Our country is sleep-deprived — desperate for restful nights, to awaken easily, and be functional throughout the day without needing a nap. The anxiety and stress of our busy world certainly makes it difficult to fall asleep and stay asleep. But, those dreams of being rested are even more difficult to achieve when nights are fraught with the tossing, turning, snoring, choking, or gasping for breath of oneself or a bed partner. Quality sleep is crucial to ensure good health and quality of life.
It is estimated that 60 million Americans snore and at least 18 million have a much more serious sleep disorder: obstructive sleep apnea. “Snoring is usually regarded as a social problem with minimal adverse health effects,” admits Dr. Beth Hamann of the Koala Center for Sleep Disorders in Phoenix. “The snorer is usually unaware of the problem but it is a big problem for the bed partner who ends up sleeping in another bedroom or on the couch. Snoring is one of the hallmark signs of obstructive sleep apnea (OSA), though not all snorers have sleep apnea.”
The Myths and Facts of Sleep Apnea
Apnea, a transient cessation of breathing, is such a common condition most Americans are familiar with at least the name, but far fewer are aware of what causes it and the dangers it can represent.
Snoring is the sound of partially obstructed breathing during sleep. When obstructive sleep apnea occurs, the tongue and tissue in the back of the throat collapse and completely block the airway, which restricts the flow of oxygen. When a person has sleep apnea, they can stop breathing from 10 seconds to a minute or longer. And, someone with severe sleep apnea may have hundreds of breathing pauses per night.
Each time your breathing stops during sleep, oxygen levels drop which alerts your brain. Your brain temporarily wakes you up to restart breathing, which prevents you from achieving deep sleep and leads to a constant drowsy feeling during the day. Symptoms of sleep apnea may include: insomnia or difficulty sleeping, loud snoring, choking or gasping during the night, morning headaches, depression, and memory loss. Many patients also suffer from gastroesophageal reflux (GERD) and migraine headaches.
Sleep-breathing disorders can be misdiagnosed as chronic fatigue syndrome, anxiety, and ADHD, especially in children. Can you imagine waking up 20 or more times an hour, every hour, all night long? It’s no wonder that patients with OSA are tired and irritable the next day. Patients with OSA can easily fall asleep during the day, whether it be at a meeting, at school, while driving, or stopped at a stoplight or watching TV. “Many believe the only people who have sleep apnea are those who are overweight or elderly. That is not the case... Sleep apnea has been linked to people of all ages including children and adolescents who may do poorly in school or have behavioral problems,” says Dr. Hamann.
OSA is a life-threatening disease becoming more and more prevalent in our society. Research has shown that treating OSA can save 7–10 years of one’s life expectancy. Patients who have untreated sleep apnea are not getting the oxygen they need. Their heart has to pump harder increasing the risk for a heart attack. Besides the increased likelihood of heart attacks, sufferers of sleep apnea are also at a higher risk for stroke, cancer, high blood pressure, and diabetes.
OSA and Headache Treatment
The first step toward combating sleep apnea is the proper diagnosis by a board-certified sleep physician who recommends the most effective treatment approach based on the results of the patient’s overnight sleep study. Sleep apnea is classified as mild, moderate, or severe, depending on the number of times the patient stopped breathing during the study. There are three primary ways to treat snoring and sleep apnea in addition to lifestyle changes such as good sleep hygiene, weight loss, and changing sleep position. Those treatment options are surgery, CPAP, and oral appliance therapy.
The CPAP or Continued Positive Airway Pressure machine has continued to be the gold standard of treatment for sleep apnea. “If a patient is using CPAP and doing well, I encourage them to stay with it,” says Dr. Shari Aftahi. “According to the American Sleep Apnea Association, approximately 60 percent of CPAP users are still using it after six months. Unfortunately, this means that about 40 percent stop using their CPAP and go untreated. The majority who come to my office for sleep-breathing disorders have been encouraged to seek a solution for their snoring problem or because they were diagnosed with OSA and were either unable to wear the CPAP device or found it challenging to travel with.”
An alternative to a CPAP device is an oral appliance which is worn at night to reposition the jaw and tongue to maintain a more open upper airway while sleeping. The appliances are non-invasive and similar to athletic mouth guards, but less bulky. According to Dr. Aftahi, “The American Academy of Sleep Medicine issued a statement in the 2006 journal of SLEEP declaring that oral appliance therapy was approved as a first line of treatment for those suffering from mild to moderate obstructive sleep apnea and has proven to be effective for those with severe sleep apnea who cannot tolerate the CPAP. “
The custom appliance is designed based on patient history and Dr. Hamann’s or Dr. Aftahi’s oral assessment of each individual. This includes examination of the temporomandibular joints (TMJ), muscles, occlusion (bite), and jaw function as well as the use of a 3D cone beam CT scanner to determine the most appropriate oral appliance. The doctor will then take a custom impression and bite record based on their assessments in order to have an FDA-approved lab fabricate the oral appliance. Once the appliance is fitted, progress is monitored and specific adjustments are made to reach maximum effectiveness, which is confirmed by a follow-up sleep study.
While some patients may need a combination treatment, Dr. Hamann emphasizes the importance of working with each patient’s physician to ensure that the overall health and wellness of every patient is addressed. It is critical that anyone who suspects they have sleep apnea, or health care providers who have patients they suspect of possible sleep apnea, be referred to their primary care physician and sleep specialists for a sleep study in order to make a diagnosis.
A Comprehensive Philosophy
“Dentists do not just treat teeth,” Dr. Hamann states. “There is an oral-systemic connection between the mouth and the body. Research shows a strong relationship between oral disease and other systemic disease and medical conditions.” Examining and treating teeth as part of the overall oral system helps dentists identify causes of problems, rather than simply treating the symptoms.
“I would have a patient come into my office to have a broken tooth repaired. Rather than just repairing the tooth, I believe in looking at why the tooth fractured in the first place. It’s getting to the source of the problem and having that comprehensive philosophy of looking at the cause and effects on the system as a whole.”
This comprehensive oral-systemic philosophy is what led her into the field of dental sleep medicine and orofacial pain. Dr. Hamann now devotes much of her practice to the management of sleep-related breathing disorders, such as snoring and sleep apnea, with oral appliance therapy as well as comprehensive diagnosis and conservative treatment of TMJ disorders (TMD), head, neck, and facial pain.
TMD is one of the most commonly misdiagnosed conditions. Referred pain from the TMJ’s and associated muscles can cause debilitating pain in the head, face, neck, and ears that mimics sinus infections, toothaches, or migraines. Many patients exhibit ear ringing or stuffiness, dizziness, or even sensitive teeth with no apparent pathology. Clenching and grinding is often reported; however, this may be a result of TMD and/or an undiagnosed sleep-breathing disorder, especially if the patient suffers from fatigue, fibromyalgia-like symptoms, anxiety, or headaches.
Close to Home
Dr. Hamann and her team feel deeply connected to the problems their patients face, as many of them or a family member have suffered from the same issues. Dr. Hamann’s own experience with Obstructive Sleep Apnea (OSA) allows her to empathize with her patients.
Wende, office manager for Dr. Hamann, understands the benefits of oral appliance therapy, having encouraged her own father to seek treatment for his sleep apnea with an Oral Appliance. He was diagnosed with sleep apnea and had an oral appliance made. “He cannot sleep without it and wears it even when he’s traveling for work, because it’s convenient and he sleeps so much better with it,” she states.
Dr. Aftahi’s son was diagnosed with OSA at a very young age of 25. His diagnosis led Dr. Aftahi to be interested to learn more about OSA and the treatment options available.
Sleep Apnea Awareness Day is March 18th. Dr. Hamann and her team are committed to building awareness of the risks of untreated sleep apnea and helping their patients breathe, sleep, and live well!
For more information on oral appliance therapy for the treatment of sleep apnea, TMJ Disorders, or facial and neck pain, please call 602-357-9845 or visit www.KoalaSleepCenters.com/Phoenix-Biltmore. They are located at 4235 N. 32nd Street in Phoenix.
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