27.01.2015
Snoring is the loud, rasping noise made by the vibration of the soft palate, uvula, and other structures of the airway during sleep.
Obstructive sleep apnea has recently been associated with risk factors for serious medical conditions including stroke, diabetes, cardiovascular diseases including hypertension, cardiac arrhythmia, heart attack, and erectile dysfunction. Obstructive sleep apnea is very common and is estimated to affect a large number of individuals where the breathing is interrupted due to a mechanical obstruction of the airway as in mandible or tongue posterior positioning, large tonsils or adenoids, or large neck size. The evaluation process starts with taking a detailed history inquiring about how long you have snored, your sleep habits, lifestyle and work issues, medical conditions, medications used, daytime sleepiness, and the impact snoring has on you and those who live with you. Sleeping on the back increases the occurrence of obstructive sleep apnea due to backward positioning of the mandible and tongue.
Overweight individuals often have large and excess fat tissues in their throat which cause narrowing of the throat leading to snoring and apnea. Euphoric conditions such as after heavy exercise, alcohol or sedative medications intake relax the muscles of your throat which may worsen snoring and apnea.
Heavy meals prior to sleep time may cause narrowing of the chest volume for the lung to expand decreasing the breathing efficiency. Surgery – there are several surgical options, but all are aimed at opening the airway by removing tissue at the back of the mouth, soft palate, top of the tongue, and in the throat.
Laser-assisted uvulopalatopharyngoplasty (LAUP) is a method of removing a portion of the soft palate and the uvula using a laser device.
Radiofrequency (RFA) ablation uses radio waves to shrink the nasal turbinates or uvula, surrounding tissues and sometimes the back of the tongue.
Your upper airway is open and unobstructed allowing air to flow from your nose, through your throat and into your lungs. During sleep, gravity and muscle relaxation allows the tongue and surrounding soft tissues to fall back into the throat area obstructing air flow. There are many signs and symptoms of SRBD with the most obvious being the loud and frequent snoring or lapses in breathing. The diagnosis of sleep apnea may be estimated by taking a thorough sleep and medical history; however, it requires objective testing during sleep to confirm and quantify. SRDB is a societal epidemic with far reaching consequences both medically and psychosocially as well as carrying an enormous economic burden. Current physician training in this area is severely lacking, resulting in a slow creep of medical and public awareness over the past 30 years. Properly trained dentists were acknowledged by the American Academy of Sleep Medicine (AASM), as being able to provide first line therapy for the treatment of mild to moderate sleep apnea. Only dentists are able to fabricate, fit, adjust, monitor, and treat complications associated with Oral Appliance Therapy (OAT), used in managing SRBD. Because dentists see patients on a regular maintenance schedule during wellness dental and dental hygiene care, they are in a unique position to identify early SRBD illness. Dentists are familiar with the mouth, oral cavity and parts of the upper airway and can easily learn to screen components of the airway with little additional training.
Identifying the CPAP non-compliant group and offering OAT co-therapy with physicians is uniquely possible for dentists. Through screening and co-treating, dentists add to the limited supply of medical practitioners who are able to assist in this area of medicine.
Increased public awareness of sleep disorders has resulted in increased public demand for more patient-friendly, non-surgical treatment options besides CPAP. Current dental training in SRBD is increasing and there are now expanding avenues for the interested dentist wanting to take the journey towards competency in treating this problem.
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While snoring itself may be harmless, it can also develop into or be a symptom of a more serious medical condition know as obstructive sleep apnea (OSA). When the tongue has fallen completely against the back of the throat, the airway is blocked and breathing stops. The airway obstruction won't clear until the brain's oxygen level falls low enough to partially awaken the sleeper. Within 3 hours of bed time, avoiding alcohol, heavy meals, and medications that make you drowsy.
Nasal CPAP (Continuous Positive Airway Pressure), a therapy in which an air compression device and a nose mask are often used to force the airway open and aid breathing during sleep. Dental Appliance Therapy, which is an effective way of treating snoring and OSA for many patients.
In recent clinical studies, physicians and dentists have found that, in a majority of patients, a well-made, well-fitted dental oral appliance will effectively reduce or eliminate snoring, and significantly relieve symptoms of mild and moderate OSA. Dental oral appliances work in three ways: by bringing the lower jaw forward, by holding the tongue forward, and by lifting a drooping soft palate. Treatment with a dental oral appliance is reversible and non-invasive (it does not require surgery). If you snore heavily and are interested in trying dental appliance therapy, it's very important that you are thoroughly examined by a physician or a sleep specialist first. Your question is timely as more research and knowledge is accumulating in the area of sleep and sleep disorders. 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. Some helpful things you can do for yourself if you have sleep apnea include losing weight and exercising.


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. Other Dental Approaches: Specially trained oral and maxillofacial surgeons may include more complex jaw advancement surgeries. 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.
Without getting enough oxygen in the lungs the body suffers, does not rest properly and can result in drowsiness, irritability, lack of focus lethargy. Salt therapy is a non medical, complimentary treatment which has no side effects when used with your normal medication.    Salt therapy is not a cure, it is a complimentary treatment that can relieve symptoms of snoring or sleep apnea.
About 80 million people in North America snore, and approximately 12 million Americans have sleep apnea. Snoring is caused by the vibration of the soft palate and uvula, occurring when the airway becomes obstructed during sleep. Dr Abri and his friendly, knowledgeable staff have accumulated many years of experience helping their patients with Sleep Apnea issues. De–stress your life, sleep better, and conquer depression with the latest news and insights on mood management, plus special offers. To help you find the answers to all your sleep apnea questions, we’ve combed the Web for the most helpful online resources. The material in this site is intended to be of general informational use and is not intended to constitute medical advice, probable diagnosis, or recommended treatments.
Obstructive sleep apnea is the momentary cessation of breathing during sleep leading to awakening of the person gasping for air or choking in a repeated manner. It may strain your relationships but may be the first sign of obstructive sleep apnea, a more serious health problem.. In addition, many motor vehicle accidents are attributed to daytime sleepiness as a result of sleep apnea.
This is different from central sleep apnea which is due to a problem in the central nervous system. The recommended therapy for sleep apnea depends on its severity, which is usually determined by the physical examination and in some cases sleep study. This type of therapy provides an alternative to CPAP and is primarily used for snoring or mild to moderate obstructive sleep apnea. However, it also includes any associated daytime sleepiness and sense of poor restfulness even with adequate time spent sleeping.
While the current gold standard for testing is an overnight, observed, laboratory sleep study in a sleep lab called a Polysomnogram (PSG), the trend towards more cost-effective and readily available testing has stimulated growth of home sleep testing. Because dentists see patients on a regular maintenance schedule during wellness dental and dental hygiene care, they are in a unique position to identify early SRBDs. Catching and managing this epidemic problem has been unmet by current approaches in medicine.
They may also identify sleep disorders by observing a SRBD behavior such as "snorers in dental chair" where patients fall asleep within a short time at dental appointments.
The bar is being raised with earlier exposure of our future dentists to this medical problem and how they can contribute to its identification and co-management.
Once that happens, the harder the sleeper tries to breath, the tighter the airway seal becomes. It is worn in the mouth during sleep to prevent the soft throat tissues from collapsing and obstructing the airway. The appliance weighs only a couple of ounces, and its small size makes it easy to travel with. It's important that this examination is done first, because you may have sleep apnea without realizing it. 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. Afterwards, your husband's dentist will continue to monitor his treatment and evaluate the response of his teeth and jaws. 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. Several things can obstruct the airway and cause you to snore, including allergies drinking before bed, being overweight and having large tonsils or a deviated septum. The two most common ways to treat sleep apnea are continuous positive airway pressure (CPAP) therapy, which is administered by a physician, and oral appliance therapy, which is administered by a dentist.
Studies have shown that the moment you remove your continuous positive airway pressure (CPAP) mask, obstructive sleep apnea returns. See the Terms of Service and Privacy Policy (Your California Privacy Rights) for more information.
Some patients may suffer from a mixed condition where both central and obstructive sleep apnea exist.
Custom-made oral appliances by a dentist hold the lower jaw and tongue forward to allow more space in the back of the mouth and throat increasing the airway space and prevent the obstruction. An example includes the excessively sleepy individual who takes naps daily, drinks massive amounts of coffee and energy drinks, and despite 7 to 8 hours of sleep at night continues to experience excessive drowsiness and a lack of energy.
Sufferers frequently have significant brain damage and require an extensive, careful work up and management along with the use of breathing equipment called Continuous Positive Airway Pressure or CPAP for short. One approach is to screen and refer suspect patients to their physician for diagnosis and treatment.


This rapidly moving air causes the soft tissues of the throat (the tonsils, soft palate and uvula) to vibrate. The most common cause of a narrowed airway is a tongue that relaxes too much during sleep and the tongue falls back into the airway with each breath taken. Dentists with training in dental oral appliance therapy can design, construct and fit these special appliances to meet their patients' individual situations and conditions. In a study conducted at Stanford University in California, one out of three chronic, severe snorers were found to have had a harmful degree of sleep apnea. 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. 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. These devices may look like orthodontic retainers or sports mouth guards but are designed to maintain an opened, unobstructed, upper airway during sleep. It also may be necessary to remove the tonsils and adenoids (especially in children), the uvula, or even parts of the soft palate. However, determining the best treatment is enhanced by joint consultation with your physician and dentist. 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.
CPAP therapy can be very effective for people with sleep apnea, but some find it difficult to sleep with a mask.
The dentist may order some testing such as radiographs of the mouth and jaw, cone beam computed tomography (CBCT) scan, or magnetic resonance imaging (MRI) to study the jaw condition as well as the quality and the size of your airway. While intermittent and shallow snoring is less likely to be associated with medical complications, as time and snoring progress in frequency and volume, associated medical and psychosocial problems can certainly develop.
There are also mixed apnea patients who have both obstructive and central apnea events during their sleep cycle. It was in use as far back as the early 1900's, but it was not until the 1980's that physicians and dentists began to work together to study and develop this alternative for of treatment, enabling more patients to benefit from it. 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. 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.
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. Left untreated, sleep apnea can increase your chances of serious health conditions like high blood pressure and heart disease. A referral to an ear nose and throat physician to examine the nose and throat or a medical sleep specialist may be recommended.
SRBD is a societal epidemic with far reaching consequences both medically and psychosocially as well as carrying an enormous economic burden. Oftentimes, the dentist requests a sleep study called polysomnography (PSG) that is usually performed in a sleep center and provides the most information about how you breathe when you are asleep. Oral appliances require time to get used to and they need to be adjusted to determine the optimum position for each patient. There is a great deal of scientific evidence supporting both the OAT and surgical, hard tissue approaches; thus, dentists should actively seek training to reach competency so they can offer these treatment options to their patients. Properly trained dentists have been acknowledged by the American Academy of Sleep Medicine (AASM), as being able to provide first line therapy for the treatment of mild to moderate sleep apnea. The combination of low oxygen levels and fragmented sleep are the major contributors to most of the ill effects associated with sleep apnea. They increase the airway space and reduce air velocity and soft tissue vibration (snoring) by moving the lower jaw into a forward position. The sleep center measures your breathing quality, heart rate, oxygen saturation, muscle activity, and other functions. These appliances require maintenance and follow-up visits to ensure they continue to fit correctly and help you breathe better.
OAT has been shown to be slightly less effective than CPAP therapy, but cross over trials comparing both treatments have validated significant patient preference and increased long-term use by patients using OAT. Only dentists are able to fabricate, fit, adjust, monitor, and treat complications associated with Oral Appliance Therapy, used in managing SRBD. 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. Patients who have tried both say that oral appliances are more comfortable to wear, easier to care for and very cost-effective.
Lately, at-home instruments have become available to measure some of these functions in a more familiar and comfortable atmosphere in your own bedroom. These oral appliances may cause sore jaw muscles or jaw joints, difficulty putting teeth together and in some cases develop changes in the way the teeth fit together.



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