Sleep Apnea

Learn how orthodontics can help people with sleep apnea

Girl who now sleeps well after receiving orthodontics sleep disorders careFollowing is useful information about receiving orthodontics such as dental braces or devices for sleep apnea (a common sleep disorder) in Colorado Springs:

Orthodontic treatments are commonly used to help people suffering from obstructive sleep apnea, a common sleep disorder that not only causes restless nights and exhausted days, but can lead to serious health conditions. People with sleep apnea stop breathing periodically during sleep, sometimes as often as 20 to 30 times an hour. This lapse in breathing and resulting oxygen deficiency triggers the body to wake up in order to restart normal breathing. Because the period of wakefulness is so short, most people don’t remember waking and assume they slept undisturbed for the entire night. However, daytime sleepiness and complaints of snoring from sleeping partners often provide the clues that lead to a diagnosis of sleep apnea.

Common symptoms

People with sleep apnea generally suffer from a range of symptoms. Loud snoring, insomnia, waking at night with shortness of breath, falling asleep during the day and headaches upon waking are some common signs that sleep is being disrupted on a regular basis. Sleep partners may notice the sufferer making loud choking or snorting sounds, which are indicative of breathing restarting.

Types of sleep apnea

Sleep apnea falls into three categories. Obstructive sleep apnea, or OSA, is the most common type and is caused by a physical obstruction, often collapsed tissue in the soft palate area of the throat. Central sleep apnea, OSA, occurs when breathing muscles don’t receive proper messages from the brain, while complex sleep apnea is a combination of OSA and CSA. Typically, snoring doesn’t happen with CSA, so most sleep apnea treatments are designed for OSA. All forms of sleep apnea are considered serious medical conditions, and sufferers are at risk for high blood pressure, heart failure and stroke. Constant drowsiness or falling asleep unexpectedly can make driving or operating heavy equipment dangerous and can lead to problems at school or at work. People with sleep apnea should also inform their doctors of the condition if they are having surgery since both anesthesia and recovery time lying flat in bed can pose dangers to apnea sufferers.

Risk factors

Though anyone can suffer from this condition, it is more common in males, particularly those over 40, and is fairly rare in children and young adults. Various lifestyle and health issues can put people at higher risk, including smoking, drinking, obesity, high blood pressure, use of sedatives and genetics. People with sleep apnea often have a relatively large tongue and tonsils compared to the windpipe opening or have a smaller airway size due to the shape of head or neck. Being overweight can contribute to apnea because additional soft fat tissue can thicken and narrow the windpipe wall. Also more common in men, central sleep apnea tends to occur more often in patients with co-existing conditions like brain tumors, heart disorders and neuromuscular conditions.

Diagnosis

A diagnosis of sleep apnea cannot be made conclusively at a regular physician office visit, as there are no blood tests or other simple means of identifying the condition. Often, the first signs of trouble are noticed by a sleep partner who has noticed the loud snoring and snorting episodes characteristic of the condition. If you suspect you might suffer from apnea, try keeping a sleep diary for a couple of weeks and write down how much you sleep and nap, how well rested you generally feel and whether you’re cranky or sleepy during the day. The type of sleep apnea and severity can be determined by undergoing a sleep lab study, where a polysonogram is used to monitors a patient’s breathing, blood oxygen levels, brain activity, heart rate, blood pressure and eye movements during sleep. Results are then reviewed by a sleep specialist and a plan of treatment developed. As an alternative to an inpatient sleep lab study, patients may be sent home with a home-based portable monitor to be record nightly sleep patterns, blood oxygen amounts, heart rate and chest movements.

Treatment

The severity of a patient’s sleep apnea, co-existing conditions and overall health all play roles in determining treatment. As a first line of treatment, patients may try lifestyle changes such as losing weight, quitting smoking, cutting down on alcohol consumption or sleeping on their side instead of their back. If these efforts fail, orthodontic devices, ventilation therapy machines or even surgery may be effective.

Continuous positive airway pressure (CPAP)

In some cases, people diagnosed with obstructive sleep apnea may use a machine that increases air pressure in the throat, preventing airway collapse during breathing. The CPAP consists of an air pump and hose attached to a mask covering nose and mouth or nose only and prongs fitting into the nose. Though many patients benefit from the machine and it is the main non-surgical remedy for sleep apnea, numerous people cannot tolerate the discomfort or find it tends to discourage intimacy with a sleeping partner.

Orthodontic treatment

For those not helped by simple lifestyle changes and who cannot tolerate CPAP well, orthodontic treatments may provide permanent relief from sleep apnea that is caused by uneven jaw growth or reduced airway space caused by old-fashioned orthodontic treatments that forced the jaw backwards. Deep overbite, bucked teeth, mismatched jaws, injuries, birth defects and various facial irregularities may contribute to sleep apnea by limiting airway space. Today’s progressive orthodontics help widen airways by realigning and reposting the jaw, thus changing the pattern of the bite and expanding the airway. Treatment improves ability to breathe and often completely eliminates sleep problems.

Orthodontic appliances

Orthodontic devices or appliances inserted in the mouth at bedtime are another non-surgical option to help remedy sleepless nights, and research has found that even advancing the mandibulars a few millimeters may be sufficient to noticeably improve breathing. Fitted by a trained orthodontist or dentist, these devices include the mandibular advancement device, or MAD, which forces the jaw backward and down, and a tongue retraining device, referred to as a TRD, which holds the tongue in its proper place to help maintain an open airway. Orthodontic devices work best for sufferers who sleep on the back or stomach. These appliances often work wonders on those with mild to moderate apnea and have better compliance rates than CPAP machines. Patients using appliances should be regularly checked for proper fit as long term use may change alignment of jaw or teeth. Although many cheaper devices claiming to help sleep apnea may be found on the Internet, they may be ineffective. Always check first with your doctor, dentist or orthodontist before purchasing any of these devices.

Rapid maxillary expansion is a common temporary orthodontic treatment for apnea. A screw device is attached to the upper teeth and tightened periodically, thus helping widen the jaw, reduce nasal pressure and improve breathing.

Surgical treatments

In severe cases where CPAP and orthodontic efforts aren’t effective enough, surgery may be recommended to shrink, stiffen or remove extra tissue in the throat or mouth or to reset the lower jaw. For sleep apnea, a surgical procedure called uvulopalatopharyngoplasty (UPPP) is the standard surgical treatment. Addressing a variety of jaw issues, this procedure can remedy a several conditions, but is generally used as a last resort in sleep apnea cases. Tonsils and adenoids may also be removed, and repair of a deviated septum or nasal polyps may also be necessary to improve breathing. Laser surgery is becoming a popular option for reducing excess tongue tissue.

Treatment costs

The costs of medical treatment for sleep apnea vary and you should consult with a sleep specialist. Orthodontic devices such as the MAD can retail from $500 up to $1,500 before insurance and are also often considered durable medical devices. Use of this type of device also means more frequent trips to the orthodontist to make sure it’s not causing tooth or jaw problems. Although initial financial layout may be high even after insurance co-payments, many patients find that the reduced doctor’s visits and the increased health and quality of life bestowed by a good night’s sleep make the investment in sleep apnea treatment well worthwhile.

Length of treatment

Sleep apnea may require life-long controlling measures or may be a one-time fix. Patients will generally need to make an ongoing commitment to maintaining a healthy weight, quitting smoking and reducing alcohol consumption. Those using CPAP machines and orthodontic appliances will likely need the assistance of this equipment for the rest of their lives or as long as their health care provider deems necessary. Nonsurgical orthodontic treatments like rapid maxillary expansion can have an immediate and permanent effect on obstructive sleep apnea, as can surgical interventions.

Discomforts associated with treatment

With the exception of post-surgery discomfort after procedures, treatments for sleep apnea normally cause little serious pain. Some people experience discomfort with CPAP machines, which can cause irritated skin, dry mouth, stuffy nose or headaches. Stomach bloating can result if adjustments are made incorrectly. Dental devices can cause some mild discomforts including excessive salivation, dry lips and tooth discomfort, most of which can be alleviated by using devices made of softer materials.

People who suspect they have sleep apnea should consult their doctor for treatment or referral to specialists. With appropriate lifestyle changes and/or orthodontic or surgical treatments, most people will be able to enjoy proper sleep and all its associated health benefits.

If you require orthodontics for sleep apnea

You can call Colorado Springs orthodontist, Thomas E. Skelton, DDS, MS, at 719-487-9303 to schedule an appointment for your dental sleep apnea care.