There are about 100 distinct clinical sleep disorders that have been recognised.Certain disorders that have a bearing on the practice of dentistry include sleep apnea, sleep grinding and chronic pain. Sleep disorders decrease the quality of sleep by breaking its continuity and pushing the person to a sublevel of wakefulness. These transient arousals can cause mood alterations, memory problems, work performance deficits, increase risk of work related /transport accidents. In the long-term sleep apnea can cause heart failure and stroke. Poor sleep can also impair pain processing and can add to the pain in chronic pain patients.
The Dentist plays an important role in sleep medicine as the Dentist is the first to look in the mouth and can assess patients for this during their 6 months or 12 monthly visits to the Dentist. Patients reporting snoring, sleepiness, morning headaches, insomnia and temporomandibular (jaw) disorders need to be assessed by a team of professionals including their Dentist, respiratory Physicians, Ear Nose and Throat Specialist (ENT) and their General Doctor.
Life without sleep is impossible. Preschool children sleep about 14 hours, teenagers sleep about 9 hours whilst adults sleep 6-7 hours.
Sleep disordered breathing (SDB) affects 30-40% of adults. It includes
- Snoring is the mildest form SDB
- Upper airway resistance syndrome (increased effort to breath but no drop-in blood oxygen)
- Obstructive Hypopnea (>30% reduction airflow for > 10 seconds)
- Obstructive Apnea (>90% reduction airflow for > 10 seconds) – most severe form SDB
In Obstructive Sleep Apnea (OSA) the airway collapses and there is no/minimal air flow to lungs. You stop breathing totally/partially from 30 times or more per hour.
OSA has also been linked with serious long term adverse health consequences such as high blood pressure, diabetes, impaired brain function and stroke. People with diabetes, obesity and hypertension have a 70 % chance of significant obstructive sleep apnea.
Snoring is turbulent airflow causing tissues to vibrate. Vibration occurs in non-cartilaginous areas such as soft palate, uvula & pharyngeal walls.
- 24% women (greater incidence post- menopausal & pregnancy)
- 40% men
- 10-12% children
While continuous positive airway pressure (CPAP) remains the first line of therapy for severe sleep apnea patients which stop breathing totally/partially for more than 30 times per hour. Mandibular advancement appliances are recommended for mild to moderate sleep apnea where you stop breathing anywhere from 5-20 times per hour. This score is determined by having a sleep study done at home or in a hospital setting.
CPAP has problems with compliance as 30-40% people are unable to tolerate it and some feel claustrophobic. On the other hand, oral appliances have a 60-70% compliance after three years, with benefits including
- Improved compliance of therapy compared to other treatments for sleep apnea
- Compact and portable – device can fit in a pocket
- Discreet – device is not visible to bed partner when mouth is closed
- Immediate response – most patients see improvement on the first night
- Energy conservation – the device does not use any electricity. You don’t have to plug the device into a wall to function.
Sleep apnea oral appliances work by moving the jaw forward, which moves the tongue forward, increases the size of the upper airway, thus reducing the air resistance that leads to sleep apnea and snoring. A custom fitted oral appliance has a higher rate of success in treating OSA than similar devices that can be acquired from a pharmacy.
A sleep study is also required again after the oral appliance is used for a period of time to determine how effective it is and whether it needs to be adjusted to increase its effectiveness.
Dr Basil has attended many courses by leaders in the field including Dr Steve Olmos, Dr Derek Mahoney, Dr Anne Marie Cole and Dr Harry Ball. He has personal experience in this field as he has been diagnosed with moderate sleep apnea and had nasal surgery to enhance his breathing. Nasal breathing is a very important component in sleep apnea and Dr Basil will assess this and recommend appropriate X rays and referrals to ENT specialists for assessments prior to any device being made. Dr Basil will offer special customised snoring devices based upon a thorough assessment involving a detailed history/questionnaire of your symptoms, X-rays, visual assessment by Dr Basil, assessment of all the relevant reports on your sleep.
Make an appointment with Dr Basil today 07 3391 4366 for a thorough assessment of your breathing difficulties.