Sleep Problems and Sleep Disorders
Sleep problems and snoring can have serious ramifications. The team at Robert Duhig Dental is specifically trained to assess and treat patients with sleep disorders, including sleep apnoea.
About 20% of the adult population snores. While snoring can be annoying for partners, it mostly isn’t a medical concern in itself. In some cases, though, snoring can be a warning sign of a serious condition, called Obstructive Sleep Apnoea.
People with Obstructive Sleep Apnoea find their airway collapses during sleep which stops them breathing for between 10 seconds to over a minute. This broken sleep pattern causes sufferers to wake up feeling very tired.
Obstructive Sleep Apnoea and other sleep breathing disorders can be linked to more serious health concerns, including high blood pressure, diabetes, stroke and heart attack.
These disorders can also cause excessive daytime sleepiness which can markedly increase the risk of:
- motor vehicle accidents
- home- and work-related injuries
- poor school performance in children
- Symptoms of Obstructive Sleep Apnoea include:
- gasping or choking at times during sleep which can lead to a dry, irritated throat
- excessive tiredness during the day
- falling asleep easily during the day
- a reduction in concentration and memory
- loss of function at work
- increased irritability which can contribute to anxiety and depression
There are many symptoms in both the mouth and teeth that patients present with when they go to the dentist. These include: tiredness and fatigue, recurrently fractured teeth and fillings, TMJ Dysfunction including TM Joint and Muscular problems, and large bony tori [bony growths on the inside of the lower jaw], and Scalloped Tongue [where the outside edge of the tongue has a scalloped appearance as a result of it being squeezed up against the inner surfaces of the teeth]. Scalloped Tongue has a 70% correlation with Sleep Disordered Breathing and is very, very common.
Sleep Disorder diagnosis and treatment
The practice has recently acquired Medibyte, Home Sleep Testing Equipment. Much simpler than a Hospital Sleep Test, the Medibyte enables an overnight test that gives a prompt and clear picture of a patient’s sleep experience. Since it has been installed we have been staggered by the number of patients that have had some form of sleep problem or another and nearly all of them have been surprised by what the Test has revealed. Some examples are a patient who knew she was afraid of driving long distances lest she have an accident. This lady had severe Sleep Apnoea. Another patient, who has Mild Sleep Apnoea and spends much of the day tired, turned out to be Sleep Walking for over two hours a night.
Diagnosis of Sleep Apnoea is based measurement of Arousal from Sleep by Complete Obstruction of the Airway [for longer than 10 seconds] -or Apnoeas, Partial Obstructions- or Hypopnoeas, and Arousals of less than ten seconds. A scale of severity determines whether a patient has Mild, Moderate or Severe Sleep Apnoea.
Patients with Moderate or Severe Sleep Apnoea will be referred to an Ear, Nose and Throat Specialist for Assessment, and then to a Sleep Physician who will require a Poly Somnogram or Hospital Sleep Test. Severe Sleep Apnoea is usually treated with CPAP [see below], while Moderate Sleep Apnoea may be treatable with Oral Appliances.
Continuous Positive Airway Pressure (CPAP), CPAP is very effective at treating sleep apnoea, but some people find this device difficult to sleep with as a long-term solution.
Surgery. This can be very effective where suitable.
Oral Appliances. This is not only a simple and effective way to treat sleep apnoea, it’s much simpler for you to become accustomed to using than a larger, more intrusive CPAP machine. Ideal for mild to moderate sleep apnoea sufferers, the appliance positions the lower jaw forward which helps prevent the airway collapsing during sleep. This method is best suited to people with good dental health and no pre-existing jaw joint problems.
Upper Airway Resistance Syndrome
Are you insomniac, you go to bed but wake up and can’t get back to sleep? Are you cranky or short tempered? Do you suffer from Headaches or Jaw Pain? Do you find you have excessive daytime sleepiness or fatigue or waking unrefreshed?
Upper Airway Resistance Syndrome is a condition that bears some similarity to Sleep Apnoea but many of these patients will get a Sleep Test, on the conventional Apnoea Hypopnoea Index [AHI], which will return a normal result, despite profound tiredness. These patients are often younger and less obese than the Obstructive Sleep Apnoea patients and are often women. They are commonly diagnosed with Fibromyalgia, Irritable Bowel Syndrome, Chronic Fatigue Syndrome and often end up at a psychiatrist or getting a bag of medications.
A Sleep Test with the Medibyte is the first step in identifying this condition. The Medibyte will assess all arousals and record, in addition to the more conventional AHI, a Respiratory Disturbance Index [RDI] which is often elevated in Upper Airway Resistance patients relative to the AHI.
Treatment may include Oral Appliances and Exercise.