Big snorts, guttural grunts and sounds so loud they seem to rattle the windows. The noises stop for a time and then suddenly begin again. For the unlucky sleeping partner of a chronic snorer, the experience can mean the very depths of misery. But the distracted bed mate is actually the lucky one. The snorer may have a serious underlying medical condition, one which poses real harm if not addressed. The source of the din and disturbance may well be obstructive sleep apnea, a disorder that affects around 12 million Americans. Health effects of OSA range from daytime drowsiness to headaches, cardiovascular problems, stroke, and even sudden death. One study, published February 2010 in the journal Sleep, suggested that the memory impairment and respiratory issues associated with OSA patients might be linked to changes in brain structure, specifically decreased gray matter. Sleep apnea reveals itself primarily two ways. The first and most common type is obstructive apnea, which takes place when throat muscles relax. The second is called central; it occurs when the brain fails to send proper signals to the muscles that control breathing. A lesser type of apnea, referred to as complex, is really a combination of the other two. In the case of the victim of OSA the throat closes to such a degree that air doesn’t reach the lungs. The situation triggers an alarm in the brain which transmits signals to reopen the airway. This process—which often produces the gasps and snorts associated with the disorder--can occur hundreds of times each night. Sleep apnea patients range from young children to the elderly. But the typical sufferer is most often obese, male, and over 60. Given rising documentation that sleep apnea results in significant health consequences, why do so many Americans remain undiagnosed and untreated? Part of the reason has to do with the fact that as a field sleep science is still very much in its infancy. Similarly new is the evidence linking restful sleep with good health overall. The determination of apnea until recently required a lab sleep study. Technicians measured the number of apnea events taking place each hour. (Five or fewer are considered normal; those whose disease is severe might register 30, 40 or even more episodes in the same period.) Now accurate exams can be conducted at home using sensors attached to the chest and fingers. The sensors measure oxygen in the blood (low levels show a sleeper struggling to breathe), the extent of tossing and turning, and airflow. According to DOCS Education dean of faculty Anthony Feck, DMD, the development of more economical and convenient testing is a positive trend. “Unfortunately, getting patients into treatment remains a challenge. We need to improve not only the quality of the therapy available to these patients but the rate of compliance generally.” Compliance has so far proved hard to accomplish. The majority of those diagnosed with sleep apnea evidence moderate to severe forms of the disease. For these individuals the gold standard of treatment is the continuous positive air pressure machine or CPAP. While the ease of use and size of these machines continues to advance, they remain exceedingly cumbersome and noisy. Many patients—and their partners—are simply unable to adhere to the regimen, despite the marked reduction in symptoms. Experts estimate that as many as 50 percent of CPAP users have simply given up trying to use them. The picture is far brighter for those whose sleep apnea falls within the mild to moderate range. Quitting smoking and consuming alcohol, losing weight, even changing sleeping position may alleviate the condition of apnea. For others therapeutic benefit may be achieved through an oral appliance obtainable from a general dentist. In fact, the American Academy of Sleep Medicine, the professional society setting standards for sleep medicine, now advises oral appliances as a first line of defense for patients with mild to moderate sleep apnea. Successful use of oral appliances still requires training in sleep dentistry and understanding not only of types of products but unique patient needs, cautions Larry Barsh, DMD. “No over-the-counter solution exists, and the possibility exists of doing more harm than good.” Dr. Barsh, a graduate of the Harvard Dental School, began working in sleep dentistry in the early 1990s, when product choices were few. Today the number of options has exceeded 100. Dr. Barsh, of New York City, explains that despite the profusion of new kinds of oral appliances basic mechanisms still apply. “The vast majority pull the mandibular jaw forward.” Another type, designed to restrain the tongue, is decidedly less popular. The degree of mandibular protrusion, body-mass index, incidence of positional apnea, and severity of disease all play a role in how likely it is an oral appliance will help, recent studies show. American Academy of Sleep Dentistry president Dr. Sheri Katz has been quoted as saying that overall 75 percent of patients with mild to moderate sleep apnea will experience improvement with the use of custom-fit oral appliances. The future may see even more innovative approaches. Scientists recently tested an experimental pacemaker-like product designed to open airways open by “zapping” the tongue during sleep. However, even if approved at a distant date, the device isn’t likely to work for every sleep apnea sufferer. Dentists have an important part to play in ensuring sleep apnea patients receive life-saving treatment, says Dr. Feck. “We’re frequently in a position to discuss sleep problems with patients and to advise them to get treatment for the problem.” Dr. Barsh agrees. “Follow up and monitoring of oral appliances is important, as is collaborating with the patient’s medical doctor. Each of us brings professional expertise to bear. The dentist is the expert regarding the temporal mandibular jaw. The dentist understands teeth placement. In order for treatment to be successful, clearly we have to work together.”

The information contained in this, or any case study post in Incisor, should never be considered a proper replacement for necessary training and/or education regarding adult oral conscious sedation. Regulations regarding sedation vary by state. This is an educational and informational piece. DOCS Education accepts no liability whatsoever for any damages resulting from any direct or indirect recipient's use of or failure to use any of the information contained herein. DOCS Education would be happy to answer any questions or concerns mailed to us at 3250 Airport Way S, Suite 701 | Seattle, WA 98134. Please print a copy of this posting and include it with your question or request.
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