Did you know a dentist can help you stop snoring?

Did you know a dentist can help you stop snoring?

If you snore or fear you suffer from sleep apnea, your dentist may have a solution for you

Who can diagnose if I have a snoring problem or sleep apnea?

If you suspect that you have a snoring problem, severe teeth grinding or sleep apnea, you can visit your dentist for advice.

By examining the conditions of your mouth, throat and teeth, together with detailed discussions with you and your spouse as well as a sleep test, a dentist can gather more information on your risks of snoring or sleep apnea.

For example, your dentist will be able to tell if you grind your teeth, which is something your brain makes you do in an attempt to open your airways.

Headaches, sore jaws, and worn-down or sensitive teeth are some ways that your dentist can tell if you grind your teeth.

How can the dentist help me deal with my snoring or sleep apnea problem?

Treatment for sleep apnea is to use the Continuous Positive Airway Pressure (CPAP) machine. However, for snorers and patients who cannot tolerate the CPAP, your dentist will be able to provide an alternative solution.

Worn during sleep, the custom-fitted oral positioning appliance is similar to an orthodontic retainer or a sports mouthguard. It brings the lower jaw slightly forward and prevents the airway from closing so you can breathe comfortably and reduce snoring.

According to research studies, 91 per cent of patients reported improvement in sleep quality after wearing a snoring appliance.

The best way to find out what type of treatment you need is to schedule for an appointment with your dentist, who may send you for a sleep test if he/she suspects that you suffer from sleep apnea.

 


 

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Obstructive sleep apnoea is a common condition among Singaporeans. Experts from SingHealth Polyclinics explain how to deal with it – including doing mouth exercises like ‘tongue tai chi’, what we call myofunctional therapy (MFT).

OSA is a common condition seen among Singaporeans, as it turns out. According to Dr Tan, over 1,000 patients visit SingHealth Polyclinics every month, and a telltale sign they have it: Snoring.

“The danger of sleep apnoea is the combination of disturbed sleep and oxygen starvation, which may lead to hypertension, heart disease, heart failure, abnormal heart rhythms, or even stroke,” said Dr Tan Teck Shi, the clinical lead for a respiratory workshop with SingHealth Polyclinics.

 


 

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Dentistry and Sleep-Related Breathing Disorders

Dentistry and Sleep-Related Breathing Disorders

Context

Sleep-related Breathing Disorders (SRBD) affect millions of people of all ages worldwide. They can be the cause of a wide range of physical, dental and mental health problems, ranging from simple day-time sleepiness to life-threatening cardiovascular complications. In addition, SRBDs can increase the risk of psychological problems, including depression and drug dependency, which can damage their social relations and adversely affect their on-the-job performance. Therefore, SRBDs can affect quality of life and have very serious socio-economic consequences including employment loss and traffic accidents.

Scope

This Policy Statement aims to highlight the important role of dentists in prevention, early screening and treatment of young or adult patients with SRBDs by establishing effective inter-professional collaboration with medical sleep doctors.

Definitions

Sleep-related Breathing Disorders (SRBD): disturbance of the normal breathing pattern during sleep.

The most common types of SRBDs are: snoring, Upper Airway Resistance Syndrome (UARS) and Obstructive Sleep Apnea (OSA). They occur when a person’s airway repeatedly becomes blocked during sleep despite efforts to breathe. The posterior section of the tongue falls back against the throat and airflow is interrupted. This results in loud snoring and pauses in breathing while asleep resulting a change from deeper sleep stage to a lighter stage even sometimes with episodes of waking up at night, feeling short of breath or gasping for air.

Mandibular Advancement Device (MAD): a therapeutic oral appliance designed to place the mandible, during sleep, in a forward position, keeping the tongue from closing the airway and allowing the patient to breathe more easily. MADs, used in mild to moderate OSA cases, are easier and more comfortable to use than the Continuous Positive Airway Pressure (CPAP) appliances. Therefore, the patient’s compliance rate is believed to be higher with MAD than with CPAP appliances. CPAP appliances are used in moderate to severe cases, but MADs should be tried even in severe OSA when the patient is non-compliant to CPAP, Surgery could in certain cases be applied but limited to careful patients selection and special indications.

Principles

After a careful screening has been performed by either or both a medical sleep doctor and a dentist (consistent with local licensure requirements), a treatment plan can be established and the appropriate appliance is decided accordingly.

Policy

FDI recommends:

universities and national dental associations to provide students and dentists with basic knowledge regarding the important role of dentistry in preventing and treating SRBD, in particular early detection in children and prevention of late onset forms. This can include immediate management as well;
all dental and medical health forms to include questions about the patient’s sleep quality and related data to do the screening of SRBDs;
dentists to provide proper information to patients to understand the process of screening, treatment options and the role of the care providers involved;
a detailed comprehensive medical, functional and dental screening and an individually tailored treatment plan are necessary to treat patients with an appropriate MAD;
dentists to maintain regular communications with the medical sleep doctor for a more patient-focused, efficient and positive result;
treatments to be subjectively and objectively evaluated for efficacy. In case of unsuccessful treatment, all etiological and diagnostic factors should be carefully re-evaluated and the appliance should be re-adjusted. If the treatment is still not satisfactory, the patient should be referred for other means of treatment;
dentists to have the training to treat SRBD patients within the ethical limits of their profession in collaboration with the medical sleep doctor involved for successful treatment outcome and higher patient satisfaction.

Disclaimer

The information in this policy statement was based on the best scientific evidence available at the time. It may be interpreted to reflect prevailing cultural sensitivities and socio-economic constraints.

 


 

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What is the Treatment for Sleep Apnea?

Sleep apnea is treated with lifestyle changes, oral appliances, breathing devices, surgery, or a combination of these. Sleep apnea is not typically treated with medications. The goal of treatment is threefold:

  1. Restore normal breathing during sleep.
  2. Relieve symptoms of snoring and daytime sleepiness.
  3. Treatment may decrease risk of medical conditions associated with sleep apnea, such as high blood pressure, heart disease, stroke, and diabetes.

Lifestyle Changes
Mild sleep apnea may improve simply with changes to your daily habits and activities. This may include:

  • Weight loss if you are overweight or obese.
  • Sleep on your side to help open your airway. There are pillows or special shirts that can help you avoid sleeping on your back.
  • Avoid alcohol and sedative medications that can make it more easy for your airway to collapse when you sleep.

Oral Appliances
Mouthpieces can help patients with mild sleep apnea or snoring with no sleep apnea. These appliances lift the jaw and tongue to help open up the airway during sleep. They are typically custom made and fitted by dentists or orthodontists.

Breathing Devices
The most common breathing device used to treat sleep apnea is the Continuous Positive Airway Pressure (CPAP) machine. It is a mask that you wear at night that covers your mouth and nose, or just your nose. The mask is attached to a machine that gently blows air into your throat to keep your airway open as you sleep. It is important to keep using the machine every night even if you no longer snore or your symptoms improve. Your symptoms will return if you stop using your CPAP machine.

The machine is usually set up by a technician who will adjust the settings based on your sleep physician’s prescription. You may need to have the machine adjusted periodically for the best results.
Some people experience side effects from using the CPAP, including:

  • Headaches
  • Dry nose
  • Dry mouth
  • Skin irritation
  • Abdominal bloating from air blowing into your stomach

If you experience these symptoms, work with your sleep medicine physician or his/her nurse or staff. They may suggest modifications to the mask, a different type of mask, or prescribe humidified air or nasal sprays to treat dry mouth or nose.

Surgery
Some patients who have difficulty with the above treatments may need surgical procedures to correct structural causes contributing or causing sleep apnea. These procedures are typically performed by otolaryngologists (head and neck surgeons). The type of procedure depends on the unique anatomy of the patient and their pattern of obstruction. Nasal surgery to treat congestion, deviated septums or enlarged turbinates can be performed. Many patients with sleep apnea have redundant soft tissue in the upper or lower throat and upper voicebox (epiglottis) that need resection or stabilization. For example, large tonsils or adenoids may be blocking the airway. Surgery to widen the palate, advance the upper jaw (maxilla) or lower jaw (mandible) can also help open the airway in select patients.

Some of these procedures can be done under local anesthetics in a clinic, while others are done under general anesthesia in a hospital or surgical center. The risks, benefits and recovery time all vary depending on the procedure.

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How Will I be Tested for Sleep Apnea?

The diagnosis of sleep apnea is made by taking your medical and family history, a physical examination, and the result of a sleep test (polysomnography). Your family doctor often performs an initial assessment, and decides whether to refer you for a sleep test or to a sleep specialist. Sleep specialists are doctors who diagnose and treat sleep disorders. They can come from different backgrounds, such as anesthesiologists, lung specialists, internal medicine specialists, and otolaryngologists (ear, nose, and throat surgeons).

History and Physical Assessment
Your doctor will ask you questions about the length and quality of your sleep, symptoms of drowsiness or headache during the day, and how loudly you snore at night. You may need to keep a sleep diary to record what time you went to bed and how often you awoke. This will help your doctor see your sleep pattern. You may not be aware of symptoms that occur when you sleep, such as if you stop breathing or gasp, and a bed partner or family member may need to report them.

Your doctor will examine your mouth, throat and neck for enlarged tissue or the structure of your palate and uvula that may predispose you to a narrowed airway.

Sleep Study
A sleep study is the most accurate way to diagnose sleep apnea. It is an evaluation of your breathing and body functions overnight. There are two types of sleep studies: Polysomnography and home-based portable monitor.

Polysomnography (PSG) is a sleep study performed in a specialized sleep center where your brain activity, eye movements, and vital signs such as heart rate and blood pressure are recorded. In addition, they measure the oxygen level in your blood, airflow in your nostrils, chest movement, and snoring. Sometimes a video records your movements during sleep. The test is painless and these measurements are made through sensors attached to your face, chest, scalp, and fingers. A PSG is recommended for complex cases or for patients with other medical conditions.

The test records:

  1. The number of times you stop breathing for at least 10 seconds (apnea)
  2. The number of times your breathing is partially blocked (hypopnea)

The Apnea-Hypopnea Index (AHI) is the number of apnea or hypopnea episodes you have in one hour. The AHI results are used to diagnose sleep apnea.

A normal test result will show:

  1. AHI less than 5 (less than 5 episodes of apnea or hypopnea in an hour)
  2. Normal brain waves and muscle movements when you sleep

An AHI greater than 5 may mean you have sleep apnea:

  • Mild sleep apnea: AHI 5-15
  • Moderate sleep apnea: AHI 15-30
  • Severe sleep apnea: AHI greater than 30 [7]

The final diagnosis and recommendations for treatment will also depend on:

  • Your medical history and symptoms
  • Other findings from the sleep test
  • Your physical examination

A home-based test is a simplified test done with a portable monitor that measures some of the same things as a PSG study. This is less expensive and allows the test to be done in the comfort of your own home. It is often recommended for patients with severe symptoms who have no other serious medical conditions that can interfere with the test results.

The results of the PSG or home-based sleep test are analysed and interpreted by a sleep expert who will then meet with you to discuss the diagnosis. If you are diagnosed with sleep apnea, the sleep medicine physician with discuss the treatment options with you.

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How do I Know If I Have Sleep Apnea?

Snoring
Snoring is one of the most common symptoms of sleep apnea, although not everyone who snores has sleep apnea. The snoring is typically loud enough to be heard through a closed door, or causes a bed partner to elbow the snorer.

Tiredness
Daytime drowsiness, including falling asleep unintentionally when working, reading, watching TV, or behind the wheel when driving is another common sign of sleep apnea.

Observed Apnea
A bed partner may tell you that you stop breathing at night, with the pause that may or may not be followed by a choking or gasping breath. [2]

  • Morning headaches
  • Memory or concentration problems
  • Waking up frequently to urinate
  • Dry mouth when you wake up
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How Common is Sleep Apnea?

Sleep apnea occurs in 4 – 26% of the population at large. It affects 4% of men and 2% of women between the ages of 30 and 60. It is also more common in obese patients: 40% of obese females and 50% of obese males have OSA.

 

 

 

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Who is at Risk for Sleep Apnea?

There are some anatomic and physiologic characteristics that put someone at risk for sleep apnea. These include:

  1. Age greater than 50
  2. Anatomic factors, such as a large tongue or small chin, that can cause narrowing or blockage of the airway. Children with large tonsils are also at higher risk.
  3. Obesity with body mass index (BMI) greater than 35 kg/m2
  4. Large neck circumference greater than 40 cm
  5. Snoring
  6. Endocrine (hormonal) disorders, such as low thyroid, or Cushing’s disease
  7. Nerve and muscle disorders, such as stroke, cerebral palsy, head injury, and myotonic dystrophy
  8. Lifestyle factors, such as smoking and drinking alcohol

The Dangers Of Drowsy Driving

The Dangers Of Drowsy Driving

Drowsy driving, the dangerous combination of sleepiness and driving or driving while fatigued, and can result from many underlying causes, including excessive sleepiness, sleep deprivation, changes in circadian rhythm due to shift work, fatigue, medications with sedatives and consuming alcohol when tired. The cumulative effects of these factors have severe effects on performance, alertness, memory, concentration and reaction times. Drowsy Driving is a growing problem in the United States, and the risk, danger and often tragic outcomes of drowsy driving are sobering. According to a survey, nine of 10 police officers reported stopping a driver who they believed was drunk but turned out to be drowsy. Further, data indicate 80,000 individuals fall asleep at the wheel each day and there are more than 250,000 sleep-related motor vehicle accidents each year. It is estimated that twenty percent of all serious transportation injuries on the nation’s highways are related to sleep.

Who is at Risk for Driving while Drowsy?

  • Young people, particularly males
  • Shift workers
  • People who work long hours
  • Commercial drivers, especially those who drive a significant number of miles at night
  • Sleep deprived individuals
  • Persons with undiagnosed or untreated sleep disorders
  • Those who have consumed alcohol
  • People taking prescription medication that contain sedatives

Tips to avoid becoming drowsy while driving:

  • Get enough sleep American Academy of Sleep Medicine recommends adults get seven to eight hours of sleep each night in order to maintain good health and optimum performance.
  • Take breaks while driving If one becomes drowsy while driving, it is recommended he or she pulls off to a rest area and takes a short nap, preferably 15 to 20 minutes in length.
  • Do not drink alcohol Alcohol can further impair a person’s ability to stay awake and make decisions; taking the wheel after having just one glass of alcohol can affect one’s level of fatigue.
  • Do not drive late at night Avoid driving after midnight, which is a natural period of sleepiness.

 


 

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Does Your Child Keep You Up At Night?

Does Your Child Keep You Up At Night?

Sleep affects your child’s development in many important ways, including mental and social development, physical health, and emotional regulation. When a child has trouble sleeping, it limits their ability to function well during the day, disrupts the household, and is a source of stress for parents and other family members. Sleep problems in children are common. Some problems are brief and resolve on their own. When sleep problems persist for more than a few weeks, they may begin to affect a child’s mood, behavior, and relationships in the home and at school.

Common behavioral sleep problems found in children include: If you feel that you are no longer in control of your child’s sleep patterns, do not know what to do to get your child to sleep on their own, or feel that you have tried everything to get your child to sleep through the night, our behavioral sleep medicine services are a great treatment option to consider!

  • Bedtime resistance or refusal
  • “Musical beds” or difficulty sleeping alone
  • Sleep schedule problems
  • Poor sleep habits and routines
  • Nighttime awakenings
  • Nighttime fears and nightmares
  • Bedwetting
  • Sleep walking / Sleep talking

If you feel that you are no longer in control of your child’s sleep patterns, do not know what to do to get your child to sleep on their own, or feel that you have tried everything to get your child to sleep through the night, our behavioral sleep medicine services are a great treatment option to consider!

We Can Help Your Child Sleep

Effective behavioral treatments are the recommended option for many common childhood sleep problems. Parents often feel overwhelmed by conflicting instructions offered by books or friends, or find that “textbook” approaches do not work for them. An understanding of individual developmental needs, behavioral and reinforcing factors, as well as the influence of unique family dynamics and parenting styles on your child’s sleep is important to developing a treatment plan that effectively addresses your child’s behavioral sleep problem.

 


 

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