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. 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.
At the Koala Center for Sleep and TMJ Disorders in Bloomington, Dr. J. Todd Gray, DDS, D. ASBA, has dedicated his practice to helping his patients find the restful sleep they’re yearning for. Many of Dr. Gray’s patients end up in his chair because of snoring. “Snoring is believed to be a social problem with minimal adverse health effects,” states Dr. Gray. “Often times, my patients will say that the snoring doesn’t bother them, but the spouse or bed partner is saying otherwise.” In fact, one study from the Mayo Clinic in Rochester Minnesota, found that spouses of people who snore woke up, at least partially, an average of 21 times an hour — nearly as often as the 27 times the snorers were awakened by their own snoring. “In hindsight, what my patients don’t always understand is that snoring is often a precursor to a more serious sleep-breathing related disorder known as obstructive sleep apnea.”
The myths and facts of sleep apnea
Apnea, a transient cessation of breathing, is such a common condition that 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. 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. The 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 sleep during the day, whether it be at a meeting, at school, while driving or stopped at a stoplight, or watching TV. According to Dr. Gray, “Many believe the only people who have sleep apnea are those who are overweight or elderly, but that is not the case. A lot of it has to do with a person’s genetics and anatomy. A small airway or a retruded jaw can result in possible issues with breathing, not just in adults, but also children. Furthermore, daytime tiredness and fatigue can lead to increased weight gain and loss of mental focus. Sleep apnea has been linked to children and adolescents who do poorly in school or have behavioral problems.”
The first step toward combating sleep apnea is the proper diagnosis by a board-certified sleep physician who can then recommend 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. Surgery, CPAP, and oral appliance therapy are the three ways to treat snoring and sleep apnea. In addition, lifestyle changes, such as good sleep hygiene, weight loss, and changing sleep position, are helpful.
The CPAP, or Continued Positive Airway Pressure machine, has continued to be the gold standard of treatment for sleep apnea. “When I see a patient who is a successful CPAP wearer, I encourage them to continue with it,” says Dr. Gray. 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 of people who come to my office for sleep-breathing disorders have been encouraged to seek a solution for their snoring problem or have been 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 an open airway while sleeping. The appliances are non-invasive and similar to athletic mouthguards, but less bulky. 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. Gray’s oral assessment of each individual. This includes examination of the temporomandibular joints (TMJ), muscles, occlusion (bite), jaw function and Cone Beam x-ray to determine the most appropriate oral appliance. Dr. Gray will then take a custom impression and bite record based on his 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.
Dr. Gray 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 speak to their primary care physician or sleep specialists for a sleep study in order to make a diagnosis.
A comprehensive philosophy
Dr. Gray graduated from the University of Iowa College of Dentistry in 1989 and then completed a General Practice Residency at Hines VA Hospital in 1990 before entering private practice as a general dentist. He practiced in East Peoria for many years before moving his practice to Bloomington in 2015. Dr. Gray was approached by one of his patients, a sleep physician in fact, about making oral appliances for his patients who could not tolerate the CPAP machine. That very conversation is what started it all. He became his first patient when he decided to do a sleep test as recommended by the sleep physician. “I was shocked to find out I had mild sleep apnea,” admitted Dr. Gray. “I worked with the lab to fabricate my appliance and here we are, eight and half years later, and my apnea and snoring are well controlled with the very same appliance I give my patients.” It was through his own experiences, coupled with countless hours of research and training, that the passion for the treatment of sleep breathing disorders and TMJ was born.
This was the opportunity to take dentistry and redirect his focus to help on a much higher level. “Dentists do not just treat teeth,” he 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.
“For years, I’ve seen patients in my general dentistry practice showing wear on their teeth from nocturnal grinding. Grinding can be our bodies’ natural mechanism to tighten the airspace, and this can lead to bite changes and potential TMJ joint damage. In our practice, we screen every new patient for both sleep apnea and TMJ because they run down parallel lines. The lower jaw position is the correlation between the two. About 65 percent of my sleep patients also have TMJ. However, I do have patients who are here strictly for TMJ treatment,” states Dr. Gray.
TMD, temporomandibular joint dysfunction, also frequently referred to as TMJ, 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, ear infections, toothaches, or migraines. Many patients exhibit ear ringing or stuffiness, dizziness, or even sensitive teeth with no apparent pathology.
“The comprehensive, yet conservative approach to the treatment of TMJ begins with pinpointing the root cause of the problem, then choosing the appropriate orthotic based on each patient’s specific needs. Goals of treatment are to improve jaw-muscle function and relieve joint sounds and pain by creating a stable bite. The patient is monitored in our office with regular adjustments until symptoms resolve.”
Dr. Gray believes that his current career path is the most rewarding one yet. “We are able to give patients back their lives in so many ways. Couples are finally able to sleep in the same room, people have the energy to do the things they enjoy, individuals are freed from pain that has held them back for too long. When I see a patient from start to finish, I see the light return to their eyes. I am so thankful for the opportunity to help patients achieve their dreams of a restful night’s sleep and a life free from pain.”
For more information on oral appliance therapy for the treatment of sleep apnea, TMJ Disorders, or facial and neck pain, please call the Koala Center for Sleep and TMJ Disorders at 309-319-6568 or visit www.bloomingtonsleep.com. Treatment with oral appliances is covered by most major medical insurance carriers, including Medicare.