Managing Sleep Related Breathing Disorders
A convergence of dentistry and medicine
by Tina Cauller
Sleep Related Breathing Disorders ( SRBDs ) are diagnosed in 24 % of men and 9 % of women ages 30-60 . SRBDs are graded according to severity . Grade 1 involves snoring without an accompanying drop in oxygen saturation . Grade 2 is referred to as Upper Airway Resistance Syndrome ( UARS ), a submedical condition characterized by abnormal airway resistance while sleeping . UARS does not stop or decrease airflow , but as the body works to overcome airway resistance , arousals may occur that affect sleep architecture and cause daytime sleepiness . These arousals activate the sympathetic nervous system and may lead to hypertension . Grades 3 , 4 and 5 are increasing levels of severity of Obstructive Sleep Apnea ( OSA ), which is linked with serious health problems including cardiovascular and respiratory diseases .
UARS can be effectively treated with behavioral changes , such as not sleeping in a supine position , elevating the head of the bed , and avoiding alcohol or sedatives . In some cases , oral appliance therapy ( OAT ) or continuous positive airway pressure ( CPAP ) therapy can be helpful .
OSA is most commonly treated with continuous positive airway pressure therapy to hold the airway open , although CPAP therapy is not well tolerated and consistent compliance is generally poor .
Plano dentist Dr . Bill Gerlach describes a hybrid approach that has proven to be remarkably effective . “ Anyone with a diagnosis of Severe OSA who is struggling with their CPAP may benefit from a hybridized OAT-CPAP to improve comfort . The improved comfort seems to be due to less leakage around the mask . We always work closely with physicians on these severe hybridized cases as well as any patient with an AHI over 5 .”
Sleep apnea may be first recognized in the dental office , and the role of dentists in managing the treatment of breathing disorders and preserving the nighttime airway is expanding . For people who do not have other significant medical conditions such as congestive heart failure , neuromuscular disease or pulmonary disease , dentists can screen for SRBD with home sleep tests , which gives patients an attractive alternative to the laboratory sleep study . The home sleep test can be completed in the comfort of the patient ’ s home using equipment with special sensors to measure breathing , blood oxygen , and heart rate while the patient sleeps . The testing device sends the information to a physician for evaluation and diagnosis of sleep apnea . In some instances , patients with a diagnosis of mild to moderate sleep apnea are able to receive medical insurance coverage for oral appliances provided by a dentist .
At the Center for Facial Pain and Sleep Medicine at Texas A & M University Baylor College of Dentistry , clinicians and physicians collaborate to provide screening and treatment for sleep-related breathing disorders . The Center provides diagnostic
Sleep apnea may be first recognized in the dental office , and the role of dentists in managing the treatment of breathing disorders and preserving the nighttime airway is expanding .
evaluation and treatment for patients with symptoms of temporomandibular joint disorders , including jaw pain , popping or clicking , difficulty eating , or opening and closing the mouth . The center also provides expert care for patients with headaches , neck or other facial pains , and atypical toothaches or other mouth pain .
For more information on the Center for Facial Pain and Sleep Medicine at Texas A & M University Baylor College of Dentistry or to make an appointment , call ( 214 ) 828-8432 or send an email to : bcd-facialpain @ tamhsc . edu .
www . northtexasdentistry . com | NORTH TEXAS DENTISTRY 21