COMMON SYMPTOMS OF A SLEEP DISORDER

Do you suffer from any of these?

Fatigue
Headaches upon Awakening
Excessive Daytime sleepiness
Falling Asleep While Driving
Difficulty Concentrating
Difficulty Breathing through your Nose
Hoarseness in the Morning
Memory Problems
Depression
Frequent Illnesses
Irritability
Night Sweats
Weight Gain
Loud Snoring

Causes of Sleep Disorder

Sleep is as important to your health as diet and exercise. Without enough sleep, it's impossible to live your life to its fullest.

By the most basic definition, anyone who doesn't get enough quality sleep has a "sleep disorder? -- a broad term that is used to identify a range of problems.

Sleep is as important to your health as diet and exercise. Without enough sleep, it's impossible to live your life to its fullest.

Sleep problems have many causes:

• It could be a problem with your airway and/or your breathing, such as snoring and obstructive sleep apnea.
• It could be a problem with the way signals travel to and from your brain, such as narcolepsy.
• It could be a condition that causes uncontrollable leg movements at night--that is, restless legs syndrome.
• Or it could be one of the many problems that lead to insomnia, such as stress.

Sleep disorders are common among patients who suffer from allergies, ulcers, arthritis, heart disease, asthma, hyperthyroidism, kidney disease, Parkinson's disease, and Alzheimer's disease. If you or someone you love is suffering from a lack of restful sleep, a smart first step is to discuss your concerns with a sleep physucian or with Dr. Demerjian.

Commonly Known Sleep Disorders

SNORING

"Laugh and the world laughs with you. Snore and you sleep alone."

Snoring is partially obstructed breathing Some 76 million people in North America (U.S. and Canada) suffer from snoring. Snoring is frequently a person's most socially disruptive and annoying personal trait. Recent research reveals that continuing throughout life as a snorer or a sleep apneic no longer is unavoidable, but rather is a personal choice - a decision by a specific person not to do anything about it.

• 60% of males and 40% of females over the age of 60 snore (female snoring increases after menopause).
• The loudness of snoring may reach as high as 90 db(worker’s compensation requires ear protection in the workplace at 90 db).
• 98.5% of snorers exhibit some apneic tendencies.

Snoring can lead to sleep apnea because it can change tissue structure. In recent clinical studies, dentists and physicians have found that, in the majority of patients, a well-made, well-fitted dental appliance will effectively reduce or eliminate snoring.

Most sleep researchers agree that the position of the tongue during sleep is a substantial causative factor in both snoring and sleep apnea. As a person goes to sleep, especially while lying on his or her back, the muscles of the tongue and jaw relax and these structures move backward against the posterior wall of the throat. As the airway becomes partially blocked, snoring occurs . If it progresses to complete airway blockage, sleep apnea (multiple stoppages of breathing for 10 seconds or longer) occurs . The tongue is attached to the lower jaw. By moving the lower jaw forward with a nighttime dental appliance, the tongue is moved forward, the airway is opened up and stays opened, and snoring stops. The snoring stays stopped as long as the appliance is worn. Most severe snorers wear their appliances for the rest of their lives. The downside of the dental approach is that there is a two to three night adjustment period (as with any other item such as contact lenses) and possible sore teeth for a few nights if the snorer is a nighttime tooth grinder. Upon awakening, your bite may be different for approximately thirty minutes.

Upper Airway Resistance Syndrome (UARS)

The term “Upper Airway Resistance Syndrome” (UARS) is used to describe chronic daytime sleepiness that is often accompanied by snoring, brief yet frequent arousals, and only slightly abnormal breathing. Unlike snoring and obstructive sleep apnea, UARS is often more prevalent among women than men.

Symptoms may include:

• Sleep-onset insomnia
• Headaches
• Gastroesophageal reflux
• Depression
• Bruxism (grinding of teeth),
• Rhinitis
• Hypothyroidism
• Asthma

People who suffer from UARS lack the typical findings of apnea, hypopnea and nighttime oxygen desaturation on polysomnography (diagnostic sleep studies). As a result, UARS is often not diagnosed by physicians. However, the arousals and sleep fragmentation related to an increased effort to breathe can be diagnosed by measurement of pressure changes in the esophagus. Source: Quiet Sleep

Obstructive Sleep Apnea (OSA)

Virtually all people that have sleep apnea snore, but not all snorers have sleep apnea. Because sleep is repeatedly interrupted during the night you never get a full night's sleep, and day-time sleepiness is a second major indication. Other indications include falling asleep during the day, automobile accidents or accidents on the job due to tiredness or exhaustion, changes in personality, mental fatigue resulting in difficulty in thinking and concentrating, frequent nocturnal urination, and high blood pressure with the attendant increased risks of heart attack and stroke. Suspect you have sleep apnea if your spouse reports that your stoppage of breathing, gasps, choking, and your attempts to start breathing again "scare her to death."

Obstructive sleep apnea (OSA) is far more common than central sleep apnea . OSA occurs when air cannot flow into or out of the person’s nose or mouth, although efforts to breathe continue. In a given night, the number of involuntary breathing pauses – or “apneic events” – may be as high as 20 to 60 or more per hour. Snoring and choking between apneic events is common, although not everyone who snores has OSA. The frequent interruptions of deep, restorative sleep often lead to excessive daytime sleepiness and may be associated with early morning headache.

OSA occurs in all age groups and both sexes but is more common in men (it may be underdiagnosed in women). Early recognition and treatment is important because OSA may be associated with irregular heartbeat, high blood pressure, heart attack, and stroke.

Once diagnosed, OSA is often managed through the use of a Continuous Positive Airway Pressure (CPAP) machine or dental appliances that reposition the lower jaw and the tongue.

• Rates of OSA are 2x-4x higher after age of 50.
• Mild to moderate sleep apnea patients are the most likely not to be screened.
• Untreated sleep apnea can put you at increased risk of developing:
• Hypertension
• Heart disease
• Stroke
• Diabetes

Source: National Sleep Foundation

Central Sleep Apnea

There are two main types of sleep apnea. “Central Sleep Apnea” appears to be related to a malfunction of the brain’s normal signal to breathe, therefore cannot be treated by dental sleep appliances. It is less common than “Obstructive sleep apnea” which may represent cessation of breathing due to mechanical blockage of the airway.

Prompt and proper diagnosis is an important first step to treating any and all forms of sleep apnea. Problems associated with untreated sleep apnea include hypertension, coronary artery disease, myocardial infarction, stroke, psychiatric problems, impotence, cognitive dysfunction, memory loss, and death.

Source: National Institutes of Health

Sleep Bruxism

Sleep Bruxism (SB) is the gnashing, clenching or grinding of the teeth during sleep. It is the third most prevalent sleep disorder, after sleep talking and primary snoring. Tooth grinding or tooth-clenching during sleep may cause:

• Abnormal wear of the teeth.
• Sounds associated with bruxism (It's about as pleasant as fingernails on a chalkboard!).
• Jaw muscle discomfort.

Some people have episodes of SB that occur less than nightly with no evidence of dental injury or impairment of psychosocial functioning. Others experience nightly episodes with evidence of mild impairment of psychosocial functioning. Yet others have nightly episodes with evidence of dental injury, temporomandibular joint (jaw) disorders , or moderate or severe impairment of psychosocial functioning.

Source: The Sleep Well, Stanford University

Excessive Daytime Sleepiness

Excessive Daytime Sleepiness (EDS) is a condition in which an individual feels very drowsy during the day and has an overwhelming urge to fall asleep, even after getting enough nighttime sleep. People with EDS frequently doze, nap, or fall asleep in situations where they need or want to be fully awake and alert. This can be particularly dangerous at times, such as when driving a car or operating other hazardous machinery.

EDS can interfere significantly with a person's ability to concentrate and perform daily tasks and routines. People with EDS often report feelings of low self-esteem, frustration, and anger about being misunderstood and regarded as unintelligent, lazy or uninterested in learning. They also report having difficulty with relationships -- in social situations, in the workplace, and within the family.

EDS is a sign of an underlying medical condition, typically a sleep disorder.

Treatment

After a thorough examination of the airway and nasal passages, if the problem is found to be in the nasal passages or adenoids and tonsils a referral will be given to an otolaryngologist (ENT) with the testing results for the ENT to be able to determine the degree of obstruction and necessity for surgery.

If a patient has been diagnosed with obstructive sleep apnea (OSA) by a sleep physician, then a qualified dentist like Dr. Demerjian can make a Dental Sleep Appliance to keep the airway open in the back of the throat, treating the obstruction and any snoring.

CPAP is an extremely effective therapy; however, nationally only 45% of patients using CPAP machines continue to use them.

The American Sleep Disorders Association is recommending dental appliance treatment for patients with severe OSA who are intolerant of, or refuse treatment with, CPAP.

What is a CPAP?

A CPAP (continuous positive airway pressure) is a machine that delivers lightly pressurized air through a hose to a small nose mask. The flow of the air acts like an "air splint" to keep the upper airway open and prevent apnea (i.e., shortness of breath). CPAP machines have 99% efficiency in restoring normal breathing during sleep. They have also undergone many improvements since an Australian invented the first one from a vacuum cleaner and a length of hose. However, the rate of patient compliance with CPAP is less than 50%.

Are There Alternatives to CPAP?

Yes! Thanks to advances in dental sleep medicine, qualified dentists can effectively treat many patients who suffer from snoring, obstructive sleep apnea, upper airway resistance syndrome and other sleep-disordered breathing problems using oral appliance therapy.

An oral sleep appliance is similar in appearance to an athletic mouthguard, and it is worn during sleep to maintain airway patency. Oral sleep appliances are safe, less expensive vs. CPAP or surgery, and easy to use. There are also few, if any, side effects. However, one size does not fit all.

There are currently six (6) different FDA-approved oral appliances we can use to treat sleep-disordered breathing. Regardless of the appliance selected, to be effective, it must be properly customized and precision fit for each patient.

For some patients, an oral sleep appliance can eliminate the need for CPAP or surgery. For patients with more severe sleep problems, an oral appliance can be an effective and convenient adjunct therapy.

At the present time, obstructive sleep apnea is defined as a medical problem and the diagnosis must be made by a medical doctor or sleep physician (pulmonologist) who is specially trained in the area of sleep medicine.

The dental profession has an important role to play in the treatment of patients with snoring and sleep apnea. If 60% of men and 40% of women between forty and sixty years of age snore, this is a huge problem. Snoring is a serious social problem for the spouse, but obstructive sleep apnea can be a life threatening situation for the patient in that it can lead to irregular heartbeat, high blood pressure and strokes.

At the present time, obstructive sleep apnea is a medical condition that is being controlled and treated mainly by the medical profession. Despite the fact that in September 1995, the American Sleep Disorder Association finally endorsed oral appliance therapy as the third currently acceptable treatment method for snoring and sleep apnea, the vast majority of the medical doctors are not aware of the value of oral appliances

As time goes on, the public is going to become more aware of the health risks associated with snoring and sleep apnea. It is the dental profession ' s responsibility to educate their members, the public and the medical profession about the important role that dentists and oral appliances play in the treatment of snoring and obstructive sleep apnea.