what you need to know about sleep apnea · 2016. 4. 14. · what you need to know about sleep apnea...

What You Need to Know About Sleep Apnea

You may be surprised to find information about sleep apnea on a dental website. However, sleep apnea is an area I’ve researched thoroughly, not just for my patients but for myself.

Sleep apnea can affect not only your overall level of functioning but also your dental health. People with sleep apnea tend to grind their teeth more often during sleep, which can be damaging to your teeth, your existing dental work, and your jaw joint.

Historically, treatment of snoring and sleep apnea have not been distinct specialty areas in dentistry. However, these problems can be addressed in the dental context in many cases. Working with a dentist to identify and treat your sleep apnea can often be an effective and less expensive route compared to a traditional sleep study.

I’ve put together this sleep apnea guide to give you some background on this common problem that can cause severe impairment in daily functioning. This information is based on my close study of more than 75 scientific articles in peer-reviewed journals, as well as what I’ve learned from attending several medical symposiums on sleep breathing disorders. In addition, I’ve shared some of my personal story about struggling with sleep apnea. You’ll also learn how dentistry can help you with sleep apnea.

If you have more questions about sleep apnea or other issues related to your dental health, I would be honored to assist you personally. Please don’t hesitate to call me at (816) 587-6444 or email me at [email protected].

Best wishes!

From the Desk of Dr. Deyton


What You Need to Know About Sleep Apnea 1

© 2011-2015 Dr. Guy S. Deyton D.D.S.


First, let’s take a look at sleep disorders in general. Then we’ll explore sleep apnea and its effects on your health.

Here are a few common types of sleep disorders:

Sleep onset problems, commonly known as insomnia, make it hard for some people to fall asleep.

Sleep maintenance problems cause some people to wake up in the middle of the night and have difficulty getting back to sleep.

Narcolepsy is a sudden onset sleep pattern that causes people to fall asleep frequently during the day.

Centrally Mediated Sleep Apnea (CMSA) is a condition in which your body sometimes loses the impulse to breath when you are asleep.

However, by far the most common and most serious type of sleep disorder is Obstructive Sleep Apnea (OSA), which occurs when your tongue relaxes against the surrounding soft tissues of your throat, causing your windpipe to be temporarily blocked while sleeping. Very short, interrupted blockages cause snoring. The greater the length of time the airway is blocked, the greater the risk. Blockages of longer than 10 seconds cause noticeable decreases in blood oxygen. Blockages of longer than 30 seconds increase the risk of heart problems and other health risks.

Common symptoms of OSA include snoring, restless sleep, muscle aches, and fatigue during the day. In the mildest cases, sleep apnea can disturb your ability to function optimally during waking hours. In the worst-case scenario, sleep apnea can lead to serious and life-threatening health problems such as cardiac arrhythmias (abnormal heart rhythms).

2What You Need to Know About Sleep Apnea


Sharp drops in blood oxygen, a possible threat to vulnerable organs like the heart and brain.

Cardiac arrhythmias caused by decreased oxygen saturation.

Higher levels of stress hormones in the bloodstream 24 hours a day, not just while you’re experiencing a sleep breathing problem.

Adult onset diabetes.

Increases in blood concentrations of Reactive Oxygenating Substance (ROS), which is associated with harmful inflammatory processes like arterial plaguing and several cancers.

Cognitive and memory disorders that mimic severe learning disabilities in the young and cognitive dementia in seniors.

Scientific studies have linked abnormal sleep patterns with these health issues:


What are the Warning Signs of Sleep Apnea?

Warning signs and symptoms of sleep apnea include:

Loud snoring.

Frequent silences during sleep due to breaks in breathing (apnea).

Choking or gasping during sleep to get air into the lungs.

Sudden awakenings to restart breathing or waking up in a sweat.

Daytime sleepiness and feeling un-refreshed by a night’s sleep, including falling asleep at inappropriate times.



Diagnosis of sleep apnea is usually done in two phases:

The first phase is an at-home sleep screening test with a Level 4 Sleep monitor. Level 4 Sleep Monitors are highly accurate and rigorously tested. This type of test has the advantage of monitoring you as you normally sleep: at home in your own bed. It avoids the errors often introduced by requiring you to sleep in a strange setting, wired to many instruments.

Level 4 sleep monitors are simple, usually worn like a wristwatch with a clip lightly placed over one finger. They are simple, yet very accurate, with some correlating with 95% - 97% accuracy with the more expensive studies done in sleep laboratories. Sleep medicine is moving toward Level 4 monitors as the definitive diagnosis for Obstructive Sleep Apnea.

The second phase is a sleep laboratory study. These are still required by most medical insurance plans to qualify treatment for sleep apnea as a covered medical expense. Although sleep medicine is moving away from laboratory based sleep studies for obstructive sleep apnea, the insurance industry always seems to lag behind.

How is Sleep Apnea Diagnosed?



What is Evaluated When Diagnosing Obstructive Sleep Apnea?

Diagnosis of sleep apnea includes an evaluation of:

The number of episodes normal breathing is interrupted during sleep.

The duration of the breathing interruptions during sleep.

The drop in oxygen levels in circulating blood due to sleep breathing problems.

Cycling time, or the time it takes for a normal breathing pattern to be reestablished.

Pulse rate and rhythm.

The greater the number of breathing interruptions and the longer the duration of breathing interruptions, the more severe the diagnosis.

Unfortunately, many insurance plans too simplistically rely on just the number of episodes, so it is important that sleep studies be performed by clinicians who also factor in breathing cessation duration, cycling time, blood oxygen saturation, and pulse rate and rhythm. The common diagnostic classifications of Obstructive Sleep Apnea are as follows:

Mild: Mild forms of sleep apnea include loud snoring and 12 or less short interruptions (no more than 10 seconds) in breathing per hour.

Moderate: Moderate sleep apnea includes 13 to 25 apneic episodes per hour of 10 seconds or longer duration.

Severe: Severe sleep apnea includes more than 25 apneic episodes per hour of sleep, dips in blood oxygen level of greater than 5%, or an irregular heartbeat associated with breathing pauses.


I personally have been diagnosed with mild to moderate Obstructive Sleep Apnea. I am a meticulous researcher when motivated, and anyone who knows me won’t be surprised to hear that my sleep apnea diagnosis made me highly motivated to understand what my treatment options were!

In 2002, I began to feel bad, not like myself. I ached most all the time, as if I had a mild case of the flu. I found myself taking one or two Advil a day, and this was very unlike me, because I really don’t like depending on medication to make me feel better. At night, I started waking up when I used to sleep the night through. Most of the time I would fall back asleep quickly. Sometimes I noticed that the t-shirt I wore to bed was damp as if I had been sweating. In the mornings I just didn’t feel refreshed when I woke, but a strong cup of coffee seemed to help get me started. During the day, I just didn’t seem to have any energy. By the end of my workday, I was so tired that I would catch myself falling asleep at stoplights as I drove myself home. Finally, one day I literally fell asleep while driving home! Fortunately, it was just a second or two. I jerked and woke up before I caused a serious accident that could have harmed me or someone else. That’s when I decided I needed to talk to my doctor!

I made an appointment with my internist and shared my symptoms. After a thorough medical exam to rule out other causes, my doctor told me I might have sleep apnea. To his credit, he immediately arranged for a hospital-based sleep study.

A Doctor Who Understands Sleep Apnea




The Hospital Sleep Study

On the appointed night, I showed up at 8:30 as requested. After I completed a medical history form, the sleep technician ushered me into a room with a hospital bed and a vital signs monitor that measures pulse, blood pressure, heart rhythm, blood oxygen, expired carbon dioxide, breathing rate, and temperature. There was also another machine called an electromyograph that is able to measure muscle activity. There was a window in one wall of the room. The sleep technician informed me that he would be in the adjoining room observing me through the window as I slept.

The sleep technician proceeded to wire me up to all the machines. He used a 5-lead electrocardiograph with adhesive pads on my torso to measure heart rhythm. He put 2 adhesive sensors on each side of my face to measure jaw muscle activity. He put a small tube under my nose similar to the kind used to deliver oxygen, saying that it was for measuring carbon dioxide. He put an elastic belt around my chest that measured the number of times a minute I breathed. He put an adhesive temperature probe on my forehead. And he put a pulse oximetry clip on my finger, secured with adhesive tape, to measure the oxygen content in my blood.

He then said, “Climb into bed and go to sleep. I’ll be watching you through this window.”

I proceed to lay in bed awake for what seemed like hours. Apparently I did fall asleep at some point, because I remember that the technician woke me up and said I should put on a Darth Vader-type mask attached to a CPAP machine. In the morning, the sleep technician told me that I had early to moderate sleep apnea and if I wore the Darth Vader mask, it would help.

I left this experience thinking: I’m not sure I believe the test, and I sure don’t like the CPAP!


Treatment for snoring and sleep-time breathing disorders depends on the diagnosis and the severity of the problem. There are 4 types of interventions and therapies associated with treatment of snoring and sleep-time breathing disorders. The therapies are listed below by category with short descriptions.

Snoring and Sleep Apnea Treatment Options


Behavior Modification

Studies have shown that the following behaviors can elevate risk factors for sleep-time breathing disorders:

Obesity: patients with a body mass index (BMI) greater than 30 showed a much higher tendency toward moderate to severe obstructive sleep apnea.

Eating high-calorie foods within 3 hours of bedtime

Drinking alcohol within 3 hours of bedtime

Sleeping supine (on your back)

Behavioral modification attempts to reduce risk factors for obstructive sleep apnea. Behavior modification therapy for snoring and sleep apnea includes:

Exercise: to lower your Body Mass Index (BMI) to below 25

Weight Loss: to lower BMI below 25 and reduce fat deposits in neck area

Change in sleep posture from back-sleeping to side-sleeping minimizes adverse tongue position with respect to airway.

Use of contoured pillows to position your head to maximize airway space.

Change in dietary habits to reduce alcohol and caloric intake in the 3 hours preceding sleep.



Experts recommend that behavioral modifications should be implemented in all types of sleep-time breathing disorders. They are not surgically invasive and cost very little.

Although behavioral modifications are logical, for some people they are not easy to implement. Studies show that people have a difficult time changing their diet, exercis-ing regularly, and learning to sleep in a new position.

It is also true that behavioral modifications, used alone, usually will not resolve moderate to severe obstructive sleep apnea.


Oral Appliances for Snoring and Sleep Apnea

Oral appliances for snoring and sleep apnea fit over both the upper and the lower teeth. The appliances work by advancing the position of the lower jaw forward.

There are several advantages to using oral appliances:

Surveyed patients prefer oral appliances to CPAP or surgical alternatives.

Oral appliance patients have a much higher compliance rate than CPAP patients. In other words, oral appliance patients were much more likely to be used regularly by patients to help them sleep than CPAPs.

Oral appliance patients perceived that their daytime sleepiness improved approximately as well as that of CPAP patients.

Oral appliances patients reported outcomes that were equal to surgery patients in the first year, but perceived outcomes were better than surgery patients after 12 months.




However, oral appliances also have disadvantages:

A CPAP is still the “gold standard” for treatment of Obstructive Sleep Apnea. If a patient will use a CPAP every night, it should be the treatment of choice!

ONLY ORAL APPLIANCES THAT CAN BE ADJUSTED FOR EACH PATIENT SHOULD BE CONSIDERED. All other appliance are made based on anatomical averages and are just guesswork.

Even though patients vastly prefer oral appliances, an appliance still requires a patient to get used to something new. There is an adjustment period of up to 3 weeks required to “calibrate” the oral appliance.

As with CPAPs, oral appliances need to be “titrated” (adjusted) and periodically re-evaluated to ensure they are still functioning properly. This can (and should) be done with a Level 4 Sleep Monitor in the setting that you normally sleep.

Indications for oral appliances for snoring and sleep apnea:

Moderate to heavy snoring.

Mild to moderate obstructive sleep apnea.

Patient inability or unwillingness to tolerate a CPAP.

Use during travel.

Use in conjunction with behavior modifications discussed earlier.


CPAP: Continuous Positive Airway Pressure Device

A Continuous Positive Airway Pressure device, or CPAP machine, is a respiratory therapy device that blows compressed air through the nostrils at a prescribed pressure to keep the airway open.


You should not use oral appliances for snoring and sleep apnea if you have these conditions:


Fewer than 6 teeth on each arch.

Teeth too loose to comfortably hold in appliance.

Inability to protrude lower jaw 6 – 12 mm (1/4 to 1/2 inch) without discomfort.

History of certain types of jaw joint problems that may be made worse with an oral sleep appliance.

Advantages of the CPAP:

Achieves the best improvement in reduction of apnea episodes per hour during sleep.

Achieves the best improvement in average amount of blood oxygen saturation during sleep.

Disadvantages of the CPAP:

Device is bulky and cumbersome to wear. Many patients have difficulty getting used to sleeping with the CPAP mask strapped on their head

Minimum compliance for CPAP is 4 Hours per night, with 6 hours giving better results. Only about one-half of CPAP patients use the machine for at least 4 hours every night. The device only works if patients wear it.




A CPAP is most helpful for people with moderate to severe obstructive sleep apnea who can be compliant and wear the CPAP every night.

Who should not use a CPAP:

Patients who are unwilling or unable to wear a CPAP for at least 4 hours every night.

Patients with nasal congestions or blockages.

Patients with certain lung diseases.

Palate and Throat Surgery

Uvulopalatopharyngoplasy (UPPP) is a surgical procedure to change the shape of back of the soft palate to increase the air-way opening. Tonsillectomy and adenoidectomy may also be indicated to change the shape of the throat and increase airway space.

The main advantage of the UPPP procedure is a high success rate during the first year after surgery, rivaling that of compliant CPAP patients.

Disadvantages of the UPPP procedure include:

Patient reports of moderate to severe post-surgical pain and difficulty eating for 7 to 10 days.

Tendency of soft tissue to re-grow, resulting in “regression.” A significant percentage of patients report diminished results after 12 months, requiring additional surgery or alternate therapy.

Indications:

Patients with moderate to severe obstructive sleep apnea for whom CPAP and oral appliances are not effective options.



Who should not use UPPP:


Because the long-term success rates are equal or better for both CPAP and oral appliances, surgery is contraindicated if patients will consent and comply with either alternative therapy.

Patients who are not good candidates for general anesthesia are not candidates for UPPP.



Call our office and ask for a snoring / sleep apnea consultation. This is a no-risk, no-treatment 30-minute appointment when you can see our office and talk with Dr. Deyton. Our staff is very friendly and will not pressure you into scheduling anything beyond the 30-minute consultation.into scheduling anything beyond the 30-minute consultation.

Complete your paperwork in the comfort of your own home. Your health is important to us, which is why we have such thorough medical and dental history forms. Prior to your consultation visit, you can download and fill out the forms in the comfort of your own home. The forms are available for easy download at:

Attend your consultation to explore how your symptoms line up with possible sleep problems. This will be your time to meet Dr. Deyton and the staff, and to see our office. We’ll make sure that all your questions about sleep apnea are answered, and you will be in complete control of whether to move on to the next step. You’ll find that we have a relaxing office envi-ronment (including water sculptures, music, and aromatherapy) and that everyone in our office is extraordinarily kind. Chances are, you will leave the consultation feeling like a tremendous burden has been lifted..

If appropriate, arrange for an at-home screening with a Level 4 Sleep Monitor. We have purchased the most Accurate Level 4 monitor available. We will lend it to our patients for a very small fee (approximately 10% of the cost of a sleep clinic study). You wear the monitor like a watch for 2 con-secutive nights. The data about your sleep is stored in the device’s memory.

If you or your spouse want a safer night’s sleep by overcoming snoring and sleep apnea, but are unsure about the feasibility of a CPAP machine, we may be able to help. Here’s what you can expect if you seek help from our office:

The Apnea Evaluation Process at Dr. Deyton’s Office

http://www.drdeyton.com/patients.html#forms



Your sleep data is uploaded and analyzed, and our office generates a detailed report. This report will tell you how many apneic events occurred, how long the events lasted, and how long the abnormal breathing cycled before returning to normal.

Consultation with Dr. Deyton to explain your results. Our staff will contact you to make an appointment for a short consultation with the doctor to explain the results of your Level 4 screening and to answer any questions you may have.

Identify the next step. At the end of the consultation, you and Dr. Deyton will identify the next step. It will be one of 4 outcomes:

The screening does not reveal a sleep breathing problem that requires follow-up action at this time.

The screening reveals a modest problem that may resolve with behavioral changes, like exercise, weight loss, dietary changes, use of contour pillows, or change in sleep posture.

The screening reveals a significant problem that warrants treatment that you hope your medical insurance benefits may cover. We help arrange a referral for a sleep study performed at a sleep clinic.

The screening reveals a significant problem, but you are certain you won’t like a CPAP. You want to discuss an oral appliance to address snoring and sleep apnea.


Do you have questions about sleep apnea or other issues related to dental health?

We would be happy to talk with you. Call Dr. Deyton’s office at (816) 587-6444 or email [email protected].

Dr. Deyton practices general and comprehensive dentistry in Kansas City, Missouri. He received his post-graduate training at Dwight D. Eisenhower Medical Center in a general practice residency program accredited by the American Dental Association Commission on Dental Accreditation.

Here’s Why People Choose Dr. Deyton’s Office

WE CARE, and it shows! Find out why patients in an independent survey rated us at 4.92 on a 5-point scale for friendliness, attitude, and concern for patient comfort. Go to http://www.drdeyton.com/what-patients-say.html and read what our patients have to say.

We’re very, very good at what we do. In an independently collected survey, our patients rated our OVERALL care 4.98 on a 5-point scale. See http://www.drdeyton.com/what-patients-say.html to find out what patients say about us.

Dr. Deyton is well-respected by other dentists. Take a look at http://www.drdeyton.com/what-doctors-say.html to read what other dentists think of Dr. Deyton.

Our office is a relaxing place to be. We’ve intentionally created a soothing environment by incorporating a calming color pallette, art and water features into our office design. You can go to http://www.drdeyton.com/office-tour.html to see our office.

Our office smells nice. We mindfully use scented candles and aromatherapy to make our office more pleasing. When you walk in the door, you won’t be confronted with medicinal or dental smells.

No dental sounds. We provide you headphones so that you can listen to over 50 non-commercial music stations or select from over 100 television stations to watch on your personal monitor.

WE’RE FUN! If headphones aren’t your cup of tea, you can join us in a game of “Name That Tune” or help celebrate one of the many occasions that we embrace to prove every day that People Matter!TM

Our service is so great, you’ll want to refer your family and friends!



Dr. Guy S. Deyton, D.D.S.6416 North Cosby Avenue | Kansas City, MO 64151

Phone: (816) 587-6444

www.DrDeyton.com


what you need to know about sleep apnea · 2016. 4. 14. · what you need to know about sleep apnea...

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