If you don’t know what sleep apnea is then I guess the title of this blog sounds like a new TV sitcom. But trust me, as I learned last weekend, sleep apnea and the dentist is no laughing matter. In fact, for some it could be a life or else matter. Let me explain.
Last weekend my good buddy, Steve G and I had the opportunity to listen to one of the leaders in the field of sleep disorders and dentistry, Dr. Kent Smith, present about sleep apnea. Dr. Smith was one of the most entertaining and engaging speakers I have ever heard (in fact 14 hours of lectures and I did not even come close to nodding off once…even after lunch both days) but his message was pretty sobering. Approximately 20% of all Americans suffer from sleep apnea but only 4% of the population shows any signs of it. And according to the American Academy of Periodontology sleep apnea ranks just under smoking as the #2 lifestyle factor that impacts oral health.
Simply put sleep apnea is when you stop breathing (or takes less than 25% of a normal breath) while you sleep. The only way to be diagnosed with sleep apnea is with a sleep study that is read by a physician. What they study in the test is how often and for how long you stop breathing for. Any time you stop breathing for more than 10 seconds it is considered an apnic event. Based off of the test results you can be diagnoses as either not, mild, moderate or severe. However, it is not just the fact that you stop breathing that is on its own very dangerous, but it affects your overall quality of sleep. Dr. Smith gave us some pretty keen insights as to what goes on while we sleep and why good sleep is so important to our health.
Here are some sleep facts:
1. The right amount of sleep (good sleep) is about 7 hours a night for adults
2. The neurophysiological effects of sleep include improved ability to concentrate, mood enhancement, you feel less stress, your immune system functions better and you actually have better pain inhibition.
3. REM sleep, which is when we also tend to have vivid dreams, is essential for allowing our brain to store data from the previous day, kinda like storing it on the hard drive of the brain.
4. When you sleep hormones that affect your diet self-regulate. If leptin and ghrelin don’t work right it is harder to lose weight. This is a catch 22 for many because being overweight is a risk factor for sleep apnea
5. Numerous studies have shown a correlation between less sleep and increased risk of cardiovascular issues. The less sleep you get the greater the levels of IL-6 and C reactive protein you have, both risk markers for heart disease.
6. Lack of sleep can lead to microsleeps (like nodding off while driving). The number of driving fatalities due to these events is on the rise.
Now, I can go on and on about facts, heck Dr. Smith spent several hours going over this stuff. The bottom line is having enough sleep is great for you, not having enough sleep hurts you and in the worst case scenario it can shorten your life span. And if you have sleep apnea, think of the pressure put on your heart when you are gasping, trying to breath to get oxygen into the lungs and then into the blood etc.
Here are some sobering facts about sleep apnea:
1. About 1/3 of patients with coronary artery disease have sleep apnea.
2. 65-80% of stroke victims have sleep apnea
3. People diagnosed with sleep apnea have a 5 times greater risk of diabetes (independent of risk factors such as obesity)
4. New studies show that bruxism(clenching/grinding of teeth) during sleep may be secondary to sleep related micro arousals (and not as much due to the bite as we have previously thought)
But why is sleep apnea and the dentist the title of this blog. For a very simple reason. The standard of care for treating sleep apnea is the C-PAP machine, a device that forces air down the nostrils via a constrictive mask while one sleeps. But for mild or moderate sleep apnea or for those who cannot tolerate the machine there are dental appliances which are medically accepted as treatment options. And while not all sleep physicians like to go that way there is an increasing number who recognize these treatment options. The dentists in essence act as the lab technician for the sleep doctors who are not trained to make oral appliances.
In addition, most physicians, if they are not sleep doctors, do not routinely screen patients for sleep disorders. So, Dr. Smith and the other leaders of sleep dentistry are doing their best to get dentists to start asking the questions of their patients. And here are some of the things we are to look for: large necks, small or recessed chins, snoring, being overweight, eroded enamel, large tonsil and tongue bars/studs to name a few.
So if you don’t feel like you are getting good sleep, or if you find yourself nodding off often during the day, you may want to ask your doctor or your dentist to screen you to see if you might have signs of sleep disorders.