Can’t Get A Good Night’s Sleep? Your Dentist May Be Able To Help
You’d be surprised by the number of my patients who tell me they fall asleep while driving. My first question for them is whether they’ve ever been tested for sleep apnea. Many of them tell me that they have been tested for it, and have been diagnosed with this condition.
So why aren’t they sleeping? Because many people hate those clunky machines most doctors use to treat sleep apnea.
My patients are surprised when I tell them that those clunky machines aren’t the only way to treat obstructive sleep apnea (OSA). In fact, one of the recent breakthroughs in sleep medicine has been made by dentists who realized they could effectively treat OSA with a simple, tiny appliance, kind of like a retainer.
Screening for and treating obstructive sleep apnea has become an integral part of my dental practice. While some people know they have OSA and choose not to get help because they aren’t aware of the available treatment options, many others have no clue they have the condition. Of the 29 million Americans suffering from OSA, 80% of those remain undiagnosed.
Obstructive sleep apnea is essentially a physical blockage of the airway, which prevents you from breathing in oxygen while you sleep. Your brain is telling you to breathe, and the muscles that contract to bring in the air are working, but oxygen can’t get into your lungs because your pharynx has become severely narrowed. The soft tissues of your upper airway collapse and seal off the throat, preventing any movement of air into the lungs. When this happens, you’ll suddenly wake yourself, usually with a sudden gasp. This can happen anywhere from a few times a night to dozens of times per hour. This process prevents people from suffering from OSA from ever getting a complete night’s sleep, leaving them physically and mentally tired when they get out of bed in the morning. That’s why so many people, like my patients, complain of falling asleep behind the wheel.
So, you might think, what’s really the big deal about OSA? If my body wakes itself up to make sure I continue breathing, then why should I see a dentist for treatment? Here’s the thing. OSA affects your entire body. You’re a whole person, after all. Some of the conditions associated with OSA include obesity, type 2 diabetes, acid reflux, depression, high blood pressure, stroke, and congestive heart failure. It can also cause you to grind your teeth while you sleep, which can result in broken teeth, headaches, muscle pain, and damage to the jaw joint (TMJ). The most alarming statistic, however, is that 46% of those with OSA have an increased risk of early death.
Adults aren’t the only ones who suffer from OSA. A multitude of conditions is linked to OSA in children, such as asthma, swollen tonsils, depression, and bedwetting. A 2013 study showed that ADHD is linked to sleep-disordered breathing [SDB] in children, and treatment of the SDB improved ADHD symptoms without medication. In fact, the study suggested that in patients with both ADHD and suspected SDB, the children should be treated for their sleeping conditions before any medication for ADHD is prescribed.
Most people are surprised to know that their dentist can help them treat their medical condition — after all, we’re supposed to only work on your teeth, right? Wrong. As I always tell my patients, dentists don’t treat teeth; we treat whole patients. We can treat your OSA by making a dental appliance that holds your jaw forward, which will pull the tongue off the back of your throat, and expand your upper airway. By removing the obstruction, you’ll breathe more readily at night, and wake up refreshed and healthier.
The gold standard for treating OSA is a continuous positive airway pressure (CPAP) machine. A patient secures a mask to her face and it forces air through the obstruction of the airway, kind of like blowing up a balloon. However, many people who try CPAP cannot tolerate the pressure of the air and choose not to wear it as instructed, or — what’s worse — they stop wearing it at all.
In fact, wearing your CPAP for just four hours a night is considered to be in compliance – and yet even with those low standards, up to 83% of CPAP patients are not wearing their devices as prescribed.
We know that CPAP works, but we also know that the therapeutic effectiveness of oral appliances is comparable to CPAP. In other words, both devices are capable of treating OSA. It’s just that, one of them fits discreetly in your mouth, and the other one covers most of your face and can be disruptive to your sleep partner. Plus, it makes you look like Bane from Batman — which you may or may not think is a bad thing.
If you have OSA and want to try an alternative to CPAP, talk to your physician about finding a dentist to treat you. When looking for a dentist to treat your OSA, it’s vitally important to make sure they are well trained. The American Academy of Sleep Medicine (AASM) and American Academy of Dental Sleep Medicine (AADSM) recommend you be treated by a qualified dentist, who meets their criteria of education and treatment standards. Sometimes side effects can arise during treatment, and a qualified dentist will be able to effectively and immediately respond to those.
Check with your dentist before your visit to see if they have the ability to bill your medical insurance. Most dentists with an AADSM qualification can. Since OSA is a medical condition, it must be billed to medical insurance, and cannot be billed to any dental insurance – no matter what your dentist tells you.
To be clear, no dentist can diagnose sleep apnea. That takes a qualified physician. A good dentist should be willing to work and communicate with your physician. Treating OSA is a team effort that requires the cooperation of a patient, their medical doctor, and their dentist. The end result is the successful management of OSA.
The world can be a noisy and hectic place —you deserve a good night’s sleep.
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