Sleep Apnea: The 5 W’s Of Dental Sleep Medicine

What is Dental Sleep Medicine? Dental Sleep Medicine refers to the branch of dentistry devoted to the treatment of snoring and sleep apnea with an oral appliance similar to a retainer. When a patient is diagnosed with obstructive sleep apnea, they are usually prescribed a CPAP (continuous positive airway pressure) machine which functions like a reverse vacuum cleaner to keep the airway open. It consists of a mask fitted over the mouth and nose which is attached to a compressor-like machine via a hose through which room air is forced. Compliance is shown to be very low due to common complaints of the machine being too noisy, the mask irritating the face, claustrophobia due to wearing the mask, inconvenience of being tethered to a machine and inability to sleep in all positions. In many cases, oral appliances are an effective alte
ative to CPAP therapy for sleep apnea.

Why do airway testing? A specially trained dentist utilizes airway testing with a Pharyngometer and Rhinometer to verify airway size and collapsibility as well as to predict success with an oral appliance. This technology utilizes sound waves in acoustic reflection much like a fish-finding device. The pharyngometer measures the cross-sectional airway in the throat to determine where there is an obstruction and whether movement of the lower jaw with an oral appliance will be effective in clearing that obstruction. The Rhinometer measures the nasal airway and determines whether there is blockage in the nose. This is critical because oral appliances are unable to open the nasal airway and should not be used if the obstruction exists in the nasal passages. Airway testing with the Pharyngometer/Rhinometer is crucial for predicting before treatment even begins whether the oral appliance will work or not.

When can we treat with Oral Appliances? Obstructive Sleep Apnea occurs when the tongue falls back into the throat and blocks the airway. Partial obstruction typically causes snoring and complete obstruction causes a cessation of breathing in addition to snoring. Oral appliances are designed to bring the lower jaw forward and thereby bring the tongue forward to open the airway. Oral Appliances were approved by the American Academy of Sleep Medicine as a first line of therapy for patients with mild to moderate sleep apnea. Patients with severe sleep apnea who cannot or will not wear a CPAP machine can also benefit from oral appliances but they are not as effective as CPAP therapy. It is better than no treatment at all.

Where is Obstructive Sleep Apnea Diagnosed? Only a physician can make a diagnosis of obstructive sleep apnea and classify its severity. For many years, diagnosis had to be made from an ove
ight sleep study, polysomnography or PSG for short. This study is conducted in a hospital or sleep laboratory. Just recently, unattended home sleep studies such as the Watch-Pat 100 are available to physicians and dentists and approved by the FDA for diagnosing obstructive sleep apnea. Diagnosis still must be made by a physician but the advantages of being able to conduct the study in the patient’s own bedroom can often provide a familiarity which lends itself to increased patient comfort and decreased anxiety. Dentist’s treating sleep apnea can also use the Watch-PAT 100 to verify the effectiveness of an oral appliance. No patient should be given an oral appliance without the follow-up of an unattended sleep study or repeat PSG.

Who is practicing Dental Sleep Medicine? This field requires a commitment to education and a commitment to technology. Most dental school curriculua do not offer any training in this arena. Numerous books have been written on this subject and many continuing education courses are offered in this area. Utilization of airway equipment and follow-up testing are imperative for the dentist to treat this properly. Guessing at severity of sleep disorder, jaw-position or effectiveness of oral appliances can be at the very least frustrating or potentially life-threatening.