Dr. Dean Tyrer recently returned from a craniofacial dental conference in Salt Lake City. The conference was a three day study of epigenetic orthodontics which helps patients with sleep apnea. "Many patients struggle with CPAP machines for the treatment of sleep apnea," says Dr. Tyrer. Tyrer Dental Care now offers an alternative treatment using oral devices to open the patient's airway and, in some cases, remodel the palate and mandible permanently. This research was introduced by Dr. G. Dave Singh who originally treated children with cleft palates. The Center for Sleep Medicine now recognizes an oral device as the treatment of choice in mild and moderate sleep apnea patients. In severe cases, it may be recommended to use a combination of the CPAP machine and an oral device.
We all know about the importance of sleep, and we know we should be getting more of it. When we wake up exhausted, drag ourselves to work or hit that afternoon slump, we blame ourselves: "Should have gotten more sleep last night." But instead of "Did I get eight hours?" we should be asking ourselves, "How well did I sleep?" We tolerate feeling exhausted during the day, but it's actually not normal to feel tired or sleepy when you wake up.
You can't ask yourself how well you're sleeping without considering sleep apnea. Sleep apnea is a condition that affects an estimated one in 15 Americans but often goes undetected. Most people who suffer from sleep apnea don't know it. Since sleep apnea ranges from mild to severe, lots of cases of sleep apnea aren't noticed by sleeping partners, and people live their whole lives undiagnosed. Sleep apnea can't usually be detected by doctors during routine office visits, but a screening from your dentist may help.
Recent studies have shown that teeth grinding, also called bruxism, is a major indicator for obstructive sleep apnea. The simple dental health screening that can improve the quality of your sleep and -- because almost everything boils down to a good night's sleep -- even save your life, begins with asking your dentist, "Do I grind my teeth?"
Sleep Apnea Q & A
Q: What is obstructive sleep apnea?
A: The most common type of sleep apnea is obstructive sleep apnea. The key word is "obstructive" -- the thing "obstructing" the airway being the jaw, which falls back as the brain approaches the deepest stages of sleep and the muscles of the airway fully relax. When the airway collapses like this, breathing becomes compromised. This is where you get snoring, which is just the sound that's made when air is getting forced through a partially obstructed airway.
Once the brain senses that breathing is dangerously compromised, it gets out of the deepest stage of sleep to regain control of the jaw muscles and reopen the airway, and keep you alive and breathing. These sleep apnea cycles can occur from five to up to 70 times per hour while you sleep -- preventing you from entering the deepest stages of sleep where the brain and body tissues can repair themselves from the wear and tear of the day. Sufferers of sleep apnea never get the benefits of the deepest stages of sleep, which is what reverses the aging process and repairs tissue damage. After just one night of the lack of deep sleep that the body craves, you awake in a damaged state. Cumulative damage could lead to expression of the Alzheimer's gene, high blood pressure, depression, mood disorders, suppression of the immune system, diabetes, cancer and weight gain.
Q: What are the symptoms of untreated sleep apnea?
A: You feel sleepy or tired during waking hours. For every sleep apnea cycle, or apneic episode, the body goes into fight-or-flight mode with an adrenaline response to "wake up" the brain to reopen the airway. That response evolved to keep humans alive in the short term, but on a nightly basis puts extraordinary wear and tear on the body.
You're anxious or stressed during the day. What's missing from the sleep apnea discussion is the emotional toll of going into fight-or-flight mode several times each night. This stress manifests itself not only physically but also emotionally -- the exhaustion that sufferers of severe sleep apnea feel during the day is partially due to emotional stress at night as they struggle to breathe.
You grind your teeth. One of the ways the brain tries to reopen the airway in an unconscious state is by grinding and clenching the teeth. People who grind their teeth at night often have sore or clicking jaws or flat, worn-down teeth. Many times, symptoms of teeth grinding can be far less obvious -- such as earaches or sensitive teeth. Snoring. The key here is that not everyone who has sleep apnea snores and not everyone who snores has sleep apnea. Snoring can go undetected if you don't have a bed partner or if you have a bed partner who is a heavy sleeper. Everyone, however, can ask their dentist if they grind their teeth at their next checkup.
Q: I might have sleep apnea. What should I do?
A: See your dentist. Get screened at your next dental checkup for teeth grinding. Your dentist can tell you definitively if you grind your teeth at night or not. Teeth grinding is a major indicator that you are struggling to keep your airway open at night and might suffer from obstructive sleep apnea. Also, see a medical sleep specialist. These specialists are the only ones who can officially diagnose sleep apnea. Make sure to discuss all of your options and let your doctor know if you're grinding your teeth.
"Sleep disorders such as sleep apnea can lead to many secondary health conditions," said Dr. Kalpalatha Guntupalli, president of the American College of Chest Physicians. "When treating sleep apnea, clinicians must also recognize and address secondary health conditions, such as bruxism, in order to fully manage a patient's sleep disorder."
People who are diagnosed and treated for sleep apnea often report that the process has "given them their life back." Quality of sleep affects most of the things that help us enjoy life: appearance, well-being, outlook on life, energy level, patience, ability to cope with stress and how we interact with loved ones. Many of us tolerate this anxiety and exhaustion every day of our lives and never get the chance to repair our bodies with the deepest stages of sleep. Asking your dentist if you grind your teeth will hopefully make the sleep apnea diagnosis a little less daunting for the millions of people who suffer from it.