Waking up to Dental Sleep Medicine
People are waking up to Dental Sleep Medicine thanks to the efforts of the Dr. Rod Willey at the Koala Center for Sleep Disorders. Dental Sleep Medicine simply described, is a dental treatment of a medical condition, Sleep Apnea, with mandibular re-positioning oral appliance therapy.
Although oral appliance therapy (OAT) to treat obstructive sleep apnea (OSA) is not a new concept, it is still a relatively unknown treatment option. Dr. Willey is working to change that status. “It’s a refreshingly simple-to-use solution with significant medical benefits,” states Willey, “and should be considered along with the traditional options of lifestyle changes, continuous positive airway pressure and surgery.”
Clearly validated by extensive research, Oral Appliances received their official nod of approval in February 2006 when the American Academy of Sleep Medicine stated that Oral Appliances were approved for use in patients with mild to moderate OSA and in severe cases when CPAP could not be tolerated. “We are finding that there is a very real need for an alternative to CPAP, because there are so many patients who either refuse to use it, or have tried and cannot tolerate it for various reasons,” states Dr. Willey. “These patients continue to go untreated, still experiencing symptoms, possibly driving drowsy and still at risk for many of Sleep Apnea’s Dirty Dozen.” (see list)
Medical research has determined that approximately 50 million Americans suffer from some form of Sleep Disordered Breathing (SDB) every night, but less than 10% have been diagnosed. Untreated sleep disorders have been associated with obesity, cardiovascular disease, high blood pressure, diabetes, acid reflux, depression, ADHD in children and a host of other problems- and it can be fatal. SDB ranges in severity from snoring, to upper airway resistance syndrome to obstructive sleep apnea, where the serious and often life-threatening problems begin. Most would agree that snoring is annoying, but it does not automatically mean that the sleeper has sleep apnea. However, even the slightest snoring can be an indication of the onset or existence of a loss of airway patency, or muscle tone which results in shallow breathing and less oxygen intake. Choking, gasping for breath, and long periods of time without breathing are all signs of Obstructive Sleep Apnea.
How do oral appliances work?
When a person falls asleep, everything relaxes including their lower jaw and tongue. Gravity naturally causes these relaxed structures to fall back toward the throat and can cause a partial obstruction of the airway (snoring) or a complete obstruction (sleep apnea). The purpose of the oral appliance is to gently hold the jaw in a position that prevents tissue obstruction and allows the airway to remain open during sleep. Oral appliances are similar to athletic mouth guards, but are less bulky. They sit comfortably over the upper and lower teeth with a telescopic bar connecting them. These bars can be adjusted to find just the right positioning for the individual patient. They are completely non-invasive. Some patients report an increase in saliva production or minor discomfort upon awakening, but that generally subsides. Oral appliances provide a non-surgical and non-pharmacological (no drug) solution.
Neuromuscular Dentistry/ TMD Treatment
Patients at Koala Center for Sleep Disorders benefit from a clinician who is trained not only in dental sleep medicine, but also in neuromuscular dentistry. A neuromuscular trained dentist understands the complex workings of the nerves, muscles and temporomandibular joint (TMJ). Patients who suffer from TMD (temporomandibular joint disorder) have found relief in Dr. Willey’s capable hands for over ten years. With modern techniques to find the “true rest position,” Dr. Willey has been able to alleviate headaches that have not responded to traditional methods, ear aches that included ringing, buzzing and/or a clogged, itchy feeling as well as popping and clicking in the jaw joint. The cause of TMD is often a “bad bite” meaning that the teeth may sit together in a position that puts strain on the nerves, muscles and joints. By finding the correct bite using TENS, K-7 electromyography and a neuromuscular orthotic (a type of appliance), these painful symptoms can be relieved almost overnight. (see diagram of TMD symptoms.)
One patient named Sue, was very skeptical about a dental solution to her problems. She was tempted to cancel her appointment many times. Good for Sue that she didn’t. After receiving her appliance, Sue was amazed! By relieving the pressure on her TMJ, she was pain free for the first time in a long time.
The neuromuscular appliance is phase I of TMD treatment. The appliance is worn over the lower teeth both day and night to promote healing and reduce swelling. Once maximum improvement is reached, usually in less than six weeks, phase II treatment is initiated. This may involve orthodontics, reconstructive dentistry to maintain the correct bite position or a long term appliance.
Every patient who comes to a Koala Center for Sleep Disorders is screened for TMD as well as OSA. “Research has shown that about 60% of patients with TMD also have OSA, and vice versa,” states Dr. Willey. “It’s all about lower jaw positioning.” If the lower jaw is positioned back, it is encroaching both the throat, causing airway issues, and the TMJ and ear, causing TMD issues. Both can be treated successfully with oral appliance therapy.
If a patient has been previously diagnosed with Sleep Apnea, the Koala Center for Sleep Disorders dentist will obtain a copy of their sleep study. It is important to know if the patient was considered mild, moderate or severe in order to be able to recommend the proper treatment therapy.
If a patient has not been previously diagnosed, the dentist will screen for sleep apnea using simple questionnaires, health histories, weight, body mass index (BMI) calculations, and neck circumference measurements as well as oral and airway evaluations. If a patient shows the markers for OSA, the first step is to obtain a sleep study. Depending on the patient’s health history, the dentist will either offer an at-home sleep test (HST) or an overnight-attended test called polysomnography (PSG). These tests are read by a local board certified Sleep Physician who will determine a diagnosis. If the patient is a candidate for OAT, the dentist will take a custom impression and bite in order to have an FDA approved lab fabricate the sleep appliance.
“We know that patients are anxious to get started once they understand the full benefits of the oral appliance,” states Dr. Willey, “and we are very accommodating to get started right away.” Some patients may not realize just how tired they were until they have experienced sleep with their appliance. Then they wonder how they were ever able to manage without it.”
Many of the patients of the Koala Center for Sleep Disorders have reported that they look forward to wearing their appliances at night. One patient, named Micki, reports that wearing her appliance relaxes her and she gladly wears it knowing she is going to have a good night’s sleep. Her spouse states that before treatment, Micki was a terrible sleeper- flailing her arms and legs and snoring so loud she was rattling the windows. Now he states her movement and snoring is reduced to a calm, quiet purr and they are both sleeping much better.
Other patients are also expressing gratitude for their Oral Appliances. Kevin is relieved that he can take the fishing trip with the guys, and actually enjoy himself. You see, in the past, he didn’t want to tote his CPAP, so he would go without it and snore like a bear- and be grouchy like one for lack of sleep. This year, he can very easily take his appliance in his pocket. Similarly, Jane was so happy that she could take the weekend shopping trip with her girlfriends and not be embarrassed by her snoring. Oral Appliances are great to travel with and also make it through airport check points much easier than CPAPs.
Professionals benefit from the ease of using Oral Appliances- military personnel can return to active duty and go where a CPAP cannot be taken, ministers can travel to remote missionary assignments with no electricity and truck drivers appreciate the convenience, as well as safety assurance that comes with using an oral appliances for healthy sleep.
Facts Based Treatment
Progress is monitored carefully as each patient has a different airway and requires specific titration, which means the appliance is slightly modified according to the patient’s specific bone and teeth structure. When a patient feels that their snoring has stopped and their symptoms have been relieved, the dentist will order a follow up sleep study with the oral appliance in place. “We do not rely solely on how the patient feels, although that is very important. We want to be medically sure that the oxygen levels are where they should be and that the sleep apnea has been treated successfully,” states Willey. Once maximum medical efficacy is reached, we will see the patient again in six months, and then yearly after that. This gives the Koala Center for Sleep Disorders dentist the ability to ensure continued treatment success and make modifications to the treatment regimen as needed.