Shine Dental

Sleep Issues: Frequently Asked Questions

Some Definitions

  1. Apnea: The stoppage of breathing
  2. Sleep Apnea: The stoppage of breathing while you sleep
  3. Obstructive Sleep Apnea: The stoppage of breathing while you sleep due to an obstruction in your airway. Measured at 80%-100% blockage.
  4. Central Sleep Apnea: The stoppage of breathing while you sleep from a brain error. Your brain 'forgets' to tell your body to keep on breathing, as there is no effort from your stomach or chest to try and breath.

Q: How can you help me?

A: Dentists are no longer being deemed the ones who only drill, fill and bill. The scope of practice has always been 'a check up, from the neck up'! And in doing so, detecting sleep apneic patients is simple to do during a regular dental exam.

Q: What signs in my mouth make you suspect that I have sleep apnea?

1) A: FLAT TEETH: When you look at the teeth of models in magazines, you'll see that their teeth are NOT flat across in the front. If your teeth are flat, it signifies that you are grinding them down in some capacity. Because research tells us that during your wakeful hours, a person will only exert approximately 20 lbs/sq inch, this is not enough to significantly wear down teeth. But research also tells us that during sleep, clenching your teeth can exert 200 lbs/sq inch and grinding can exert up to 900 lbs/sq inch on your poor teeth! This gives us reasons why your teeth could be flattening at nighttime.

2) A: SCALLOPED BORDERS OF THE TONGUE: If an airway is being obstructed' part of the obstruction comes from a tongue that is falling back and closing the airway. The body's response to remedy this is to fire the muscles in the tongue that push it forward, to stop the obstruction in the throat. This pushing of the tongue forwards (and laterally as well) will cause an imprint of the teeth on the tongue which makes the front and sides of the tongue look wavy or scalloped.

3) A: LARGE TONSILS: If your tonsils look something like this picture, then your tonsils could be adding to a sleep apnea problem by narrowing the size of your airway, making breaking more and more laborious.

4) A: GENERALIZED LARGE BUILD UP OF BONE: Just like a bunion on the side of your big toe from walking funny, excessive grinding of your teeth will cause more and more bone to be laid down in your mouth.

5) A: DIVOTS IN TEETH NEAR THE GUMS: The dental term for these types of lesions are called abfraction lesions. Historically, they were thought to be from brushing too hard, but today it is realized that they are from excessive flexion of the teeth from grinding.

Q: Why is snoring related to sleep apnea?

A: The same physiological problem presents itself in both conditions: an unstable airway. When an airway is fully open, it is difficult to make it close. But, when an airway is narrow, the tissues become close enough to make a vibrating sound like a reed on a saxophone, which in the throat is known as a snore. That same unstable, narrow airway that produces a snore will eventually result in a complete obstruction, which is apnea.

Q: What is a home sleep test?

A: A Home Sleep Test, or HST, is a test that can very accurately determine if you are at high risk of having a sleep breathing disorder. The device that we utilize will determine the loudness and frequency of snoring, heart rate, oxygen saturation of your blood, chest and abdomen distention, airflow through your mouth and nose and body position. This can help us determine just how dangerous your sleep breathing disorder is and which medical practitioner to send you to.

Q: Is a home sleep test as good as a laboratory sleep test?

A: According to some of the latest research, YES. The attached research article states, "Compared with the home-based protocol, diagnosis and treatment of OSA in the sleep laboratory does not lead to superior 4-week outcomes in sleepiness scores, sleep quality, quality of life, BP, and CPAP adherence."

Q: Can you treat all sleep breathing disorders?

A: No. Treating all sleep breathing disorders is truly a multi-disciplinary approach. For example, if a patient presents with a mild case of sleep apnea, or just a really loud snoring problem, an oral appliance will be wonders for their quality of sleep and subsequent daytime energy levels. But, if they have severe obstructive sleep apnea, they may be best treated with a CPAP (continuous positive air pressure) machine. If a patient has a nasal obstruction causing a respiratory effort related arousal, then going to a naturopathic doctor for nasal ballooning or NCR may be in order, or possibly even a respirologist or ENT doctor for nose surgery. In certain cases, insomnia may be due to a brain that just won't shut off, and counseling or a visit to a psychiatrist may be the best solution. For those patients that have unsuccessfully tried a CPAP machine, an oral appliance can work wonders as well! And simple sleep hygiene education can help the most mild forms of sleep breathing disorders.

Q: Is there a link between obstructrive sleep apnea and TMJ?

A: SOMETIMES. In many cases the physiological problem of both OSA and TMJ/TMD is a jaw that is too far retruded or back. A retruded jaw increases the chances of an obstructed airway and also increases the chances of the bottom jaw being stuck too far back. This would cause headaches, ringing in the ears, morning jaw stiffness, migraines, clicking in the jaw, ear pain, jaw pain, neck pain, limited mouth opening and a host of other symptoms as well.

What other symptoms might point to a risk of sleep apnea?