Sleepless in America
It is the foundation of human life. An oft-forgotten element of Maslow’s Hierarchy of Needs, sleep has been dismissed and deprioritized too long. However, it looks like things are starting to change. The ever-evolving field of Sleep Science sheds light on the fact that sleep is pivotal to living a happy and productive life. Given that we spend over a third of our life sleeping, it's not that surprising that sleep is fundamental to not only who we are, but how we are as well. Unfortunately, as the scientific community discovers more and more about the nature of sleep, it is also becoming increasingly understood that many people in this day and age suffer from problematic sleeping. Sleep problems, we are learning, are associated with compromised health and well-being, but even with this understanding, we are seeing an epidemic of chronic sleep deprivation.
Obstructive Sleep Apnea
Obstructive sleep apnea – also known as OSA or simply, sleep apnea -- is one of the most common sleep problems. It is a condition that is characterized by shallow breathing or pauses in breath while sleeping, called apneas. For those 20-25 million US adults who suffer from OSA, their breathing can be halted for a few seconds to over one minute, potentially hundreds of times each night. How does this happen? Let’s take a look. While you sleep, your muscles typically relax. For those with OSA, the mechanism that relaxes their muscles during sleep results in the collapse of the palate’s soft tissue, which causes their airway to become blocked. The result of a chronically blocked airway during sleep, which is the case for those with OSA, is reduced oxygen levels while the event occurs.
A Close-Up On Snoring
As a comic book standard, the concept of snoring is often used as a funny character quirk. Giant block-lettered “Zs” pouring out of a night-capped grandpa’s slack jaw or Bruno the bulldog’s soggy nose -- you know the drill. But talk to someone whose partner is a chronic snorer or consider the way snoring can have an impact on your overall health and it becomes clear that outside the comic book world, snoring is not a laughing matter. Though it may not seem that serious, snoring is classified as a legitimate sleep problem – one of the most common sleep problems, in fact. The condition directly affects one’s sleep quality, which, in turn, has serious consequences to one’s quality of life.
It is important to recognize the symptoms of snoring and discuss any concerns you may have with your doctor or dentist.
The term, “snoring” refers to a sound that occurs when the soft tissue of the upper airway resonates with a person’s breath when they sleep. Though it used to be considered a condition that primarily affected men, today we understand that snoring can affect all genders. Aggressive snoring can be a symptom of sleep apnea, however snoring is not the sole indicator of the condition, nor does the presence of snoring necessarily mean you have sleep apnea.
Conditions and behaviors that are known to increase the risk of snoring include:
- Nasal obstruction
- Alcohol consumption
Treating OSA: An Action Plan For Getting Help
- If you are concerned that you or your partner’s snoring may be more than the occasional nighttime disturbance, or if you are frequently feeling excessively fatigued during the day, consult your physician or your dentist.
- Explain your concern and express that you would like to be evaluated for sleep apnea.
- Only board-certified sleep physicians -- as opposed to your primary care physician or dentist - can issue a formal diagnosis of sleep apnea. However, a primary care physician or dentist should be able to consider your symptoms and advise you whether your odds of having sleep apnea are high. If your family doctor or dentist determines that you may indeed suffer from sleep apnea, they can refer you for a formal diagnosed.
- In order to make the diagnosis, sleep physicians must collect data on your sleep activity. To acquire this data for a potential diagnosis, they can give full evaluations of your symptoms in several ways including:
- Admittance to a sleep center for an overnight evaluation
- A self-administered at-home sleep apnea test
- After you are tested, if you are diagnosed with sleep apnea, your sleep physician will provide you with information including the severity of your condition. They will diagnosis you as having either, “mild,” “moderate,” or, “severe” obstructive sleep apnea (OSA).
How Your Dentist Can Help:
- Research shows that the use of oral appliances for the treatment of mild to moderate sleep apnea and snoring is effective and most patients find an oral appliance to be a comfortable and convenient option for the treatment of their apnea. The American Academy of Sleep Medicine recommends use of an oral appliance for cases of “mild” and “moderate” OSA.
- For patients with “severe” OSA who cannot comply with use of a Continuous Airway Pressure (CPAP) machine, Oral Appliances may be recommended as an alternative.
- An oral appliance is fitted and monitored by dentists and/or oral surgeons; the appliances help you maintain an open upper airway during sleep
- Oral appliances are to be worn at night, have a similar fit to a sports mouth guard or orthodontic appliance, are portable and require low maintenance care
- If you are diagnosed with obstructive sleep apnea, oral appliance therapy is covered by many medical insurance plans.
- MAD-FITTM, APP-NEATM LLC's flagship product, bypasses the trial and error in fitting oral appliances, making it easier for dentists to get the right fit the first time. To learn more about finding an APP-NEATM certified dentist click here.
If you choose a dentist who has received training and is certified by App-NeaTM, LLC, you will be able to choose a MAD-FITTM dentist, which will allow you to avoid the time-consuming and inconvenient “trial-and-error” fitting procedure typical of other oral appliances.How Your Doctor Can Help:
- If you are diagnosed with “severe” obstructive sleep apnea you may be advised to use a Continuous Airway Pressure, or CPAP, machine
- Talk to your doctor about what the best course of treatment is for you. Although CPAPs are the standard practice for the treatment of “severe” OSA, they may not be readily tolerated by all patients
- If you are unable to tolerate a CPAP, an oral appliance becomes your second line of defense, which is a better option than letting your apnea go untreated.
There are a number of behavioral and lifestyle changes you can consider when trying to lessen the symptoms of your sleep apnea and snoring. These include:
- Losing weight
- Avoiding alcohol and smoking
- Sleeping on your side
No matter what your diagnosis ends up being and what treatment option you choose, we recommend that you make these life changes, regardless!
Relevant Clinical Studies
Op-Ed: Sleep deprivation is a major social problem
Can You Make Up For Lost Sleep? And How Much Is Losing Sleep Hurting You In The First Place?
What can cause dizziness when waking up?
Sleep problems during pregnancy affect glucose, may increase risk of childhood obesity
Have sleep apnea? Using your CPAP device consistently may slow memory loss
'Bidirectional' relationship seen between type 2 diabetes and obstructive sleep apnea
One-minute heart rate variability – an adjunct for airway obstruction identification
Continuous positive airway pressure improves nocturnal polyuria in ischemic stroke patients with obstructive sleep apnea
Treatment of Adult Obstructive Sleep Apnea With Positive Airway Pressure: An American Academy of Sleep Medicine Systematic Review, Meta-Analysis, and GRADE Assessment
Sleep Apnea Common in MS-Related Fatigue
Know how to watch for signs of sleep apnea
Obstructive Sleep Apnea Treatment May Slow CKD Progression
30 Million Cases of Undiagnosed Sleeping Disorders | Economic Burden of Undiagnosed Sleep Apnea in U.S. is nearly $150B per year
Sleep Apnea Increases Risk of Sudden Cardiac Death by American College of Cardiology
Infographic ~ Seven Things You Need to Know About Excessive Sleepiness ~
Obstructive sleep apnea and cardiovascular disease in women
Temporomandibular Joint Internal Derangement Score (TIDS): novel magnetic resonance imaging assessment score and its relation to invasive treatment in patients with clinical temporomandibular joint pathology
National Sleep Foundation: Study Finds Actual Changes in the Brain After Sleep Loss That Make Pain Worse Brain regions involved in our pain response appear to function differently when we skimp on shut-eye.
Study helps solve mystery of how sleep protects against heart disease
Increased Systemic Malondialdehyde Levels and Decreased Mo/Co, Co/Fe2+ Ratios in Patients with Long-Term Dental Titanium Implants and Amalgams
National Heart, Lung, and Blood Institute ~ Sleep Deprivation and Deficiency: Feb. 2019 Report
Diagnostic accuracy and reliability of panoramic temporomandibular joint (TMJ) radiography to detect bony lesions in patients with TMJ osteoarthritis
National Institute on Aging: Sleep & Aging ~ 2019 Update
The MEOPAeDent trial protocol—an observational study of the Equimolar Mixture of Oxygen and Nitrous Oxide (EMONO) effects in paediatric dentistry
Automated segmentation of dermal fillers in OCT images of mice using convolutional neural networks
Treatment of non-odontogenic orofacial pain using botulinum toxin-A: a retrospective case series study
Augmentation of DMLS Biomimetic Dental Implants with Weight-Bearing Strut to Balance of Biologic and Mechanical Demands: From Bench to Animal
Sleep Bruxism and Occurrence of Temporomandibular Disorders-Related Pain: A Polysomnographic Study
Temporomandibular joint disc displacement with reduction: a review of mechanisms and clinical presentation
An innovative total temporomandibular joint prosthesis with customized design and 3D printing additive fabrication: a prospective clinical study
Oral Appliance Therapy – Cracking the Code
Effect of exercise training on sleep apnea: A systematic review and meta-analysis.
Associations between Macronutrient Intake and Obstructive Sleep Apnoea as Well as Self-Reported Sleep Symptoms: Results from a Cohort of Community Dwelling Australian Men
Benzodiazepine prescribing patterns and deaths from drug overdose among US veterans receiving opioid analgesics: case-cohort study
Effect of Sleep-Disordered Breathing Severity on Cognitive Performance Measures in a Large Community Cohort of Young School-Aged Children
Obstructive sleep apnea and psychomotor vigilance task performance
Obstructive sleep apnea in children with cerebral palsy and epilepsy
Reciprocal dynamics between self-rated sleep and symptoms of depression and anxiety in young adult women: A 14-day diary study.
Risk of Occupational Accidents in Workers with Obstructive Sleep Apnea: Systematic Review and Meta-Analysis
What Is the Prevalence of Symptomatic Obstructive Sleep Apnea Syndrome in Chronic Spinal Pain Patients? An Assessment of the Correlation of OSAS with Chronic Opioid Therapy, Obesity, and Smoking.
Sleep–wake disorders persist 18 months after traumatic brain injury but remain under-recognized
Pre-diagnostic Sleep Duration and Sleep Quality in Relation to Subsequent Cancer Survival