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. Tara Griffin of
the Koala Center for Sleep Disorders in Bloomington. “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.
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 sleep 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 children and
adolescents who may do poorly in school or have behavioral problems,”
says Dr. Griffin.
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. Griffin. “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.”
Oral appliances are 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. Griffin, “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. Griffin’s oral
assessment of each individual. This includes examination of the
temporomandibular joints (TMJ), muscles, occlusion (bite), and jaw
function to determine the most appropriate oral appliance as well as
utilization of modern technology such as acoustic pharyngometry and 3D
cone beam CT scanning as needed. Dr. Griffin will then take a custom
impression and bite record based on her 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. Griffin 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
A
1998 graduate of the University of Kentucky College of Dentistry, Dr.
Tara Griffin completed a residency at a Veterans Affairs Medical Center
before entering private practice as a general dentist. Through her
experiences in her practice as well as advanced education in occlusion,
TMJ, and sleep-breathing disorders, Dr. Griffin has developed a
comprehensive philosophy of dentistry.
“Dentists do not just treat
teeth,” she 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. Griffin now devotes 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.
Griffin 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. Griffin’s own experience with temporomandibular
joint disorder (TMJ) allows her to empathize with her patients, not only
through the pain they’re experiencing but also with the frustration
they feel when previous treatments have failed to bring them relief.
Erica,
office manager for Dr. Griffin, understands the benefits of oral
appliance therapy, having encouraged her own husband to have a sleep
study to determine the deeper roots of his snoring and fatigue. 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.
Griffin’s patient care coordinator, also named Tara, lost her mom to
untreated sleep apnea. She was 45 years old and died of heart failure in
her sleep about three years ago. Her mom had been previously diagnosed
with sleep apnea and could not tolerate the CPAP. Unfortunately, Tara
and her mom knew nothing about oral appliances for sleep apnea at that
time.
Sleep Apnea Awareness Day is April 18. Dr. Griffin 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
snoring, sleep apnea, TMJ disorders, or facial and neck pain,
please call the Koala Center for Sleep Disorders at 309-319-6568 or
visit www.taragriffindmd.com.