Fast Trax Orthodontics

Snoring/Sleep Apnea

Snoring and Sleep Apnea

Sleep apnea is a condition characterized by episodes of choking or not breathing during sleep. In normal conditions, the muscles of the upper part of the throat keep this passage open to allow air to flow into the lungs. These muscles usually relax during sleep, but the passage remains open enough to permit the flow of air. Some individuals have a narrower passage, and during sleep, relaxation of these muscles causes the passage to close, and air cannot get into the lungs. Loud snoring and labored breathing occur. When complete blockage of the airway occurs, air cannot reach the lungs.

For reasons that are still unclear, in deep sleep, breathing can stop for a period of time (often more than 10 seconds). These periods of lack of breathing, or apneas, are followed by sudden attempts to breathe. These attempts are accompanied by a change to a lighter stage of sleep. The result is fragmented sleep that is not restful, leading to excessive daytime drowsiness.

Older obese men seem to be at higher risk, though as many as 40% of people with obstructive sleep apnea are not obese. Nasal obstruction, a large tongue, a narrow airway and certain shapes of the palate and jaw seemto increase the risk as are persons who have had extraction orthodontics. A large neck or collar size is strongly associated with obstructive sleep apnea. Ingestion of alcohol or sedatives before sleep may predispose to episodes of apnea.

The classic picture of obstructive sleep apnea includes episodes of heavy snoring that begin soon after falling asleep. The snoring proceeds at a regular pace for a period of time, often becoming louder, but is then interrupted by a long silent period during which no breathing is taking place (apnea). The apnea is then interrupted by a loud snort and gasp and the snoring returns to its regular pace. This behavior recurs frequently throughout the night.

During the apneas, the oxygen level in the blood falls. Persistent low levels of oxygen (hypoxia) may cause many of the daytime symptoms. If the condition is severe enough, pulmonary hypertension may develop leading to right-sided heart failure or cor pulmonale.

This is a relatively new field for Dr. Norton. He has spent the last eighteen months studying the dental and orthodontic roles for this menacing disorder and is now incorporating treatment into his practice. He has attended over 100 hours of post graduate training and visited offices in Dallas, Denver, West Virginia and Milwaukee that limit their practice to sleep apnea and snoring.

Forty million Americans suffer from some sort of chronic, long term sleep disorder, and 20 million suffer occasional sleeping problems. People with sleep apnea have an eight times greater chance of auto accident, and it is estimated that forty percent of truckers have sleep apnea. SDB (sleep disordered breathing) has relational, functional, behavioral, and medical consequences. We will pick only one to address in this forum. Hung et al, 1991 looked into independent predictors of myocardial infarction. The odds ratio of this study were as follows:

Risk Factor Odds Ratio
Standard 1.0
Overweight 7.1
Hypertension 7.8
Smoking 11.1
OSA (AI>5.3) 23.3

OSA is obstructive sleep apnea and AI>5.3 is the mildest form of OSA. If you have this mild form of sleep apnea, then you are 23 times more likely to have a heart attack. Think what the odds might be for a moderate to severe sleep apnea patient. Therefore mild sleep apnea patients have twice the risk of heart attack as a smoker, the next likeliest victim. Think of the money and research that goes into the treatment of hypertension yet sleep apnea is three times more likely to promote a heart attack than hypertension.

Adult symptoms of Sleep Apnea
Adult symptoms of Sleep Apnea
Adult symptoms of Sleep Apnea (continued)
Symptoms of OSA in Children Symptoms of OSA in Children (continued) ADHD Bed Wetting

As a dentist, Dr. Norton cannot diagnose sleep apnea. Only an MD can do this following a polysomnogram. A polysomnograph is a test of sleep cycles and stages through the use of continuous recordings of brain waves (EEG), electrical activity of muscles, eye movement (electrooculogram), breathing rate, blood pressure, blood oxygen saturation, and heart rhythm and direct observation of the person during sleep. You typically spend the night in a sleep center with dozens of electrodes attached to various and sensitive parts of the body. If during the study you test positive for sleep apnea, they will wake you and fit you with a CPAP machine. Nasal CPAP delivers air into your airway through a specially designed nasal mask or pillows. The mask does not breathe for you; the flow of air creates enough pressure when you inhale to keep your airway open much like blowing up a baloon. CPAP is considered the most effective non-surgical treatment for the alleviation of snoring and obstructive sleep apnea.

Polysomnogram and nasal CPAP are the gold standard for treatment of sleep apnea. However, many people cannot comply with their use.

Medical doctors receive very little sleep training in school, but this is still more than most dental students receive. It has fallen on Pullmonologists to tackle this prevalent disorder. Their answer is sleep labs to do polysomnograms and CPAP machines. Both are very expensive and profitable for the people who work this form of treatment.

Results of an 11 year study at Milton Kramer, Bethesda Hospital Cincinnati, Ohio as to why patients do not receive adequate care for SDB(sleep disordered breathing) are as follows:

Total referred to lab 7025
Refused PSG (sleep study)1755 25%
Did not have OSA 1686 24%
Refused treatment 921 13%
Chose other treatment 71710%
Rejected CPAP at trial 5458%
Stopped CPAP 5848%
Poor compliance 441 6%

Those receiving
adequate treatment 576 6%

The CPAP machine is the gold standard of the sleep industry, yet more than 50% of the patients receiving CPAPs will not use them. Successful use of CPAP is considered as between four and five hours per night five nights a week. Even with this low patient compliance there are 1.5 million PSGs per year, 1.0 million new OSA patients per year, and 750,000 CPAPs sold each year at a cost of about $4,000 each. The number of sleep labs and tests is growing at a rate of 40% per year.

Other practitioners that treat sleep are ENTs. They tend toward surgical solutions for sleep apnea. Chiropractors use manipulations and nutrition. Psychologists use counseling. Internests use medicines such as Ambien. The point is that your therapy will differ based on the professional you seek treatment from. There is not a doctor that treats sleep trained through a residency based program like a surgeon. This leaves the field wide open. The Academy of Sleep Medicine and The Academy of Dental Sleep Medicine have tried to standardize the industry. For this reason you need to know exactly how your practitioner treats Snoring/Sleep Apnea.

What Fast Trax can offer. We use a non-surgical approach at Fast Trax to treat snoring and sleep apnea. We can screen for the possibility a patient has sleep apnea. Since I cannot diagnose, I cannot bill medical insurance for the procedures I perform. Those wishing to use their insurance should seek dual treatment with my office and a sleep lab with a medical doctor. I have a home monitoring device with three leads that has a 97% correlation rate with polysomnograms. I can fabricate a mouthpiece that is recommended by the Academies for snoring and mild to moderate OSA (sleep apnea). I can also treat patients who do not tolerate CPAP with the same oral appliance. The appliance I make holds the lower jaw forward during sleep which keeps the airway more patent and lowers the number of apneas, or choking experiences, one has during the night.

A complimentary consultation appointment can further educate you on the subject. Occasionally, Dr. Norton lectures locally on the subject, and you can attend a lecture to find out more.

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