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Sleep Apnoea

What is Sleep Apnoea

Sleep Apnoea is a serious medical condition, that not only affects sleep, but can severely impact health and quality of life.

80% of people with Sleep Apnea are undiagnosed and remain at risk.[1]

Sleep Apnoea affects millions of people each year. It is caused when the walls or muscles of the upper airway relax in such a way that they collapse during sleep, blocking the airway, producing soft tissue vibrations – snoring. An Apnoea is the interruption of air supply to the lungs. During an apnoea, there is either no sound (the snoring stops, momentarily) followed by a chocking noise.

Who’s at Risk of Sleep Apnoea

Whilst typically overweight men, over the age of 40 have become the stereotypical patient, there are other health and lifestyle risks that attribute to Sleep Apnoea including high blood pressure, smoking, diabetes and Asthma. However, almost anyone can suffer sleep apnoea, even petite woman and children.

Diagnosing Sleep Apnoea

If you think you may be at risk of Sleep Apnoea, the first step is to discuss your concerns with your GP. The GP may then refer you to a sleep physician for a sleep study. If you are diagnosed with Sleep Apnoea, the Sleep Physician will discuss treatment options with you.

Treatment by Dental Devices

One of the main forms of treatment for Sleep Apnoea which has been scientifically proven to be effective and comfortable, is a customized dental or oral appliance, also known as a Mandibular Advancement Splints (MAS). The MAS device is similar to an orthodontic retainer or a sports mouth guard and is worn during sleep. It is custom made and then fitted by a dentist qualified in sleep dentistry. It is discrete and allows the wearer to open and close the mouth normally while wearing the device, the wearer can even eat and drink with the device in position.

The MAS device works by gently and noninvasively adjusting the forward movement of the jaw which opens the wearer’s airway for easier breathing and restful sleep - for both the patient and their bed partner, as it also prevents snoring.

Benefits of North Adelaide Dental Care MAS devices

  • Custom made and comfortable
  • Improved sleep quality
  • Permits full range of mouth opening and closing
  • Minimises disruption to normal oral functions such as speech, drinking & yawning
  • Easily adjustable
  • Non-invasive treatment
  • Durable and easily cleaned
  • Easy to travel with

MAS devices are a suitable form of treatment for all patients with mild to moderate Sleep Apnoea. They are also recommended for patients who cannot tolerate CPAP therapy or who are not suitable or unwilling to have surgery.

Interdisciplinary approach to Sleep Apnoea treatment

At North Adelaide Dental Care, we strive to support the broader health system of our patients and recognise the wider impact Sleep Apnoea has on causing chronic illness, increased medical costs and the major loss of quality of life for those who suffer from it. Therefore, we take an interdisciplinary approach to the management of Sleep Apnoea, amongst other dentally related medical issues. Prior to proceeding with the construction of a MAS device, a referral from the patient’s GP to a sleep specialist is required for a diagnosis of Sleep Apnoea and the severity. All dental treatment progress in relation to the patient’s Sleep Apnoea is then communicated back to the sleep physician to support the overall treatment plan.

Dental Sleep Apnoea appointments

The initial appointment for Dental Sleep Apnoea treatment involves a review the sleep condition history, a thorough examination of teeth, mouth, head and neck and impressions are taken of the upper and lower jaws (models or casts of the teeth and mouth). This enables a comfortable fit of the customized appliance. The next appointment is to fit the device. At North Adelaide Dental Care the customized and adjustable appliances that we use greatly enhance comfort, with clinical research backing their effectiveness. We have a wide range of adjustable appliances from leading suppliers, enabling the Sleep Dentist to tailor the MAS device to each specific mouth/jaw shape and comfort need.

For more information on dental sleep apnoea treatment, please contact us or visit us at 155 Archer Street, North Adelaide, opposite the North Adelaide Village Shopping Centre where you can park for up to 2 hours free. You may also find our extended business hours convenient.

Learn more about Sleep Apnoea

Why Apnoea’s are Harmful

The interruption to the circulation of oxygen in the blood decreases the bodies ability to replenish itself. This has a severe effect as it reduces the supply of oxygen to vital organs such as the brain and heart.

When the brain recognizes that the body is struggling to breathe, it will wake up briefly, overriding the system by shocking the cardiovascular system into action to clear the airway. This is witnessed externally, often by the sleeping partner, as a sudden gasp for air or a chocking noise. This may happen hundreds of times per night.  The patient may not remember waking but the brain and body certainly start to feel the effects of these disturbances.

Signs and Symptoms

If untreated the complications from Sleep Apnoea include, daytime sleepiness, cardiovascular problems and eye problems. But the patient may not be the only one suffering the consequences, often bed partners are also sleep deprived.

Risks of untreated Sleep Apnoea

Effects of apnoeas include, disturbed sleep, increases in heart rate and blood pressure and changes to the body’s normal metabolic processes. These effects have the ability to become serious long-term medical problems such as hypertension and diabetes.

Sleep Apnoea increases the following risks:

Stroke (blood clots in the brain)
People with Sleep Apnoea are 3 times more likely to suffer a stroke. Almost 70% of people who have had a stroke have Sleep Apnoea.[2]

Obesity
77% of people who are obese (Body Mass Index greater than 30) may have Sleep Apnoea.[3]

Heart attack
People with Sleep Apnoea may have an increased risk of suffering a heart attack.[4]

Depression
Sleep Apnoea doubles the risk of developing depression.[5]

High Blood Pressure
Sleep Apnoea is a common cause of high blood pressure. Conversely, 50% of people with high blood pressure may also have Sleep Apnoea. Patients on multiple medications to manage their blood pressure have an 83% chance of having Sleep Apnoea. [6]

Motor Vehicle Accidents
People with Sleep Apnoea are 7 times more likely to have a motor vehicle accident.[7]

Type 2 Diabetes
58% of patients with Type 2 Diabetes may have Sleep Apnoea.[8]

Job Impairment
People with Sleep Apnoea are 3 times more likely to suffer a work-related injury or fatality. [9]

However, research undertaken by the Independent Sleep Physician Cohort (ISPC) found that treating Sleep Apnoea may decrease the risk of suffering a cardiovascular event (stroke or heart attack) by 64% if diagnosed and treated early, along with improving an array of other health and lifestyle benefits.[10]

Other Treatment Options

Whilst there is no common cure for Sleep Apnoea, there are generally 3 other different paths (in additon to Dental Devices) that sleep physician’s follow, depending on the severity, to assist in reducing the symptoms and/or severity of Sleep Apnoea.

Lifestyle Modifications

There are several lifestyle modifications including weight loss, avoiding muscle relaxants before bed such as alcohol, caffeine and sedatives[11], developing a sleep routine of going to sleep and waking at the same time each day and sleeping on the side, which may help to keep the airway open. 

Continuous Positive Airflow Pressure (CPAP) therapy

This is commonly prescribed for patients. The CPAP device works by blowing a continuous stream of air into the airway via a small mask worn whilst sleeping. An ‘air splint’ that helps support the tissues of the throat from collapsing.

Surgery

Surgery for Sleep Apnoea, may be an option for some patients when other treatments do not work.

There are many surgical interventions which range from the removal of tonsils, adenoids or uvula, opening nasal passages to improve tolerance to CPAP therapy, implants of devices to the anterior chest wall or the mouth palate, tongue reduction or repositioning, moving the entire upper jaw and teeth forward, bariatric (obesity) surgery, to a tracheostomy which is generally reserved for morbidly obese patients with severe sleep apnoea and who are not candidates for other treatments.

As with any surgery, these types of surgeries carry the risk of complications and infections.

Generally non-invasive treatment options are often preferred over surgical options.

NADC & Dental Sleep Medicine

Our own Dr. Greg Miller in October 2016 was the MC and Chair of Day 2 of the 10th annual Australasian Sleep Association's Oral Sleep Medicine course ‘Sleep – The dental connection’, which was held as part of the main meeting of the Sleep DownUnder 2016 at the Adelaide Convention Centre. Dr Miller has completed the Graduate Diploma in Dental Sleep Medicine from Adelaide University in 2014 with Distinction.

References 

[1] Medical Services Advisory Committee, Public Summary Document, Application No. 1130 – Unattended Sleep Studies in the Diagnosis and Reassessment of Obstructive Sleep Apnoea March 2010.
[2] Bassetti et al. Sleep apnea in acute cerebrovascular diseases: final report on 128 patients. Sleep 1999;22:217-223.
[3] O'Keefe T. Patterson E. Evidence Supporting Routine Polysomnography Before Bariatric Surgery. Obesity Surgery 2004;14:23-26
[4] Jose M Marin, Santiago J Carrizo, Eugenio Vicente, Alvar G N Agusti. Long-term cardiovascular outcomes in men with obstructive sleep apnoea-hypopnoea with or without treatment with continuous positive airway pressure: an observational study: Lancet 2005;365:1046–53.
[5] Paul E. Peppard, PhD; Mariana Szklo-Coxe, PhD; K. Mae Hla, MD; Terry Young, PhD. Longitudinal Association of Sleep-Related Breathing Disorder and Depression. Arch Intern Med 2006;166(16):1709-1715. doi:10.1001/archinte.166.16.1709
[6] Logan et al. High prevalence of unrecognized sleep apnea in drug-resistant hypertension. J Hypertension 2001;19:2271-2277
[7] Naughton M, Pierce R. Sleep apnoea's contribution to the road toll. Aust NZ J Med 1991;21(6):833–834 [PubMed]
[8] Resnick HE, Redline S, Shahar E, et al. Diabetes and sleep disturbances: findings from the Sleep Heart Health Study. Diabetes Care 2003;26:702–709 [PubMed: 12610025].
[9] Hillman DR; Murphy AS; Antic R et al. The economic cost of sleep disorders. SLEEP 2006;29(3):299-305.
[10] https://www.healthysleep.net.au/sleep-apnea/
[11] It is important that concerns re medication and the effect they may have on sleep are discussed with the patients doctor before making any changes to prescribed medications.

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