We commonly come across people who snore during their sleep. Sometimes the snoring is so bad that not only our partners are disturbed in their sleep, but the ones who snore may also wake up. Sleep apnea is defined as difficulty in breathing during sleep.
In 1993, a Wisconsin sleep cohort study revealed that one out of every fifteen US citizens suffers from some kind of sleep apnea. Classical clinical symptoms include fatigue, daytime drowsiness, loss of mental alertness, and irritability. Contrary to prevalent notion that sleep apnea has destroyed personal social and work lives of adults, some children are also affected.
Types of Sleep Apnea
Difficulty in breathing during sleep can occur mainly due to three reasons: a central nervous system anomaly, an airway obstruction, or a combination of both.
Central Sleep Apnea
The goal of respiration is to maintain a balance between the levels of carbon dioxide and oxygen within the body, which is under the control of the central nervous system. In some cases, when the central nervous system does not respond quickly enough to alterations in the carbon dioxide-oxygen level, a reduction in the respiratory rate may be observed.
Obstructive Sleep Apnea
This is the most common form of apnea, and is caused by a partial or complete obstruction in the airway. The primary cause of airway obstruction may be due to enlargement of lymph nodes in the throat region as a result of a chronic or acute Ear, Nose, or Throat (ENT) infection. Alternatively, an enlarged tongue may fall back onto the oral structures during sleep and cause obstruction. Snoring is observed during sleep in individuals with obstructive sleep apnea.
Complex or Mixed Apnea
This is the second most common cause of sleep apnea and is basically a combination of central and obstructive sleep apnea.
Role of Dentist in Treatment of Sleep Apnea
A careful and vigilant dentist is usually the first healthcare professional to diagnose factors that may cause or aggravate sleep apnea. Due to their thorough knowledge of oral and maxillofacial anatomy, they are not only able to pinpoint the cause of apnea, but are also capable to aid in its treatment. Nowadays, more and more dentists are getting specialized training in the diagnosis and management of sleep apnea.
How is Sleep Apnea Diagnosed?
Dentists and physicians arrive at a diagnosis by observing the clinical symptoms, by performing a sleep study, or through an oximetry test. Sleep studies are aimed at determining the sleep pattern of an individual suffering from apnea. On the other hand, oximetry determines the oxygen levels of patients while breathing during sleep.
Management of Sleep Apnea
Patients are initially instructed to avoid any aggravating factors such as alcohol or anxiolytic drugs that may relax the muscles in the throat. Also, patients laying down in a supine position produce greater difficulty in breathing. Hence they are educated to sleep on their sides. In more extreme cases drug therapy, provision of a dental appliance, or surgical intervention may be considered.
Oxygen therapy has been found to be effective in some conditions. Oral drugs such as zolpidem and triazolem can also be given in central sleep apnea, provided depression in respiratory rate is not observed.
Dentists can alsoprovide their patients with appliances that either keep the jaw in a protruded position or prevent the tongue from collapsing over the airway. These appliances are most suitable for treatment of mild to moderate obstructive apnea.
In extreme conditions, when drug therapy and oral appliances prove ineffective, a surgical approach aimed at broadening the airway by performing tonsillectomy may be considered. In other cases, removal of excess oral tissues such as the tongue may be another option.
A Final Words
Sleep apnea, although a menace for both the patient and the ones near to them, is very much treatable. However, studies have shown that prolonged cases of sleep apnea favor angiogenesis that may be a precursor to cancer development. Therefore, if anyone discovers the above mentioned symptoms of apnea, he or she should visit their dentist immediately for treatment.