As I have posted previously on my blog, sleep apnea is a very serious condition that can be life-threatening. It is this life-threatening aspect of the apnea that really caught my attention when Dr. Kent Smith introduced apnea to me in Dallas. The dentist is very well equipped to identify and diagnose those patients with sleep apnea for a variety of reasons. Dentists tend to see their patients more frequently than physicians and dentists tend to spend more time with their patients, whether it is for a cleaning with the hygienist or an appointment with the dentist for restorative care. This is an area where physicians and dentists can dovetail their care for the betterment of the patient. Dentists also specialize in this area of the body. Examining the airway is nothing new to a dentist. The dentist and sleep physician work together to establish the best possible treatment for the patient.
The treatments for patients that have been diagnosed with sleep apnea include the following:
1) CPAP Mask (“Continuous Positive Airway Pressure”)
2) Oral Appliance
In certain cases, losing weight can have a positive effect on reducing the degree of sleep apnea. Strengthening the soft tissues, can also reduce the incidence of OSA (obstructive sleep apnea).
Avoiding alcohol, tobacco and sleeping pills – these all have negative effects on the airway during sleep.
The problem with the CPAP is intolerance. Patients tend not to like it because it is uncomfortable. It may be hard to sleep with a mask on your face. Multiple studies have shown that the majority of patients do not use the CPAP beyond one year due to the fact that it is uncomfortable. Really, what good is a treatment if it isn’t utilized? If sleep is interrupted, for answering nature’s call, etc., it is unlikely that the CPAP is put back in place. The CPAP can also cause nasal irritation, facial skin abrasion, sore eyes and headaches.
The oral appliance basically repositions the lower jaw and tongue in order to keep the airway open. Like the CPAP, oral appliances can only be effective if they are used. Studies have shown that oral appliances have a greater chance of being used than the CPAP.
There is no one answer in sleep apnea. An oral appliance may be the answer for a patient, but the appliance may need to be titrated (adjusted) to the right measurement. The jaw joint (TMJ), the soft tissue of the mouth and the teeth themselves are all components of an oral appliance that need to be evaluated and monitored by the dentist, after the delivery of the appliance.
Please note: No matter what treatment modality is utilized, it is extremely important to have sleep studies performed. These include a baseline study prior to treatment and a followup sleep study to see if the treatment is effective.
Very often the snoring may be eliminated, but the apnea (oxygen deprivation) still exists. This is called Silent Apnea.
In severe cases of sleep apnea, surgery is necessary. Very often multiple surgeries are necessary before any real results are obtained. The various types of surgeries depend on the causative problems. There are many different types of surgeries and, if this route is considered, this treatment needs to be evaluated with respect to the severity of the apnea and the viable alternatives.
In summary, sleep apnea is a serious, life-threatening disease with far-reaching physiological implications. If you suspect someone has sleep apnea, a sleep partner or a friend, it does not take great effort to get a sleep study performed. As the saying goes, the life you save may be your own.
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