Snoring and sleep apnoea are prevalent within the population, about 5% have severe sleep apnoea and a further 20% have mild or moderate sleep apnoea. The effects on a patient’s general health if left untreated is significant and dentally there can be many effects which negatively impact the patient.
Medically, there is an increased risk of:
- High blood pressure
- Heart attack
- Type 2 Diabetes
Dentally there are significant issues which are associated with snoring and sleep apnoea:
- Sleep bruxism (teeth grinding)
- Wear of the teeth
- Cracks forming in the teeth
- Breakage of fillings/crowns
- Muscle pain in the jaws, temples, neck especially
- Dry mouth
- Persistent gum inflammation
- Excessive day time sleepiness
What is sleep apnoea?
There are two types of sleep apnoea, Obstructive and Central.
Obstructive sleep apnoea (OSA) is when the airway is partially or completely obstructed whilst asleep. Snoring can happen when the airway narrows and a noise will be audible. This can be disturbing to the other person in the bed but snoring itself does not cause harm, If the airway narrows further then the ability to breathe normally is impacted and if this happens for more than ten seconds, then this would be an apnoeic event. People can have these apnoeic events dozens of times per hour and the effect it has on the body is significant due to the lack of intake of adequate oxygen.
Central sleep apnoea is much less common and is due to the body’s inability to regulate respiratory effort during sleep
How do I know if I am snoring or have sleep apnoea?
There are several ways to gather information to help diagnose what condition you may have.
The ideal way would be to get a sleep study done through your GP. We can liaise with the GP to inform them of the signs and symptoms we are seeing which could indicate a sleep disorder. The GP can then arrange a hospital or at-home sleep study. The results are then assessed by a sleep physician and a diagnosis made. From that the appropriate treatment can be undertaken.
What is the treatment for snoring and sleep apnoea?
Depending on the diagnosis there are several treatments available.
- Surgery to the airways to help remove excess tissue
- Mandibular Advancement Device to hold the lower jaw forwards to open the airway, keep the tongue forward and provide easier air flow when patients are sleeping.
- If mild or moderate obstructive sleep apnoea is diagnosed, then the treatment choice is usually a Mandibular Advancement Device.
- If severe sleep apnoea is diagnosed, then a CPAP machine is indicated as the “gold” standard.
- There can be issues with compliance of CPAP machines and if patients cannot tolerate the CPAP machine, then use of a Mandibular Advancement Device would be indicated.
What type of Mandibular Advancement Device do you make?
At The Aesthetic Smile Collective we are wanting to provide the best possible outcome to each patient, and this is reflected in the type of appliance we provide. The NOA device by OrthoApnea is an excellent mandibular advancement device which holds the lower jaw in a balanced position where the airway is optimally opened and maintained at night, to allow improved airflow in a comfortable jaw position. It allows for some movement of the jaw side to side and opening so patients do not feel restricted when they are wearing it. An example of the device is shown:
These questionnaires can help with identifying the patients who may be at risk of sleep apnoea.
How do you know if the appliance is helping?
We use a combination of methods to assess the effectiveness of the NOA appliance. The first is to see how the appliance is making the patient feel. Is it helping to reduce snoring, does the patient feel more energised when waking, is there are reduction in jaw pain/headaches, is there less waking up during sleep? The use of a sleep diary to record the hours of sleep, whether there were disturbances to the bed partner etc can be helpful. Using an App which records snoring noises can also be utilised to log how many snoring episodes there were per night. An example of this would be SnoreLab.
The other method is to use a sleep recording device to analyse the quality of sleep whilst wearing the appliance. Usually we have the original sleep study which we can compare to. After 2 months of wearing the appliance, a new sleep study would be done to see objectively how the appliance is helping with the signs and symptoms of sleep apnoea.
Depending on the results of all these measures, the appliance can be adjusted or titrated to see if an alteration to the position of the lower jaw will help the patient’s symptoms further. This is a simple process for the patient as they would swap in the new lower portion of the NOA appliance which they are supplied with.
We also have a device called a WatchPAT200(® which is used for checking the effectiveness of the NOA appliance and this can be used by our patients to wear in their own bed and is clinically validated with an 89% correlation to a Polysomnograph (PSG). A PSG is the type of sleep study which is used to diagnose sleep disorders. It is very simple to use and is a great piece of technology to have at The Aesthetic Smile Collective.
If you have any questions regarding any aspect of sleep apnoea or the treatments available, please call the practice on 3089-4455.