Dentistry and sleep disorders

Sleep is a behavioural state that is a natural part of every person’s life. In fact, we spend about a third of our lives asleep. Although sleep and its roles are still poorly understood by the medical community, we do know that it is an essential activity that is required for normal daily functioning. We know that an inadequate amount of sleep can have a detrimental effect on a person’s life.

We also know of more than 70 sleep disorders, and one of the most common of these is known as obstructive sleep apnea. The word apnea literally means ‘no breathing,’ and people with sleep apnea have multiple episodes of interruption of breathing during sleep. OSA can result in daytime drowsiness, reduced quality of life, memory loss, and poor concentration.

OSA has also been linked to a number of serious health issues, including hypertension (high blood pressure), coronary artery disease (angina and heart attack), heart failure, cerebrovascular disease (stroke), depression, and type 2 diabetes.

Our understanding of sleep disorders has increased greatly over recent years. In fact, it has only been since 2009 that the Public Health Agency of Canada has been studying OSA and other sleep disorders and reporting statistics on incidence. The first published data in 2009 indicated that three per cent of Canadian adults reported that they had been diagnosed with sleep apnea. It is suspected that the actual incidence is much higher, since the only way to definitively diagnose OSA is with a sleep study, and many Canadians have never had this medical test. Some health professionals are now advocating for routine testing of all adults for OSA, in the same way that routine colonoscopy is recommended for adults over 50.

Not everyone who snores has sleep apnea, and yet snoring is one of the most common symptoms of sleep apnea. Other common symptoms are sudden awakening during the night, daytime drowsiness, headache, and inability to concentrate. Males suffer sleep apnea more than females, and obesity is also a risk factor.

At present the most common treatment for OSA is the nightly use of a continuous positive air pressure machine, which keeps the airway open with a continuous gentle stream of air. Although a CPAP machine is effective in treating sleep apnea, there are some objectionable aspects to the device, including the noise generated by the machine, having to wear a mask on the nose overnight, and dryness in the mouth.

For those who find using a CPAP machine difficult or objectionable, there is an alternative treatment available, and this is where dentists can become involved in OSA therapy. There are a variety of oral appliances fabricated by dentists that can effectively treat sleep apnea.

These appliances offer some advantages over a CPAP machine since they don’t have to be plugged in, are more portable and less bulky, and are silent. Anyone who has either symptoms of OSA or risk factors for sleep apnea should first consult their family doctor to determine whether a sleep study is indicated. Once a diagnosis of obstructive sleep apnea has been made, then either the CPAP or oral appliance treatment option can be considered.

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