Sleep Apnea

Do you constantly feel fatigued? Not only is the endless process of snoring and night awakenings a nuisance, but it may also be symptomatic of a dangerous health condition, sleep apnea. This sleep disorder deprives the body of much-needed oxygen, leading to fatigue at work, irritability, and various long-term health complications, including heart disease and stroke. It gradually erodes your health and quality of life, one sleepless night at a time. Historically, sleep apnea was considered the domain of sleep specialists, but contemporary dental practices are now at the forefront of innovative treatments.

At SoCal Dental of Agoura in Agoura Hills, we understand our practice’s vital role in helping patients achieve restful sleep. We provide innovative and effective dental treatments, including custom-fitted oral appliances that gently reposition the jaw and tongue to keep the airways open, allowing you to breathe easily and comfortably throughout the night. Contact us today to schedule a consultation and learn how we can help you reclaim restful nights and revitalized days. But first, familiarize yourself with the condition through the information below.

What is Obstructive Sleep Apnea (OSA)?

Obstructive Sleep Apnea (OSA) is a long-term health disorder characterized by recurrent upper airway blockages during sleep. These blockages can cause partial or complete cessation of breathing, often lasting ten seconds or longer. This interruption in breathing, also called apneic events, can occur dozens or even hundreds of times in a single night, severely disrupting sleep and overall health. Unlike central sleep apnea, which is caused by a failure of the brain to signal the muscles to breathe, OSA results from a physical blockage of the airway.

The OSA pathophysiology is based on the biomechanics of the upper airway. As a person falls asleep, the body’s muscles, including those of the tongue and throat, relax. In people with OSA, this relaxation is excessive, causing the soft tissues at the back of the throat, including the soft palate, uvula, tonsils, and tongue, to lose structural support. This causes them to collapse inward and backward, blocking airflow. The individual finds it difficult to breathe against this obstruction, usually accompanied by loud and annoying snoring.

When the airway is completely blocked, breathing stops entirely. This causes a life-threatening decrease in oxygen saturation levels in the blood. The body senses this shortage of oxygen and accumulation of carbon dioxide, which causes a fight-or-flight reaction. The brain unconsciously arouses the person briefly from deep sleep, tightening the throat muscles and reopening the airway to resume breathing. This process is so brief that the individual is often unaware of awakening. However, this repeated cycle of airway collapse, oxygen deprivation, and brief arousal prevents the individual from achieving the restorative, deep stages of sleep, leading to profound daytime fatigue, cognitive impairment, and a heightened risk for serious systemic health issues.

Characteristic Sleep Apnea Symptoms

The first step in diagnosing and treating sleep apnea is recognizing its signs. Though you could spot some of the symptoms, you will notice what the bed partner notices first. The symptoms are usually classified into two groups:

Those experienced at the time of sleep
Those experienced at the time of the day due to poor sleep quality

Symptoms experienced during sleep include:

Loud, persistent snoring — One of the most common symptoms of OSA, snoring occurs as air attempts to pass through a partially narrowed airway. It is often loud, disruptive, and interrupted by pauses in breathing.
Episodes of stopped breathing witnessed by another person — Your partner may notice snoring abruptly stopping, followed by gasping, snorting, or choking as breathing resumes. These episodes are characteristic of OSA.
Waking up gasping or choking — You may awaken feeling like you are suffocating. This is your body’s urgent response to insufficient oxygen, prompting sudden and startling arousal to clear the airway.

Some of the common daytime symptoms include the following:

Excessive sleepiness and fatigue — You can still feel fatigued and groggy even after spending much time in bed. This is so since the frequent arousals will not allow you to go into the deep restorative phases of sleep. This may cause falling asleep at workplaces, whilst driving, or in other quiet engagements.
Morning headaches — Waking with headaches may indicate sleep apnea. Repeated nighttime oxygen deprivation can dilate blood vessels, causing a sore, aching head in the morning.
Difficulty concentrating during the day — The inability to sleep peacefully may seriously affect your mental ability. You can have brain fog, memory impairment, and an inability to concentrate on your tasks in general.
Dry mouth or sore throat on waking — This is the symptom of breathing through your mouth all night, a natural response process when nasal passages and throat are blocked. The constant flow of air dries out the delicate tissues of your mouth and throat, leading to a parched feeling or soreness in the morning.

Consulting a health service provider is essential if you or one of your loved ones has been experiencing the symptoms. Correct diagnosis means proper treatment, greatly enhancing your quality of life and decreasing health risks in the long run.

How We Screen for Sleep Apnea During Your Checkup

Historically, sleep apnea was treated exclusively by sleep medicine specialists. Today, contemporary dental practices play a central role in its diagnosis and management. Dentists, recognizing the connection between oral and systemic health, can detect subtle signs of sleep-disordered breathing during routine dental exams. In many ways, your mouth provides a window into your airway health during sleep.

The role of dentists is not to make a definitive diagnosis but to perform a critical screening assessment. When dentists examine your mouth, we are searching for several vital clues that can help indicate that you are at a high risk of obstructive sleep apnea.

The following are what we examine in your checkup:

Severe tooth wear (bruxism) — Excessive tooth grinding or clenching, known as bruxism, is common in patients with sleep apnea. As the body struggles to breathe against a collapsed airway, it may unconsciously attempt to realign the jaw, causing worn, chipped, or fractured teeth and straining jaw muscles and joints.
Scalloped tongue — Dentists also look for indentations or “scalloping” along the sides of your tongue. It is a good indication that your tongue is too big to fit in your mouth and is constantly pressed against your teeth, a typical anatomical aspect that may block the airway.
A large tongue or tonsils — A large tongue or tonsils that are swollen can cause a physical blockage in the airway, causing difficulty in passing air. An oral examination would help us determine the size of these structures and how they may obstruct breathing during sleep.
Narrow palate or crowded airway — The shape and size of your mouth and jaw are significant. A narrow and elevated palate or a very small jaw may obstruct the air passage, leaving no space to accommodate the tongue and other soft tissues when lying down.
Redness and irritation in the throat — Chronic snoring is one of the symptoms of OSA, and this process may lead to inflammation and redness of the soft palate and uvula. Also, the obstruction of the airways may add to the gastroesophageal reflux disease (GERD), resulting in the erosion of the acid and throat irritation.

When dentists see these signs, we will not merely treat the symptoms, like tooth wear. We will discuss our findings with you and recommend a referral to a sleep specialist for a proper diagnosis. This proactive measure will ensure you receive the thorough care you require to treat the cause of your symptoms.

The Serious Health Risks of Untreated Sleep Apnea

Unattended sleep apnea is not merely a nuisance, but a grave clinical condition that imposes significant stress on your whole body, especially the heart. The recurring episodes of the loss of blood oxygen (hypoxemia) and the frequent awakenings that take place during the night cause a constant fight-or-flight reaction. This puts excessive pressure on your heart and blood vessels, increasing your risk of several serious, chronic health issues.

The major associated health conditions include:

High blood pressure (hypertension) — Due to the stress reaction of the body’s activity during each apnea episode, your blood pressure reaches its peak. This long-term cycle of high blood pressure may result in chronic high blood pressure with time, and this is one of the risk factors of heart disease and stroke.
Heart disease, heart attack, and atrial fibrillation — A combination of the ongoing burden to the cardiovascular system may result in the development of a variety of heart-related issues. Sleep apnea in untreated cases has been directly associated with a heightened risk of heart attack, heart failure, and irregular heart rhythm like atrial fibrillation. This is because the absence of oxygen may cause damage to the heart muscle over time, rendering it inefficient.
Stroke — The deprivation of sleep as a result of high blood pressure and other cardiovascular complications that accompany sleep apnea is also a good reason to increase your chances of a stroke. Recurrent oxygen deprivation may impact the blood vessels within the brain, which may become more vulnerable to blockages or rupture.
Type 2 diabetes — As with sleep apnea, there is a strong link between sleep apnea and Type 2 diabetes. This state of irregular sleep and continuous stress reaction may result in insulin resistance, making your body less able to use glucose as an energy source and raising your blood sugar level.
Daytime sleepiness and accidents — In addition to the impact on physical health issues, excessive sleep apnea can lead to a highly significant risk of accidents due to its very high level of daytime sleepiness. One of the causes of car crashes is drowsy driving, and a lack of concentration may cause severe incidents at the workplace.

Ignoring the signs of sleep apnea can have grave consequences. With your awareness of the symptoms and the treatment, you can manage these risks to a great extent and maintain your health in the long run.

Oral Appliance Therapy (OAT)

An oral appliance is a custom-made, mouthguard-like device worn only during sleep. These devices are designed by a qualified dentist specializing in dental sleep medicine to provide a non-invasive, comfortable, and effective solution for obstructive sleep apnea (OSA). Unlike over-the-counter mouthguards, a professional oral appliance is meticulously crafted to fit the unique anatomy of a patient’s mouth, ensuring maximum comfort and therapeutic effectiveness. The customization process involves taking precise impressions of the teeth and jaw to create a device that provides a secure and comfortable fit, promoting consistent use throughout the night.

The most common and effective type of oral appliance is the Mandibular Advancement Device (MAD). A MAD works by gently and subtly repositioning the lower jaw (mandible) slightly forward. This forward movement has a critical physiological effect. It tightens the soft tissues and muscles in the upper airway, including the tongue, soft palate, and uvula. The airway remains open and unobstructed, preventing these tissues from collapsing backward into the throat. This mechanism directly addresses the root cause of obstructive sleep apnea, the physical blockage of the airway, allowing for continuous, unimpeded breathing throughout the night. The result is a significant reduction in or elimination of snoring and a decrease in the frequency and severity of apneic events, leading to a more restful and restorative sleep.

Oral Appliance Therapy (OAT) is an FDA-approved treatment option recognized as a primary therapeutic solution for specific patient populations. It is an excellent and highly effective choice for individuals diagnosed with mild to moderate obstructive sleep apnea. OAT often provides a comfortable and convenient alternative to other treatments, like Continuous Positive Airway Pressure (CPAP) therapy for these patients.

Furthermore, OAT is a crucial secondary treatment option for patients with severe OSA who have tried CPAP therapy but cannot tolerate it due to discomfort, claustrophobia, or other issues. For this group, a custom oral appliance offers a viable and clinically proven alternative that can help manage their condition effectively. The decision to use OAT is based on a comprehensive evaluation by a sleep medicine physician and a qualified dentist, ensuring the treatment is appropriate for the patient’s needs and condition. Its non-invasive nature and high patient compliance rate make OAT a powerful and attractive solution for improving sleep quality and overall health.

Oral Appliance Therapy vs. Continuous Positive Airway Pressure (CPAP)

When comparing oral appliance therapy (OAT) and continuous positive airway pressure (CPAP) for sleep apnea treatment, it is important to understand the core differences in their mechanisms, uses, and patient experiences. CPAP is considered the gold standard, particularly for moderate to severe Obstructive Sleep Apnea (OSA) cases. It delivers a continuous stream of pressurized air through a mask, acting as a pneumatic splint to open the airway. While highly effective, CPAP can be a challenge for some patients due to its bulky nature, noise, and the potential for discomfort, skin irritation, or feelings of claustrophobia.

Conversely, OAT is also a great option, particularly in patients with mild to moderate OSA. Mandibular Advancement device (MAD) is an oral appliance, a personalized mouthguard-like instrument, which can be explained as simply repositioning the lower jaw forward. This movement tightens the soft tissues in the throat, thus no longer collapsible to block the airway.

OAT is also a crucial option for severe OSA patients who cannot tolerate CPAP. It is powerful as it is non-invasive and enjoys high patient compliance. Its efficacy, though, may not be confined to the patient’s exact anatomy and the tailored fit’s accuracy. Furthermore, the best treatment choice is made in consultation with a medical professional, considering the patient’s needs and the severity of their condition.

The Process of Getting a Custom Oral Appliance

The process of acquiring a custom oral appliance is clear and straightforward. It focuses on the appropriate medical procedures and cooperation between a dentist and a sleep physician. This is done so that the treatment is safe and effective.

Referral to your dentist — The process would start with an appointment with a dental sleep medicine dentist. In this visit, you will learn about your symptoms, for example, snoring loudly or feeling tired in the day, and the dentist will perform a clinical examination to check your oral and airway structures.
Referral to a medical diagnosis — This is an important step in this process, which involves the formal diagnosis. A dentist cannot legally diagnose sleep apnea. That can only be done by a sleep physician. Thus, your dentist will send you to a sleep physician, where you will undergo a formal sleep study, also called a polysomnogram. The study is critical in ensuring the proper judgment of whether you are experiencing obstructive sleep apnea and its severity.
Receiving a prescription — When the sleep study has been conducted, the physician will offer an official diagnosis. In the event of a diagnosis of OSA and the doctor decides that OAT is the correct course of treatment, the doctor will prescribe an oral appliance. You will then return this prescription to the dentist to begin the fabrication process.
Impression and fabrication — The dentist uses your prescription to create precise impressions of your teeth and jaw, producing a custom-fit appliance that is comfortable and therapeutically effective, unlike generic over-the-counter devices.
Fitting and adjustment — In this last stage, you will have a delivery appointment where the dentist will fit the appliance and make it comfortable. They will also guide on how to take care of it and use it in detail. This is usually followed by follow-up appointments to adjust any necessary changes and ensure that the appliance is effectively managing your sleep apnea.

Lifestyle Changes that Can Complement Your Treatment

Although the primary intervention in treating obstructive sleep apnea (OSA) can be performed using professional methods such as Oral Appliance Therapy (OAT) and CPAP, some lifestyle modifications may dramatically supplement these types of interventions. These self-help strategies can help reduce the severity of symptoms and improve overall sleep quality.

Some of the lifestyle changes you should consider adopting include:

Weight management — Managing your weight is also one of the most effective changes you can make. Excess weight, particularly around the neck, can also lead to the constriction of the airway and exacerbate the symptoms of OSA. It has also been demonstrated that a small amount of weight loss of 5% to 10% of your body weight can significantly decrease the number of apneic events and result in more successful primary treatment.
Positional therapy — For most people with mild to moderate sleep apnea, lying on your back may worsen the symptoms. Lying on your back, the tongue and the soft palate may fall back and block the airway due to the effects of gravity. Positional therapy entails the ability to train yourself to sleep on your side. Basic aids, including special pillows and sewn-in tennis balls on a t-shirt, will help prevent you from rolling over on your back during the night.
Avoid alcohol and sedatives — Drinking or taking sedatives, particularly in the hours before bed, may negatively impact sleep apnea. They are muscle relaxants, which overrelax the muscles that cover your throat. This enhanced muscle laxity may cause more severe and frequent upper airway collapse, causing more frequent and severe apneic events. It is advisable to stay off these substances, particularly during the 4 to 6 hours before sleep.
Better sleep hygiene — This is a collection of practices conducive to sleeping well. These involve having a regular sleep cycle, keeping your bedroom dark, quiet, and calm, not eating heavy meals, consuming caffeine, and having vigorous exercise near bedtime. Building a space and a routine that encourages healthy sleep would help you optimize the results of your professional therapy and help you lead a healthier life.

Find a Sleep Apnea Expert Near Me

Sleep apnea is not merely snoring, but a severe health complication that may deprive you of restful sleep and endanger your health in the long run. The good news is that you do not have to suffer in silence. With advancements in dental sleep medicine, effective and comfortable solutions like Oral Appliance Therapy are readily available. With the help of a team of qualified dental professionals, you can once again control your sleep and well-being.

Are you ready to begin your journey to better sleep? Call SoCal Dental of Agoura in Agoura Hills at 818-597-0100 today to schedule a consultation and take the first step toward a healthier, more rested you.

Socal Dental OF Agoura