Sleep Apnea Explained

Sleep is arguably the most important part of the day. It helps to restore and maintain our immune, skeletal, muscular and nervous systems. It also helps to maintain mental performance, mood, memory and even sexual health. With the over-stimulating rigours of day-to-day activities, poor lifestyle choices, deadlines, and our obsession with technology, it seems to be harder and harder to get a good night sleep. However, beyond environmental factors, there are also medical conditions that can affect our sleep.  One of the most common is Obstructive Sleep Apnea.

So, what exactly is sleep apnea?

Obstructive sleep apnea (OSA) involves repeated episodes of partial or complete blockage of the upper airway that last for 10 seconds or longer. As a result, blood oxygen levels drop. This causes you to wake, often subconsciously, so that breathing can return normal. These interruptions can have a profound negative effect on sleep quality and can occur hundreds of times during a given night. Often, people have no idea that these events are happening during sleep. Men, women and children can all be affected.

Sleep apnea can leave an individual more susceptible to stroke, heart attacks, high blood pressure, type 2 diabetes, obesity, depression, anxiety, motor vehicle accidents and poor performance at work.

If sleep apnea is suspected, a sleep study will be arranged. This allows for a diagnosis of sleep apnea to be ruled in or out, and if present, whether it is mild, moderate or severe. This is based on the Apnea-Hyponea Index (AHI) which records the number of apnea and hypopnea moments per hour of sleep. An apnea is when there is a complete blockage of the upper airway, whereas a hypopnea involves partial blockage of the upper airway.  Mild sleep apnea is defined as 5-14 apnea and/or hypopnea episodes per hour; moderate sleep apnea is defined as 15-29 apnea and/or hypopnea episodes per hour; and severe sleep apnea is defined as more than 30 apnea and/or hypopneas per hour. The diagnosis and severity helps to determine the treatment.

What is the link between sleep apnea and oral health?

Dentists with training in sleep medicine, play a role in both diagnosis and treatment of sleep apnea. They are often the first to identify that there is a potential problem by asking specific questions such as: ‘Do you wake up feeling refreshed’ or ‘Have you ever woken up gasping for air?’. They are also in a unique position to analyse the anatomical structures that can leave someone susceptible to sleep apnea such as, the size of the tongue in relation to the airway, thickness of the neck, as well as other oral signs that can indicate potential sleep-related problems. If sleep apnea is suspected, they can then refer a patient on to their medical GP, a sleep physician, or ENT to have a sleep study.

In mild to moderate sleep apnea cases, a sleep physician may recommend an oral appliance which helps to keep the lower jaw and tongue forward at night – known as a Mandibular Advancement Splint (MAS). They work by keeping the airway open and reducing the chances of the tongue falling back into the airway, causing a blockage. The dentist will take custom moulds for a MAS to be made, fit it and adjust it accordingly to achieve the desired results. These appliances have been shown to reduce the severity of sleep apnea, snoring, and tooth grinding. Patients who wear them generally find them comfortable and report a better night sleep.

One of the most common characteristics of people who suffer from sleep apnea, snoring or sleep disordered breathing is tooth grinding. This leaves a patient more susceptible to cracked teeth, tooth wear, headaches, neckaches and pain in the jaw joints. By treating sleep apnea, you are reducing the risk of these problems.

Similarly, people who suffer from sleep apnea are also more likely to be very tired and stressed. This can result in repeated poor dietary decisions such as the selection of food and beverages that are high in refined sugars to provide short-term energy. This can result in higher rates of tooth decay.

How does sleep apnea affect your sexual health?

Besides increasing the risk of a range of serious medical conditions, sleep apnea can also have a profound effect on sexual health. It has been shown to cause a loss of libido in woman and erectile dysfunction in men. Testosterone is the hormone implicated. With good quality sleep, testosterone is usually produced in abundance and consequently sexual health is maintained. However, with sleep apnea, hormonal levels drop and sexual dysfunction can occur.

Snoring, which may be a sign of sleep apnea, is also one of the leading causes of divorce in the USA and UK. Constant interruption of sleep and snoring can place undue strain on relationships due to a lack of rest. A study out of the University of California Berkeley has shown that poor sleep can make us more selfish and focus on our own needs rather than the needs of our partners.

What steps can you take to remedy it?

The treatment of sleep apnea is dependent on the severity of the condition. It may be as simple as a combination of lifestyle changes such as dietary modification, weight loss, avoidance of smoking and alcohol, and adjustment of sleeping position. However, in addition to these measures, the use of a Mandibular Advancement Splint (MAS) which holds the lower jaw and tongue forward and opens the airway may be indicated. In more severe cases, a continuous positive airway pressure device (CPAP) may be recommended. This is a mask that fits over the nose and/or mouth and gently blows air into the airway to help keep the airway open during sleep.  As a last line of treatment, surgery may be necessary.

In an average life-time we sleep for approximately 25 years. Therefore, it is important to be sleeping well. If we aren’t sleeping well, so many aspects of our health can suffer. The good news is that this condition is treatable. Seeing a dentist that is trained in sleep medicine is one of the best ways to identify if there is a problem with your sleep and to do something about it.

Lewis Ehrlich