How dentistry can improve your sleep and health

Dear Doctor,
My husband’s snoring has gotten worse to the point where he almost stops breathing. His dentist recently told him this could be dangerous and should be treated. What can be done, and why is it a dental concern?

Snoring occurs when the soft tissue structures of the upper airway (back of the throat) collapse onto themselves, the tongue drops back, and air is obstructed in its movement through the mouth and nose into the lungs. As a result, these obstacles create the vibration that produces snoring. Large tonsils, a long soft palate, a large tongue, the uvula (the tissue that looks like a mini punch-bag dangling at the back of the mouth), and even fat deposits can also contribute to blockage and hence snoring.

Your husband may have a condition called Obstructive Sleep Apnea (OSA; “a” – without; “pnea” – breath), which occurs when the upper airway collapse becomes more profound causing significant airflow disruption, or even no airflow whatsoever for 10 or more seconds. This is often associated with many “micro-arousals,” one to three second waking episodes throughout the sleep cycle. This can be quite dangerous to health as blockage of the upper airway causes reduced airflow into the lungs and therefore low blood oxygen levels. And when oxygen levels drop low enough, the brain moves out of deep sleep and the individual partially awakens followed by a loud gasp as the flow of air starts again. This can happen many times during the night, sometimes more than 50 times an hour. The combination of low oxygen levels and fragmented sleep are the major contributors to most of the ill effects associated with sleep apnea. In addition to excessive daytime sleepiness, studies show that sleep apnea patients are much more likely to suffer from heart attack, congestive heart failure, high blood pressure, brain damage and strokes, as well as a higher incidence of work and driving-related accidents.

Some helpful things you can do for yourself if you have sleep apnea include losing weight and exercising. Medical and dental treatments include:

Continuous Positive Airway Pressure (CPAP): CPAP bedside machines generate pressurized air delivered through a tube connected to a mask covering the nose and sometimes mouth. The force of the pressurized air opens the airway (windpipe) in the same manner as blowing into a balloon; when air is blown in, the balloon opens and gets wider.

Oral Appliance Therapy: Here’s the dental connection. Oral appliances are worn in the mouth to treat snoring and OSA. These devices may look like orthodontic retainers or sports mouth guards but are designed to maintain an opened, unobstructed, upper airway during sleep. There are many different oral appliances available but less than 20 have been approved through the FDA (Food and Drug Administration) for treating sleep apnea. They may be used alone or in combination with other means to treat OSA. And they work in several ways: repositioning the lower jaw, tongue, soft palate and uvula; stabilizing the lower jaw and tongue; and increasing the muscle tone of the tongue.

Other Dental Approaches: Specially trained oral and maxillofacial surgeons may include more complex jaw advancement surgeries. Additionally, an Ear, Nose & Throat (ENT) specialist may consider surgery to remove excess tissues in the throat. It also may be necessary to remove the tonsils and adenoids (especially in children), the uvula, or even parts of the soft palate.

Since OSA is a serious medical condition, a physician specially trained in this area of medicine must diagnose it. Diagnosis is based on the results of an overnight laboratory sleep study called a polysomnogram (PSG; “poly” – many; “somno” – sleep; “gram” – record). However, determining the best treatment is enhanced by joint consultation with your physician and dentist. It is also important to note that only dentists trained in sleep disorders and related oral appliance therapy are familiar with the various designs of appliances. These experts can best determine what is suited for an individual’s specific needs as well as manage any unruly tooth, bite, gum, or jaw joint effects.

If your husband needs an oral appliance, it may take several weeks to months to complete. Afterwards, your husband’s dentist will continue to monitor his treatment and evaluate the response of his teeth and jaws. His dentist needs to work with a physician as part of the medical team in diagnosis, treatment, and on-going care of your husband’s sleep disorder.

In conclusion, chronic loud snoring, pauses in breathing during sleep, and daytime sleepiness are neither benign nor inconsequential and should be addressed early to avoid serious health problems. These can include heart problems, blood pressure issues, and brain and general health effects on the body — all of which can affect long-term health and well-being.

Dr. Calvo is one of only 300 members in the world to achieve AACD Accreditation status.  Recently, she was honored by being selected as the featured dentist in an ad for Accreditation published in several dental journals.  Dr. Calvo is a well-respected Cosmetic Dentist in the Los Angeles and Beverly Hills areas.  Dr. Calvo is passionate about changing lives and increasing self-esteem in the patients she has helped serve through Smile Makeovers, Porcelain Veneers, Dental Implants and other artistic dental services. Click hereto view her blog for more information or become a Fan of her Facebook FanPage by Clicking Here.

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How Sereno, the center for snoring solutions based in San Francisco, is helping patients utilize advancements in sleep medicine

(HealthNewsDigest.com) – Many of us sleep alone because we snore. But we may no longer have to. Over the past several years there have been dramatic improvements in the treatment and medical understanding of the complex issues of snoring and sleep apnea.

Only a few short years ago, only unattractive options existed for patients suffering from these ailments. The most common solutions varied from those difficult to comply with, like a continuous positive airway pressure mask (CPAP), to those aggressive and risky, like removing palatal tissue with surgery (UPPP) which carries with it the promise of a permanently altered anatomy and a low to average efficacy rate. Further, many solutions ignore the effect on the patients’ lifestyle and relationships. For example, CPAP masks are embarrassing to wear and discourage intimacy. Ultimately, solutions like these only treat some of the symptoms of snoring and sleep apnea and replace one problem with another.

While the problems of snoring and sleep apnea are complex, technology now exists that supports a minimally invasive approach to achieve effective results. These solutions, which work to alleviate snoring and mild to moderate sleep apnea, are low-risk, virtually painless and designed to be permanent. They do not require the patient to actively comply with the treatment, like a mask or a nose-strip. Further, there is overwhelming evidence that suggests most patients have more than one factor contributing to their snoring or sleep apnea problem. As a result, studies show, and my experience shows, that when used correctly and in combination, these minimally invasive solutions are even more efficacious than when used alone.1

An area of the anatomy which is almost universally a contributing factor to patients’ snoring and sleep apnea is the soft tissue on the roof of the mouth, called the soft-palate.

A significant technological advance has been the development of devices which stiffen the palate, like the Pillar Procedure®. Similar to the way battens stiffen a sail, the Pillar Procedure® works to minimize the fluttering or vibration of the soft palate which is often responsible for producing the noxious noise of snoring. The pillars are tiny woven implants made of the same material that has been used in surgery to fix hernias and other medical procedures for over 50 years. Using local anesthesia, these pillars can be inserted into the soft palate in a specialized Ear Nose and Throat (ENT) physician’s office, in less than 20 minutes. Using a very sophisticated syringe, the implants are inserted into the palate without any cutting or stitching. While initially only 3 pillars were inserted into the soft palate, a dosage response to the procedure has been realized. Most patients require more than 3 pillars, but this ultimately depends on each patient’s anatomy. This incredible FDA-approved advancement has generated a bed partner satisfaction rate of over 90% at one year, according to bed partners of chronic snorers (however, this study was performed before the dosage response was understood; results may be better today).2 No major complications have been associated with this procedure. The success of the Pillar Procedure® is largely attributed to its tissue sparing approach and ability to capitalize on the body’s natural response to the pillar inserts–fibrotic tissue forms around the pillars, which stiffen the palate thus minimizing snoring. Treatments like the Pillar Procedure® offer a significant reduction in the risk of severe complications compared to more aggressive surgeries like UPPP, which have significant risk factors, considerable downtime and failure rates in excess of 50%.3

Another area of the anatomy that often contributes to snoring, sleep apnea and nasal congestion is the nasal airway.

A substantial technological breakthrough to address this area of the anatomy is the use of radiofrequency energy (RF) to shrink nasal tissue. RF energy is an attractive alternative to surgical or laser removal of tissue because it does not substantially alter the anatomy (it is “tissue sparing”) or physiology of the nasal turbinates, and can be used with only a local anesthesia. Patients who undergo RF treatment typically have little to no downtime and report minimal to no pain during their procedures.4 RF energy can be used to shrink the soft tissue of the nasal turbinates in the nose, which helps to improve nasal breathing while preserving the functionality of the turbinates (the turbinates are responsible for ensuring proper humidification of inhaled air as well as sensory perception of nasal airflow). This is possible because RF turbinate reduction therapy allows for volumetric reduction (i.e., reduction in size) of the membranous soft tissue of the turbinates, while preserving their surface lining. This approach is in contrast with traditional surgery or laser therapies which remove or cut away the turbinates, permanently altering their function. Turbinate reduction therapy using RF energy takes only minutes to perform in the office using local anesthesia, compared to an hour or more in the operating room to perform less advanced, more invasive procedures. This minimally invasive procedure has been FDA approved since 2002 and has treated tens of thousands of patients. Success rates in improving nasal airflow are over 90% with little to no risk of serious complications.5

While each patient’s anatomy is different, we increasingly observe at my center (Sereno), that a heightened and specialized medical understanding of the complex problems of snoring and sleep apnea are giving patients the reprieve they desire. Technological breakthroughs, including as those cited above, coupled with use and development by highly specialized medical practitioners like the medical staff at Sereno are dramatically improving the lives of people who snore. Because of these breakthroughs, Sereno patients are no longer forced to sleep alone.

Dr. Mingrone is a Board Certified Otolaryngologist (Ear, Nose and Throat Physician) who specializes in snoring and sleep apnea issues. He serves as President and Medical Director for Sereno, The Center for Snoring Solutions. Sereno is a custom-built medical center dedicated to offering snoring sufferers and their loved ones long-term solutions to alleviate their snoring and live healthier, happier lives. With a highly trained medical staff utilizing FDA-approved, effective, virtually painless, minimally invasive procedures combined with comprehensive lifestyle and nutrition recommendations, Sereno aims for total patient satisfaction. To learn more about Sereno please visit http://www.serenocenter.com.

1 Friedman et al.: Minimaly Invasive Treatment for OSAHS, Laryngoscope 117, October 2007. 1859-1863
Maurer et al.: Long-Term Results of Palatal Implants for Primary Snoring, Otolaryngology –Head and Neck Surgery (2005) 133, 573-578
Sher et al.: The efficacy of surgical modifications in adults with obstructive sleep apnea syndrome. Sleep 1996;19:156-77
Back et al.: Radiofrequency Thermal Ablation of Inferior Turbinates, Laryngoscope 112, 2002. 1806-1812
Bhattacharyya et al.: Clinical Effectiveness of Coblation Inferior Turbinate Reduction. Otolaryngol Head Neck Surg. 2003 Oct;129(4): 365-71

source- http://www.healthnewsdigest.com/news/Research_270/Treatment_of_Snoring_and_Sleep_Apnea.shtml

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WASHINGTON — The number of veterans receiving disability benefits for a sleeping disorder has increased 61% in the past two years and now costs taxpayers more than $500 million per year, according to Veterans Affairs data released to USA TODAY.

More than 63,000 veterans receive benefits for sleep apnea, a disorder that causes a sleeping person to gasp for breath and awaken frequently. It is linked to problems ranging from daytime drowsiness to heart disease. The top risk factor for contracting the disorder appears to be obesity, though a sleep expert at the VA and a veteran’s advocacy organization cite troops’ exposure to dust and smoke in places such as Afghanistan and Iraq as contributing factors.

More claims are likely to be made in the future as Baby Boomers age and get heavier, says Max Hirshkowitz, director of the Sleep Disorder Center at the Houston Veterans Affairs Medical Center.

Veterans are four times more likely than other Americans to suffer from sleep apnea, Hirshkowitz said. About 5% of Americans have the disorder, he said, compared with 20% of veterans.

Veterans benefits for sleep apnea are more generous than those for workers in the private sector, records show. For example, Elaine Fischer, a spokeswoman for the Washington State Department of Labor and Industries, which handles workers’ compensation in that state, said the department is not aware of any occupational exposure that would cause sleep apnea. “We’re unaware of it being directly caused by something work related,” she said.

In 2007, Congress asked the Department of Veterans Affairs to pay closer attention to sleep apnea among veterans. Greater awareness of the disorder has prompted more veterans to seek treatment, Hirshkowitz said. The result has been a sharp increase in claims and disability payments to veterans, according to data provided to USA TODAY by Veterans Affairs:

•The number of veterans claiming sleep apnea as a disability has jumped to 63,118 in 2010 from 39,145 in 2008, a 61% increase.

•Payments to apnea patients with a disability rating of 50 — by far the largest group receiving benefits — rose to a minimum of $534 million in 2010 from $306 million in 2008. The minimum payment for a disability with a rating of 50 is $9,240 a year but increases if a veteran is married and has children.

The Social Security Administration recognizes sleep apnea as a disability. It pays benefits to those who can’t work because of a disability that is likely to last at least one year or will kill them. The VA says veterans, however, can receive benefits and hold jobs.

Some veterans may be predisposed to sleep apnea, Hirshkowitz said, because many are built like football players. They’re big men, and as they age, many “become sedentary” and gain “an enormous amount of weight,” he said. “When you get to middle age or late middle age your level of exercise does not maintain particularly when you have knee problems and hip problems.”

Daniel Chapman, a psychiatric epidemiologist at the Centers for Disease Control and Prevention, agreed: “I really can’t think of a reason other than what’s happening in the general population, which is that we’re growing increasingly obese.”

Chapman and Hirshkowitz said some sleep apnea cases may be caused by exposure to toxins from smoke or fires.

Along with increased screening, the rise in sleep apnea cases may also be due to exposure to dust, sand and grit in Iraq and Afghanistan, said Thom Wilborn, a spokesman for the Disabled American Veterans organization.

“Give a guy a rifle and put him in a desert, and he’s going to suffer some respiratory issues,” Wilborn said.

Losing weight can help some people with sleep apnea, Hirshkowitz said. Though he notes that some thin men and some women also have the disorder.

Veterans with a disability rating of 50 require breathing assistance with the airway pressure device, the VA said. The breathing machines work well, Hirshkowitz said, and can prevent veterans from developing more serious heart and lung problems.

Source- http://www.usatoday.com/news/health/2010-06-07-apnea_N.htm

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