possible lifelong learning disabilities.

Sleep Apnea Appliances

What are the Signs of Sleep Apnea?

The most common signs of sleep apnea are snoring, and exhaustion.

Other signs include:

  • Intermittent stoppages of breathing during sleep
  • Excessive daytime sleepiness
  • Restless sleep
  • Difficulty in concentration
  • Poor memory
  • Irritability or moodiness
  • Impotence
  • Falling asleep during the day while doing normal activities (i.e.; driving, working at desk, etc.)

What Causes Sleep Apnea?

Sleep Apnea is a result of obstructed airways.

Airways, simply put, are the passageway from your nose and mouth to your lungs. When these passageways are narrowed, either due to increased weight gain, allergies, excessive growth of tissue, insufficient development of the jaws of the face (and by other means), there is a decrease in airflow to the lungs and a resultant decrease in available oxygen to the brain and the rest of the body.

Consequences of Sleep Apnea

Failure to treat sleep apnea can result in multiple very serious health consequences. The prevalence of cardiovascular diseases in patients diagnosed with OSA is alarming. The following list shows the correlation between cardiovascular diseases and OSA.

  • Hypertension- 57%
  • Ischemic heart disease-25%
  • Coronary heart disease-17%
  • Bradyarrhythmias-10%
  • Acute myocardial infarction-8%
  • Stroke-7%

Another way to look at the dangerous effects of OSA is to consider how often people diagnosed with other conditions also suffer from OSA. For example, 90% of people complaining of nighttime chest pain (nocturnal angina) were diagnosed with OSA, as were 38% of heart attack victims!

  • Nocturnal angina-90%
  • Asymptomatic nocturnal bradycardia-86%
  • Coronary artery disease-76%
  • End stage renal disease-60%
  • Cardiac sinus arrhythmia-50%
  • Congestive heart failure-45%
  • Ischemic stroke-40%
  • Acute myocardial infarction-38%
  • Hypertension-30%
  • Ischemic heart disease-28%

Treatment of Snoring and Sleep Apnea

In order to confirm that you have sleep apnea, it is necessary for you to have a sleep study. This can be arranged by your family or primary care physician. Once you have been diagnosed by a qualified sleep physician, your appropriate treatment will be determined.

The two simplest and least invasive (non surgical) treatments are the use of CPAP (Continuous Positive Air Pressure), a machine that requires the use of tubes to the nose forcing air into the airways, and Oral Sleep Appliances (OSA), which are made by a properly trained dentist to help open the airways.

While CPAP is the gold standard for treatment and if used properly, will most often result in the most reduction of apneas, many patients find CPAP hard to wear every night. The OSA is often a viable alternative for these patients, or for patients who use their CPAP but find it unwieldy for travel.

How do Oral Sleep Appliances Work?

If you have ever taken a basic life support course, one of the first things that we are taught to do before treating patients that have stopped breathing, is to open their airways. We do this with the “chin lift” and “head tilt”
These actions are designed to be sure that the airway is open to allow us to force air into the non-breathing rescue victim. Well… the same principals apply when it comes to snoring and sleep apnea.
By advancing the chin, the tongue (which is often a major contributor to blocked airways) comes forward with the lower jaw (to which the chin is attached). Most people don’t realize that their tongues are attached to their lower jaws by a series of muscles, so with the advancement of the chin, the tongue comes forward too and leaves more space in the throat for the passage of air.

For people who snore or have sleep apnea due to airway obstruction, repositioning of the tongue forward can be easily accomplished with the use of a dental appliance. This appliance works by having the patient’s lower jaw gently repositioned with the patient biting more forward. In addition, these appliances can be adjusted by the patients themselves for maximum comfort.

Other Means to Diminish Snoring

There are many other things that patients can do themselves to reduce snoring and sleep apnea. These include the following:

  • Lose weight; if overweight, even your tongue and throat tissues become larger.  Losing weight will result in a shrinkage of these tissues and a more open airway
  • Decongestants: these medications, often available directly at your pharmacy, can help open nasal passages and reduce airway obstructions
  • Use of Saline nasal rinses.  These too can help open nasal airways and reduce inflammation of the nasal tissues which can result in swelling and nasal obstruction
  • Removal of tonsils:  Often in children, enlarged tonsils are a major cause of snoring and sleep apnea.  Removal of these enlarged tissues can often result in dramatic sleep and health improvements for children.
  • Sleep Hygiene: get the dog out of your bed!!!  Also allow yourself sufficient time before bed to be fully relaxed prior to turning out the light.  This means no TV or computer use prior to sleep, try to exercise earlier in the day, avoid caffeine and alcohol prior to sleep as these are drugs which can interfere with your crucial REM sleep.