Snoring wake up call/ dentistry studies

Snornig
The Wake Up Call
INDIAN DENTAL ACADEMY
Leader in continuing dental education
www.indiandentalacademy.com

Introduction

 Sleep disorders are very common.
 Over two hundred million adults suffer from
chronic rest-related problems. An additional
twenty to thirty million get inadequate sleep.
 Anxiety, exhaustion and concentration difficulties
are all common symptoms of such disturbances.
Not surprisingly, excessive daytime fatigue
increases the likelihood of accidents, especially
when driving.
They can be Life Threatening: Treating It Is
Important

The International Classification of Sleep Disorders
(ICSD) lists over 84 different types.
The ICSD divides sleeping problems into four
general classifications:
 Dyssomnias,
 Parasomnias,
 Medical/psychiatric problems,
 Proposed disorders

A dyssomnia is a disruption of the body's natural
resting and waking patterns. Dyssomnias may
be extrinsic (having an external cause), or
intrinsic (having their cause in the body).

 Parasomnias are conditions that interrupt
sleep. They're caused by difficulties with
arousal or sleep stage transitions.

Medical or psychological conditions
 Alcoholism, ulcers, asthma and anxiety
disorders, can cause rest-related disturbances.
In such cases, treating the underlying problem
should improve a person's rest pattern.

Proposed disorders are rest-related disturbances
that are under investigation. They may or may
not prove to be actual disorders.

Sleep apnea is a disorder that commonly affects
more than 12 million people
It takes its name from the Greek word apnea,
which means "without breath."
People with sleep apnea literally stop breathing
repeatedly during their sleep, often for a minute
or longer and as many as hundreds of times
during a single night.

There are three types of sleep apnea—
Obstructive,
Central,
Mixed.

Obstructive Sleep Apnea: By far the most
common variety of the disorder, obstructive
apnea occurs when the airway is partially
blocked.
Central Sleep Apnea: The mechanism in the
brain responsible for breathing sends faulty
messages while the body is asleep, causing
frequent cessation of breathing.
Mixed: A combination of the other two types.

Causes

 The exact cause of OSA remains unclear. The
site of obstruction in most patients is the soft
palate, extending to the region at the base of the
tongue.
 When you breathe normally, air passes through
the nose and past the flexible structures in the
back of the throat such as the soft palate, uvula
and tongue.
 While you are awake, muscles hold the airway
open. When you fall asleep, these muscles
relax, but, normally, the airway stays open.

 The arousal from sleep usually lasts only a few
seconds.
 These brief arousals disrupt continuous sleep
and prevent the person from reaching the deep
stages of slumber, such as rapid eye movement
(REM) sleep,
 The body needs this in order to rest and
replenish its strength. Once normal breathing is
restored, the person falls asleep only to repeat
the cycle throughout the night.

 Typically, the frequency of waking episodes is
somewhere between 10 and 60.
 A person with severe OSA may have more than
100 waking episodes in a single night.

Risk Factors

 Excessive weight gain is a primary risk factor
 Age is another prominent risk factor.
 Men have a greater risk for OSA

 Anatomic abnormalities, such as a receding chin
enlarged tonsils and adenoids, are the main
causes of OSA in children
 Family history of OSA, is seen although no
genetic inheritance pattern has been proven
 Use of alcohol and sedative drugs, relax the
musculature in the surrounding upper airway
 Smoking, causes inflammation, swelling, and
narrowing of the upper airway
 Hypothyroidism, acromegaly, amyloidosis, vocal
cord paralysis, post-polio syndrome,
neuromuscular disorders, Marfan's syndrome,
and Down syndrome
 Nasal congestion

Signs and Symptoms
Excessive daytime sleepiness,
Nonrestorative sleep,
Automobile accidents,
Personality changes,
Decreased memory,
Depression.
Drowsy driver syndrome

 The physical signs that suggest OSA include
loud snoring, witnessed apneic episodes, and
obesity.
 Hypertension is prevalent in patients with OSA,
although the exact relationship is unclear. It has
been shown, however, that treating OSA can
modestly lower blood pressure.

Complications
 Diminished quality of life brought on by chronic
sleep deprivation
 Coronary artery disease, cerebral vascular
accidents (strokes), and congestive heart failure
are being evaluated to define the exact nature of
their connection to OSA.

Diagnosis

History from the patient and his/her sleeping
partner (supported by the use of questionnaires
such as the Epworth Sleepiness Scale)
Ear, nose and throat examination (to identify any
obvious physical obstructions)
Body Mass Index (determined from the subject's
weight and height).
Polysomnography.

Treatment
 Changes in life style
 Positional therapy
 Positive Pressure Therapy
 Surgery
 Oral Appliances

Changes in life style
 Losing excess weight
 Getting regular exercise
 Within three hours of bedtime, avoiding alcohol,
heavy meals, and medications that make the
person drowsy.

Positional therapy
 Avoid sleeping on the back
 Train to sleep on the side

Nasal CPAP (Continuous Positive
Airway Pressure)
 An air compression device and a nose mask are
used to force the airway open and aid breathing
during sleep.

Surgery

 Somnoplasty – this minimally invasive procedure
uses radiofrequency energy to reduce the soft
tissue in the upper airway.
 Uvulopalatopharyngoplasty (UPPP) – this
procedure removes soft tissue on the back of the
throat and palate, thereby increasing the width
of the airway at the throat opening. (see
uppp.htm)
 Mandibulo maxillary advancement surgery – we
can surgically correct certain facial abnormalities
or throat obstructions that contribute to sleep
apnea.
 Nasal Surgery – Nasal obstructions such as a
deviated septum should be treated by
appropriate surgical procedures.

Oral Appliance Therapy
Oral appliances are relatively small, and easy to
wear. The appliance is usually of little weight and
its small size makes it easy to travel with.
Most people find it takes no more than a few weeks
to become completely comfortable wearing the
appliance.

 Oral appliances are relatively inexpensive. The
total cost of therapy is considerably less than the
cost of alternative treatments.
 Treatment with a oral appliance is reversible and
non-invasive (it does not involve surgery).
 ADA glossary of dental items now provides a
dedicated item No. 985 for oral appliances for
snoring and sleep apnoea

Oral appliances work in one of three
ways
 Hold the tongue forward
 Bring lower jaw forward
 Lift a drooping soft palate

Basic categories of appliances
 Soft palate lifters for snoring only
 Tongue retainers
 Mandibular repositioners

Mandibular repositioners

Mode of action
This serves to open the airway in several different
ways
 By indirectly pulling the tongue forward
 By increasing the baseline genioglossus activity
(muscle tone of the tongue)
 By stabilizing the mandible and the hyoid bone

Thornton Adjustable Positioner
(TAP®)
 Oral appliance, which is a mandibular
advancement device composed of two
separate arches (maxillary and
mandibular).
 Containing an advancing mechanism
which permits unlimited advancement of
the lower jaw.

The OASYS Oral/Nasal Airway System
 Is another, but is the first dental device to be
reviewed by both the dental and ENT divisions
of the FDA and to be approved as a dental
device for treatment of snoring and sleep apnea
It works through mandibular repositioning and
also as a nasal dilator for reduction of nasal
resistance and improved nasal breathing

The SILENT NITE® device
 Does not interfere with breathing through the
mouth, and is one of the more comfortable
designs. It is not made for severe grinders, but it
is a comparatively small device with tiny
connectors attached to transparent flexible
upper and lower forms.

Endsnore Appliance

Klearway

Tongue Retaining Device
 The "TRD" is constructed of a flexible polyvinyl
material adapted to the general contours of the
teeth and dental arches.
 It does not depend on teeth for retention. Rather,
the tongue is held forward by the negative
pressure created in the vacuum bulb on the front
of the appliance

Tongue Stabilizing Device
 The aveoTSD is made from a soft medical
silicone for comfort and works by holding the
tongue forward by gentle suction preventing it
from falling back against the back of the throat ,
keeping the airway open during sleep .

Requirements for oral appliance
 Patient has no or minimal Temporomandibular
Joint Dysfunction
 Controlled gum disease and dental decay
 Preferably no full dentures (but not a total
contraindication)

Common side effects
 Excessive salivation
 Transient discomfort to teeth, TMJ
 Dry mouth
 Soft tissue irritation
 Temporary, minor bite disharmonies

Uncommon side effects
 Significant TMJ discomfort/dysfunction
 Permanent occlusal changes

Effectiveness of oral appliances
 Various studies demonstrate 70-90% success
rates
 In suitable selected subjects snoring and OSA
may be effectively reduced or eliminated

Conclusion
 OSA although a potential life threatening
disorder, is relatively simple to treat.
 The dentist is a essential part of the
interdisciplinary team in providing patient care.
 The oral appliances are effective, noninvasive,
reversible treatment modality that needs to be
given due consideration.

For more details please visit

Bibliography
1. The role of oral appliances in treating obstructive sleep apnea NEDA
MOHSENIN, MINA T. MOSTOFI, D.M.D. and VAHID MOHSENIN, M.D. J
Am Dent Assoc, Vol 134, No 4, 442-449. © 2003 American Dental
Association
2. Current principles in the management of obstructive sleep apnoea with
mandibular advancement appliances
A. Johal1 and J. M. Battagel2
MAY 26 2001, VOLUME 190, NO. 10, PAGES 532-536
3. Oral appliance therapy for snoring and obstructive sleep apnoea
Dr J A Gerschman
4. Oral Appliance Therapy for Obstructive Sleep Apnea
Kathleen Ferguson
Am. J. Respir. Crit. Care Med., Volume 163, Number 6, May 2001, 1294-
1295

 Titratable Oral Appliances for the Treatment of Snoring and Obstructive Sleep
Apnea
• Alan A. Lowe, DMD, Dip. Ortho., PhD, FRCD(C) •
© J Can Dent Assoc 1999; 65:571-4

Snoring wake up call/ dentistry studies

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