Sleep apnea is a condition where patients airway collapses while they're asleep.
So they have what we term a micro arousal so the patient awakens slightly
in order to gasp and take a deep breath. Many, many people witness that and are
familiar with that I think it's just a normal normal part of life and really we
need to get the message out better that no that is a serious medical condition.
Medical risks increase with sleep apnea include hypertension arrhythmias or
funny beats in the heart there's an increased risk for heart failure atrial
fibrillation with ankle pulmonary hypertension and it increases
cerebrovascular risk for stroke risk. A prosthodontist is a specialized dentist
with advanced training in oral health issues.
We specialize if the top part of the pharynx or the oral pharynx the tongue
the tonsils, the soft palate, the arrangement of the upper and lower jaw.
It's been shown that patients see their prosthodontist more frequently
than they see any other medical professional. That puts us in an
important position to screen our patients. In my practice every patient
that comes in whether it's for replacement of a tooth or aesthetic
change they come in and they fill out questionnaires for sleep disruption.
Questions such as do you or a family member snore? Do you or a family member
choke or gasp for air when you're asleep? Patients who have a lot of weight gain,
hypertension that's a red flag. As many times happens in my office the patient's
bed partner presents them for treatment because of snoring. I was having issues
with snoring and keeping my partner awake. I kept her awake at night, kept me awake
at night too. Sleep apnea is diagnosed by a sleep study being performed
and then that sleep study being read by a sleep physician. I think the best sleep
medicine is provided through a multidisciplinary team. Prosthodontists
have a unique position in the treatment of sleep apnea. I'm looking at the tongue
size and volume because really the tongue collapsing backwards when they
sleep and the soft palate, the drape of the soft palate and the narrowing in
that throat is really the issue at hand. Our physician colleagues can treat sleep
apnea with a CPAP which is a continuous positive air pressure machine. This is a
CPAP machine it takes room air it draws it in through the back here filters and
cleans it pressurizes it. This is called a nasal pillow mask it's small sets up
underneath the nostrils and it allows the air pressure come in through the nose.
A CPAP has been shown to be a very successful treatment if a patient can
tolerate it. The pressure of the air going in and out was very difficult to
have you know to be able to sleep with it. Frankly the the mask was a little claustrophobic.
Patients whose sleep studies show that they have stopped
breathing thirty times or less per hour those are
a patient who a mandibular repositioning device can be a first line therapy. This
appliance here is an appliance where you can see on the lower appliance there is
a wing and so that wing is pushed forward. Pulling the lower jaw forward
applies tension to the tongue it makes the tongue more stable which is
important in sleep apnea because often times collapse at the base of the tongue
is one of the significant factors. So a lot of patients will go on TV and
they'll see oral appliances that you can get at the local drugstore. They can
cause joint issues for the patients they can cause tooth movement in the patient.
It's so important that a patient has mandibular repositioning device
fabricated by the prosthodontist. "I'm going to let you pop the appliance in place" because
the device must be custom-made for the patient it must take into account the
patient's anatomy. They show you how to advance it and then they give you
recommendations on how much to go each day. I've so used that I love it it's
actually it's been a huge help. Is a CPAP or an oral device better depends on the
patient it's what's best for the patient. In prosthodontics often times patients
come to us because it's complex and when we look at sleep apnea it's a complex problem.
I mean this is the first really in ten years that we've gotten any
decent sleep.