Sleep Apnea Dentist / Sleep Apnea Dental Appliances
Sleep-related breathing disorders are sleep disorders in which abnormalities in breathing occur during sleep that may not be present while awake. It is estimated that sleep-related problems affect 50 to 70 million Americans of all ages. Because sleep-related breathing disorders happen during sleep, many cases go undiagnosed. There are several types of sleep-related breathing disorders, but the three most common are snoring, Upper Airway Resistance Syndrome (UARS), and Sleep Apnea.
These disorders occur when a person’s airway becomes partially or fully blocked during sleep, despite efforts by the body to breathe. Let’s take a closer look at each of these conditions:
Snoring is not just an annoyance to your sleeping partner. Snoring occurs when muscles and tissues in your mouth and throat relax during sleep. These relaxed tissues vibrate as the air flows during breathing. When an airway is narrowed, the airflow becomes more forceful, causing a louder vibration. This is the sound we refer to as snoring.
Upper Airway Resistance Syndrome (UARS)
When there is less volume in the airways, pressure increases. This increase in airway pressure is the definition of UARS. Narrowing in the airways increases the effort required to breathe, sending the body into overdrive trying to maintain oxygen levels.
People who have sleep apnea stop breathing several times during the night. There are three types of sleep apnea: obstructive, central, and complex sleep apneas. Each Apnea is characterized by abnormal periodic cessation of breathing, though the cause is different for each type of apnea. Obstructive Sleep Apnea (OSA) is by far the most common form of sleep apnea. Obstructive Sleep Apnea is caused by relaxed muscles and tissues blocking the airway and causing periods of stopped breathing during sleep.
Though each sleep-related breathing disorder has its own characteristics, they often share the same root cause(s):
- underdevelopment of the mouth and oral structures
- small airways
- poor tongue positioning
During facial and oral development, there are lots of things happening at once. The natural and proper resting position of the tongue is on the roof of the mouth, helping to shape the upper jaw. Because the upper jaw is the same bone that houses the nasal sinuses, proper tongue resting position is critical to the growth and development of the airways and mid-face region. When a tongue positions itself in the lower jaw enabling mouth breathing, the pressure changes the growth of the lower jaw so that it grows more vertically, creating a longer face, and compromising the development of the upper jaw, mid-face, and airways. When the upper jaw is too small, the tongue can no longer fit properly, and tends to drift into the back of the mouth during sleep, creating an airway obstruction.
The underdevelopment of oral structures and airways often causes a snowball effect of other issues. Because the body requires oxygen for survival, it will often compensate for the lack of air in other ways, like clenching and grinding teeth. By thrusting the jaw into a more forward position, this opens the airway, allowing more oxygen into the body. Unfortunately, the clenching and grinding can create other problems like worn or broken teeth, headaches, and can lead to TMJ (temporomandibular joint) issues or TMD (temporomandibular dysfunction). Many doctors do not recognize the connection between these issues and treat each condition separately. Unfortunately, this often leads to “band-aid solutions” which do not address the underlying cause.
When left untreated, sleep-related breathing disorders can lead to more serious medical issues.
Sleep-related breathing disorders don’t just disrupt your sleep and breathing. These conditions worsen over time and can become life-threatening when left untreated. The repeated nighttime awakenings can make quality sleep impossible, causing severe daytime drowsiness and often irritability. You might find yourself having difficulty concentrating at work or school and falling asleep during regular activities. The unstable supply of oxygen associated with sleep-related breathing disorders causes sudden drops in blood oxygen levels, increasing blood pressure and straining the cardiovascular system. Untreated sleep apnea is linked to many other serious medical conditions, including stroke, heart failure, obesity, diabetes, arrhythmias, cardiomyopathy, kidney disease, fatty liver disease, erectile dysfunction, metabolic syndrome, ADHD, and depression. It is important to identify sleep apnea and other sleep-related breathing disorders as soon as possible to avoid further health complications, and to restore quality sleep and breathing function.
Here are a few symptoms to look for:
- Waking up gasping for air
- Dry mouth upon waking up
- Headaches in the morning
- Difficulty falling asleep
- Difficulty staying asleep
- Teeth grinding
- TMJ pain
- Teeth crowding
- Tongue scalloping
- Difficulty concentrating
Though we often focus on the quantity of sleep, the quality of sleep is also important.
The breathing part is quite simple – the body needs oxygen to survive. But sleep, on the other hand, is often overlooked. Even when we do think of sleep, we assume that because we are getting the recommended amount of sleep that we are generally well-rested. Seldom does one consider the quality of the sleep they are getting, which is equally – if not more – important.
Like breathing, sleep is an essential function that allows your body to recharge each night. Sleep provides an opportunity for the body to repair and rejuvenate itself. Many of the body’ major restorative functions like muscle growth, tissue repair, protein synthesis, and growth hormone release occur mostly, or in some cases only, during sleep. When you are not getting quality sleep, you may not be getting the restorative benefits that come with it.
Here is The National Sleep Foundation’s recommended sleep quantity suggestion for each age group:
|Age Group||Age Range||Recommended Amount of Sleep per Day|
|Newborn||0-3 months||14-17 hours|
|Infant||4-11 months||12-15 hours|
|Toddler||1-2 years||11-14 hours|
|Preschool||3-5 years||10-13 hours|
|School-age||6-13 years||9-11 hours|
|Teen||14-17 years||8-10 hours|
|Young Adult||18-25 years||7-9 hours|
|Adult||26-64 years||7-9 hours|
|Older Adult||65 years or older||7-8 hours|
When a person has a sleep related breathing disorder, it makes it difficult to achieve quality sleep. The underdevelopment of the oral structures and airways changes the way the body takes in oxygen. When there is not enough room in the upper palate (maxilla), there is often not enough room in the nasal sinus, making nasal breathing increasingly difficult. Nasal breathing is the ideal and natural way of getting oxygen into your lungs.
Benefits of Nasal Breathing include:
- The nose has tiny hairs (cilia) that help to filter the air you breathe of germs and debris. The cilia also warm the air before it reaches the lungs.
- Nasal breathing allows you to take deeper breaths, engaging the lower lungs. Active lower lungs can pump more oxygen to the rest of the body. More oxygen helps maintain healthy tissue and body function.
- Engaging the lower lungs activates the parasympathetic nerve receptors, sending calming hormones that help combat stress.
- Nasal breathing releases nitric oxide which mixes with oxygen, increasing blood flow to the lungs and lowering blood pressure by dilating blood vessels.
- Nasal breathing enables proper oxygen-carbon dioxide exchange during respiration, helping to maintain a balanced blood pH.
- Nasal breathing uses the diaphragm, an important postural and core stabilization muscle.
- Air inhaled through the nose passes through the nasal mucosa, which stimulate the reflex nerves that control breathing and help achieve deep sleep. Deep sleep is when Human Growth Hormone is release, which is essential to brain development and bone growth.
- Nasal breathing strengthens the immune system by activating immunoglobin production.
When the nasal breathing is too difficult because of cramped sinuses and a narrow nasal passage, many people begin to breathe through the mouth some, or all, of the time. Mouth breathing can take a serious toll on growth and development as well as overall function.
Negative Effects of Mouth Breathing:
- An open mouth posture does not allow the tongue to rest in the upper palate, leading to further underdevelopment of the upper jaw. This can lead to physical abnormalities like narrow mouth, gummy smile, crooked and crowded teeth, and poor posture.
- When the tongue rests in the lower jaw, it stimulates vertical growth. This creates a longer “horsey” face and affects the development of the mid-face region.
- Mouth breathing stimulates the upper lungs, triggering the sympathetic nerve receptors, and sending the body into a constant stressed out state of flight-or-fight.
- The constant state of stress prevents the body from entering deep sleep, affecting the quality of sleep achieved. Poor sleep quality can affect attention focus and productivity at work and school.
- Mouth breathing bypasses the nasal mucosa, making regular breathing difficult, often leading to snoring, breath irregularity, and sleep apnea.
- Breathing through the mouth causes imbalance in the amounts of oxygen and carbon dioxide in the bloodstream. Less oxygen reaching the brain affects the ability to focus, and causes fatigue, chronic tiredness, and brain fog.
- Open mouth posture often causes speech difficulty and the inability to produce certain sounds.
- Mouth breathing does not filter out foreign particles in the air, and often causes dry mouth, bad breath, and cavities.
So, it’s all connected?
That’s right, it’s all connected – and it starts with underdevelopment. In simple terms: small mouths and jaws mean small airways. Small airways mean difficulty breathing. Difficulty breathing means difficulty sleeping. Each with its own list of unpleasant side effects. Many people end up seeing a different doctor and taking a different prescription for each ailment. But, before you run out to get a CPAP machine for your breathing, a prescription for sleeping pills to help you sleep better, and a nightguard to mask your TMJ headaches…
What if there was a solution that would treat and potentially cure sleep apnea and other sleep disorders, along with all the side effects?
Growth appliance therapy addresses the root cause – underdevelopment. New dental appliances like the VIVOS DNA, ALF Appliance, Liao Starter Appliance, and Schwarz Appliance are now available for treatment of underdevelopment for both children and adults. By re-development of the oral-facial structures and jawbones, growth appliance therapy offers a potential cure for TMJ dysfunction, headaches, sleep disorders, and more.
Growth appliance therapy can increase the width and depth of the jaws. The increase in depth of the lower jaw helps the tongue and airway tissues to remodel, growing forward out of the airway. By balancing the bite, opening the airway, and remodeling the oral structure enables healthy nasal breathing patterns, restores proper oral resting position, and promotes quality sleep.
Holistic orthodontics and appliance therapy uses functional forces such as chewing and tongue pressure to promote proper facial development. The best treatment for sleep apnea and other sleep breathing disorders is to never get it or prevent it with growth appliance therapy.
75% of people who have TMJ Pain also have Sleep Apnea or Upper Airway problems. Most people know they have TMJ problems, but not Apnea
Link between Sleep Apnea and TMJ Video:
Most People who have TMJ Pain Have Airway Problems and Possible Sleep Apnea.
FAQ about Sleep Apnea:
How can I get Diagnosed with SA?
First, come in for a consultation and we can recommend a home sleep study. We believe home sleep studies are the most accurate since they are performed in the normal home environment. The home sleep studies are read by board certified sleep doctors (medical doctors). Dentists can provide therapies to improve the airway, but only a sleep medical can diagnose SA.
Natural Dentist Associates is one of the topmost holistic dentistry clinic specializing in the holistic sleep apnea treatment helping patients with a healthy natural dental health for 25+ years.
Will my Insurance Pay for SA Treatment
It depends on your insurance coverage. Dental insurance may have orthodontic coverage. Medical Insurance may have Sleep Apnea coverage. We can not bill medical insurance but we will provide the correct procedure codes and a medical insurance claim form so patients can file the claims themselves.
What Treatments Are Available for Sleep Apnea?
Mandibular Repositioning Appliances:
Below is the EMA Appliance. This is by far one of the most popular appliances around. These Appliances can be used for patients with Mild to Moderate SA. The Appliance requires the patient to bite forward with the lower jaw. When the lower jaw (Mandible) moves forward there is a mechanical opening of the mouth and airway. The appliance is worn at night for the rest of the patients life and when it is not used the SA patient will have a recurrence of Sleep Apnea episodes.
Positive Air systems that literally push air into the airway to overpower obstructions and increase airflow to the lungs. Obviously when the CPAP is not used SA recurs or worsens. These systems are not popular and many patients have compliance issues.
DNA Appliance corrective Airway Appliance (above)
DNA Appliance is a corrective therapy that redevelops the jaws and some of the facial bones. The Therapy increases the size if the mouth, nasal passageways and throat. The therapy can greatly improve or even correct Sleep Apnea. There are other Redevelopment Appliances available such as the ALF Appliance and the Homeoblock Appliance. This treatment since it is corrective is obviously the treatment of choice for many patients. Redevelopment Appliances take time and cost more money than CPAP and Mandibular Repositioning Appliances, but the can correct Sleep Apnea permanently and have other health benefits.
What Causes Sleep Apnea?
Many people have heads and faces that under develop. Under development causes individuals to have small mouths, noses and throats. No surprise, small mouths, noses and throats allow for less airflow to the lungs. Small mouths can be caused by kids not eating enough hard and chewy foods, bottle feeding vs breast feeding, malnourishment and of course genetic factors.
Wouldn’t I know if I have SA?
80% of patients with SA are not diagnosed. Sufferers of SA may have no symptoms at all.
SA people may have symptoms such as:
- morning tiredness or the feeling that it takes hours to “wake-up”
- Difficulty Concentrating. SA Kids have been mistakenly diagnosed with ADHD
- TMJ symptoms
- Weight gain/slow metabolism
- tightness in the neck, shoulder blades and muscles of the face
- “bags” under the eyes
- scalloped tongue
- history of difficult orthodontic treatment including extractions of teeth to correct dental crowding
Most people do not understand the health consequences of SA. The consequences of not treating sleep Apnea are Heart and Kidney Disease and possibly early death. Chronic SA sufferers find themselves disproportionately with Heart Attacks, Kidney Failure and Dialysis.
Do I have Sleep Apnea (SA) if I Snore?
YES, If you snore, you most likely have SA. Snoring is a noise made by air forcing through nose and mouth passages. Snoring can be caused by many factors. SA often associated with snoring and if an individual Snores, they should receive a Polysomnogram AKA, Sleep Study. Individuals who snore may not have Sleep Apnea. A snoring patient may just have an upper airway restriction. People with SA might not snore. Snoring is caused happens when air going to the lungs is partially blocked. If air flowing to the lungs is blocked completely and repeatedly, the diagnosis of SA is given to the patient. Treatment of Sleep Apnea is very important since it is one of the leading causes of HEART AND KIDNEY DISEASE. We will repeat, SA IS ONE OF THE LEADING CAUSES OF HEART AND KIDNEY DISEASE AND EARLY DEATH.