Sleep apnea affects an estimated 25 million American adults, and approximately 80% of sufferers are undiagnosed. Sleep apnea can lead to stroke, cardiovascular issues, and a myriad of other healthcare concerns, not least of which is the fogginess and fatigue that can cause poor judgement and raise your risk of an automobile accident. While the link between oral care and sleep apnea isn’t well understood, we do know that the most common form of sleep apnea involves the soft tissues in the mouth. For this reason, your dentist or oral hygienist can serve as your first line of defense in diagnosing sleep apnea.
What is sleep apnea?
Sleep apnea is a potentially serious sleep disorder where breathing stops and starts repeatedly during sleep. To be categorized as apnea, breathing must pause for 10 seconds or more. The interruptions in breathing cause sufferers to partially wake throughout the night dozens or hundreds of times, preventing deep, restful sleep. People with sleep apnea are often unaware of these shallow wakeful moments but they will notice exhaustion or drowsiness the next day.
Sleep apnea symptoms include:
- Daytime fatigue
- Awakening with dry mouth or sore throat
- Morning headache
- Difficulty concentrating and/or forgetfulness
- Mood changes
- High blood pressure
- Decreased libido
- Waking abruptly gasping or choking
What are the causes of sleep apnea?
The actual causes for sleep apnea can vary widely. Men are more likely than women to suffer from sleep apnea, and though it can affect people of any age, even children, it most often occurs in people over 40.
Risk factors for sleep apnea include:
- Nasal obstructions or sinus problems
- Enlarged tonsils
- Large tongue or large neck
- Small jawbone
- Family history of sleep apnea
Sleep apnea takes one of three forms: obstructive sleep apnea, central sleep apnea, or complex sleep apnea.
Obstructive Sleep Apnea (OSA): OSA is the most common form of sleep apnea, accounting for over 80% of cases in the U.S. OSA occurs when the muscles that support the soft tissues in your throat, such as the tongue and soft palate, relax too much narrowing your airway. The causes for OSA can range from dental malformations to sinus and allergy issues to obesity.
Central Sleep Apnea: Central sleep apnea is a neurologic issue in which the brain fails to activate respiratory muscles during sleep. Central sleep apnea most often occurs in association with another neurological disorder like a stroke or Parkinson’s disease.
Complex Sleep Apnea: A combination of central and obstructive sleep apnea, in which breathing problems persist even after airway obstruction is treated.
Sleep Apnea and Oral Health
Since the most common cause of sleep apnea involves all the soft tissues in the mouth, a dentist is often the first medical professional to spot the issue. Sleep apnea’s most common symptoms can be caused by a variety of factors. However, a few telltale signs in the mouth can indicate to a dentist that you have risk factors for Obstructive Sleep Apnea.
Bruxism is the technical term for tooth grinding. Grinding teeth in your sleep can cause headaches or neck and jaw pain in the morning. Research suggests that 13% of adults frequently grind their teeth while sleeping and more than 80% are unaware they do so. Dentists can spot tooth grinding in the wear on your teeth, inflamed, and receding gums.
Bruxism might be one of the body’s natural reactions to obstructive sleep apnea. Studies show that when your throat begins to relax before apnea, the jaw reflexively clamps down to prevent the airway from being blocked. Bruxism and OSA both appear to be related to certain sleep positions, and certain types of mouthguards called mandibular advancement devices reduce both bruxism and OSA.
Temporomandibular joint (TMJ) disorders are often reported in close association with obstructive sleep apnea. The TMJ connects the lower jaw to the upper jaw with two joints, one on either side of the face. When the joint or the muscles surrounding it are misaligned or otherwise malfunctioning, patients experience headaches, neck stiffness, ear pain, and popping or clicking noises when they move their jaw.
While the specific relationship between TMJ disorders and sleep apnea hasn’t been fully defined, both clearly involve malfunctions with the muscles surrounding and inside the mouth. One study in the Journal of Dental Research found that people with OSA were twice as likely to have TMJ disorders than those without sleep apnea.
People who suffer from sleep apnea often breathe through their mouth at night because the airways leading to the nose are narrower and more easily obstructed. Breathing through the mouth leads to mouth dryness, a major contributing factor to plaque, gingivitis, and periodontal disease. This is because saliva helps wash the surface of the teeth, cleaning away bacteria and the debris left from food that bacteria thrive in. While gingivitis and tooth decay certainly aren’t a clear indication of sleep apnea, taken along with other factors they might point to an OSA diagnosis.
How can a dentist treat sleep apnea?
The American Academy of Dental Sleep Medicine (AADSM) helps train and educate dentists like those at UGD in treating OSA. Most doctors will recommend a continuous positive airway pressure (CPAP) to treat sleep apnea, but patients may find this difficult to adjust to or prefer to try a less invasive treatment first. Our dentists have experience selecting oral appliances that can correct the obstructed airways and help get OSA patients restful sleep. We work with your doctor to pinpoint the causes for your obstructive sleep apnea and find the best treatment for you.
If you have trouble sleeping, snore loudly, or wake often feeling unrested, make sure you mention it at your next dental appointment so your dental care providers can check for other signs of sleep apnea. Likewise, if you know you have OSA and struggle to tolerate CPAP speak to one of our dentists about whether a customized oral appliance might be right for you. University General Dentists has trained oral appliance therapy specialists, as well as more than 30 years of experience in all other forms of oral care. Schedule an appointment at our UT office at 865-305-9440 or at our West Knoxville office at 865-500-5700.