WHAT IS SLEEP APNEA?
Obstructive Sleep Apnea (OSA) is a very common sleep disorder where a person momentarily stops breathing due to complete or partial upper airway obstruction or a narrow upper airway. Excess or floppy tissues in the throat can collapse, obstructing the airway. This upper airway obstruction can cause breathing to stop (apnea). This causes snoring or choking sounds as the person tries to breathe. When oxygen levels drop, the heart rate and blood pressure will also increase - leading to hypertension.
In some people, nocturnal teeth or tooth grinding (sleep bruxism) can occur together with sleep apnea. In mild sleep apnea, sleep bruxism may be one of the earliest sign of airway restriction.
“1 In 3 People Snore Or Have Obstructive Sleep Apnea. 30% Of These Patients Will Be Found To Have Moderate To Severe OSA.”
WHAT IS SNORING?
Snoring is the sound produced by the vibration of the tissues in the nose, mouth and throat.
HOW DO I KNOW IF I HAVE OSA?
Have you any of these symptoms? Or have you been told that you have any of the following
During the day:
- Excessive sleepiness or tiredness
- Poor memory
- Poor concentration
- Morning headaches
- Dry mouth/throat upon awakening
- Mood changes
During the night:
- Choking sensation at night
- Gasping for air at night
- Frequent awakening
- Frequent urination
- Loud snoring
- Teeth Grinding
Try to complete our sleep questionnaire to find out if you are at risk of having sleep apnea!
IS SNORING / OBSTRUCTIVE SLEEP APNEA DANGEROUS?
The early hours of the morning are the most dangerous for people with obstructive sleep apnea. Between midnight and 6 am, patients with sleep apnea are 6 times more likely to die from a stroke or a heart attack triggered by chronic high blood pressure, and low blood oxygen can trigger.
Patients with sleep apnea have a shorter life expectancy compared to people without sleep apnea.
HOW IS SLEEP APNEA TREATED?
Patients with sleep apnea potentially may have a “global” problem, i.e. obesity, or a “local” anatomical problem (those with huge tonsils, long thick palate, big tongue and/or a small jaw).
General tips to reduce OSA include:
- weight loss
- regular close follow up
BMI, neck circumference, oral cavity adequacy, tonsillar size, palate size/length, tongue size, upper airway assessment, and the nasal passage size are assessed to guide treatment.
Management of snoring and sleep apnea may be non-surgical and/or surgical.
ORAL APPLIANCES FOR SLEEP APNEA /BRUXISM
Oral appliances are designed to widen the airway. Oral appliances can be very useful if you cannot or do not wish to have surgery, or are unable to tolerate CPAP.
Mandibular Advancement Devices (MAD) clip on to the upper and lower teeth and position the lower jaw forwards.
More patients can tolerate regular continued use of MADs compared to CPAP (see below).
Close monitoring of a sleep appliance is mandatory.
The CPAP system uses compressed air forced through a mask worn by the patient on the nose or the face. The mask must be throughout the entire night and for every night for life, which is difficult to do.
CPAP is effective only if the mask is worn, and only 34% of patients do so.
Common reasons for poor compliance with CPAP include:
- nasal problems
- mask problems
- equipment problems
“Heart Attack And Stroke Risk Are Similar For CPAP-Treated OSA And Untreated OSA.”
HOW IS SLEEP APNEA DIAGNOSED?
Check out our sleep questionnaire to find out if you are at risk of having sleep apnea!
Sleep Assessment Tests
HOME SLEEP TESTS
The NightOwl is currently the world’s smallest home sleep apnea test.
The NightOwl system consists of a small sophisticated sensor which is placed on the fingertip and the cloud-based NightOwl software. The NightOwl sensor can measure all parameters recommended by The American Association for Sleep Medicine (AASM) Manual for the Scoring of Sleep and Associated Events for home sleep apnea testing.
The test results will be interpreted, and this will be used to see if you require more extensive sleep testing (polysomnography).
The Watch PAT is a USFDA and Singapore HSA-approved home sleep apnea test system.
Watch PAT results have been shown to mirror hospital sleep testing very closely.
HOSPITAL SLEEP TESTS
Polysomnography measures multiple parameters such as brain wave activity, muscle activity, eye movement during sleep etc.
Although the in-hospital overnight sleep test is the most comprehensive, there are some drawbacks and limitations
- high cost
- long waiting lists
- intensive labour requirements (requiring a sleep technician overnight)
- difficulties for elderly or very ill patients to travel to the hospital and spend the night in the sleep laboratory
- many patients often find the equipment too cumbersome and
- the first night effect (due to the new environment, patients might not be able to sleep at all)
Due to these shortcomings, patients should have their sleep monitored at home, to begin with.
SNORING/SLEEP APNEA MANAGEMENT AT NUFFIELD DENTAL
Step 1: Assessment
Breathing patterns and tooth wear is assessed as part of a new patient examination and active maintenance. Your nose, sinus abnormalities and lower jaw disproportion can be assessed on dental x-rays. (Both an Orthopantomogram and a Lateral Cephalogram)
Further testing will then be done to assess the severity of your condition. A home sleep test ( NightOwl or Watch PAT) may be prescribed.
If needed, we can make a Trial Dental Sleep Apnea Device on the Same Day.
Step 2: Making and fitting of your oral appliance
If you have been advised that you require a customised oral appliance, then mould of your teeth and bite records will be made.
Once made, the appliance will then be fitted and adjusted to ensure maximum comfort. Expect a period of adjustment when you first start using the appliance. It is common to experience difficulties falling asleep, increased salivation and mouth dryness. Several adjustment visits may be needed to fine-tune the appliance. The dentist will use your home sleep tests to titrate the dental appliance to make it work best for you and monitor treatment effectiveness.