Sleep Apnea and Inspiratory flow limitation associated with Sleep-disordered breathing
Most of us spend almost one-third of our lives asleep. That is a lot of time! What many of us don’t consider however, is that sleep has a function beyond just “making us less tired”. Sleep is a fundamental process that is vital to our bodily health and sustenance.When an individual has disrupted sleep, the consequences can be severe.
Sleep-disordered breathing is a potentially dangerous disorder that can significantly affect the health of our patients. There are essentially three forms of sleep apnea: Obstructive sleep apnea (OSA), central sleep apnea (CSA) or a combination of both OSA and CSA. Sleep apnea occurs when the soft tissues at the back of the throat (upper airway), cause either the lateral walls of the pharynx, soft palate, and/or tongue to collapse. This often results in repeated blockage of the airway while we sleep (OSA) or brain signal failure wherein the body is not told to breathe (CSA) throughout the entire night. To try to imagine what is happening in your airway, think of sucking through a straw that is completely plugged (full blockage).
Another airway disorder that occurs at night is Inspiratory flow limitation (IFL). To visualize this disorder, try sucking a very thick milkshake through a thin straw. It’s not easy, imagine needing to do that all night to breathe! IFL creates a disturbance in our sleep patterns and stress on our stomatognathic system.
As you might expect, not breathing or having a limited flow of air during the night can lead to a breakdown of our minds and bodies – a breakdown of our overall health. It is my personal belief that it is better to look at the prevention of this potentially dangerous disorder rather than waiting for the disease to come to a conclusion. For example, it would be better to detect heart disease and take appropriate preventive measures, than to wait for the first heart attack or stroke. This is why, at Braeside Dental Centre, we take the steps to identify, help with diagnoses, and treat potential patients that may be suffering unknowingly as early as possible.
What are some of the health complications associated with Sleep Apnea?
Here are a number of health risks associated with Sleep Apnea:
Nocturnal sympathetic nervous system activation
Elevated blood pressure
Large negative intrathoracic pressure swings putting stress on the heart and great vessels
Can lead to cardiovascular events such as strokes
Associated with Type II diabetes
This is only a small number of risks from a more expansive complete list. If you feel a discussion would be appropriate, please let us know. We can either do a sleep study to start the process or recommend that you speak to your primary care physician.
What are the stages of sleep?
There are essentially 4 stages of sleep. We sleep in cycles of 90-120 minutes during the night. Non-REM sleep is made up of the first 3 stages. Stage I and Stage II of non-REM sleep are lighter stages of sleep. It is during the third stage, the deep sleep, that we experience muscle recovery, hormone release, and increased short term memory storage. Therefore, in a simple summary, Non-REM sleep helps with the recovery of the body in the early stages of the night. REM sleep, which is the fourth stage, helps with healing and managing emotion, anxiety, depression, and pain management. Essentially, Stage four or REM sleep helps with the recovery of the mind.
What does sleep apnea or sleep disordered breathing have to do with dentistry?
In dentistry, we observe signs and symptoms that correlate with the rest of the body. So, if there are signs and symptoms observed in the mouth, they are also likely to be happening elsewhere in the body. Dentistry is a window to the overall health concerns someone maybe experiencing.
For example, in patients likely to have sleep apnea, we may see some of the following:
- Increased inflammation
- Chronic stress
- T.M.J. issues
- Migraine and tension headaches
- Worn dentition (Bruxism and clenching)
- Chronic fatigue syndrome
- Adrenal fatigue
- Anxiety disorders
- Increased incidence of hypertension
- Narrow upper jaw
- Retrognathic lower jaw
Who should get tested?
Some of the signs and symptoms for sleep apnea that you should watch out for include: snoring, fatigue, insomnia, headaches, increased BMI, mood disorders, increased BP, type II diabetes, periodic gasping for air, unrefreshed sleep, daytime fatigue, and genetic predisposition. In general, we recommend that individuals take the STOP BANG questionnaire. If you hit certain points and reach a concerning result, a discussion would be meaningful.
As a very generalized approach, here are some “rule of thumbs” for taking the STOP BANG questionnaire and having a discussion with us on risk factors.
1) Males over the age of 50
2) Females premenopausal that suffer from insomnia
3) Females postmenopausal that suffer from fatigue
4) Children that have repeated ear infections, are not attentive at school, and/or snore
What happens with untreated sleep apnea? Can I die from it?
As a summary, I would summarize the effects of sleep-disordered breathing with the 3 D’s. They are death (due to an increased incidence of cardiovascular incidents, type II diabetes, and strokes etc), depression (mood disorders in general), and divorce (couples not being able to sleep in the same room, fatigue, and unable to communicate and act as they should).
What is the treatment for sleep apnea or sleep disordered breathing?
There are many tests to help detect and obtain greater clarity of what is going on. They include: polysomnography (the current gold standard), type III home sleep tests, high resolution pulse ox, cardiopulmonary coupling and esophageal pressure monitoring to name a few. All of these tests are helpful, but unfortunately, there does not exist one perfect test. They all have limitations, which make detection and diagnosis that much more challenging.
Sleep Apnea Treatment
There are few approaches to the condition, but I will limit the response to the most common two. Please ask us if you would like a more complete answer.
The gold standard for controlling the signs and symptoms is the CPAP. CPAP is a continuous positive airway pressure devise. It is effective on a vast majority of the population (as long as they wear the devise). Unfortunately, the compliance is not optimal. I have seen many different studies with the compliance rate ranging from 30-60 percent. That is a very broad range. My opinion on the broad range is how they define compliance with the CPAP. Is compliance defined as 7 days a week for a minimum of 7 hours per night? Or, is it 3 nights per week usage for 3-4 hours per night? More studies have to be done to clearly define compliance and the net benefit (cause and effect) for the patient when wearing the appliance.
The other most common option is an oral appliance called a Mandibular Advancement Device (MAD). This option does not have the same efficacy as the CPAP, but it does have a higher compliance. The oral appliance appears to be effective on about 60 – 70 percent of people, but due to the higher compliance, studies would indicate it has almost the same overall effectiveness as the CPAP. For some people, the oral appliance is not recommended and they should be directed towards the CPAP. This includes individuals with CSA (central sleep apnea), BMI over 35, atrial fibrillation, obligate mouth breathers, significant systemic health disease, or people on significant meds.
If you’re interested in an oral appliance for sleep-disordered breathing, please speak to us. We have purchased a devise called the Matrix Plus that not only can help in the diagnosis of the disorder, but it is also able to perform a Theragnostic study that will identify which patients the oral appliance will be effective on prior to treatment being provided.
Can thin/very fit people have Sleep apnea or sleep disordered breathing?
Yes, it is not just the “older-man-that-is-over-weight” disorder. It affects children, women, and men that appear to be healthy and in good shape. Some things that can be done to reduce incidence is the reduction of alcohol consumption, smoking, and decrease in BMI.
If you feel that you, or anyone in your family, would benefit from a discussion on this topic, please do not hesitate to begin the conversation with us at our office. We are here to help with your oral health AND your overall health. This is why we have purchased the Matrix Plus from Zephyr technologies. If we can help, we will! If you would benefit from a different source, we will let you know.