Sleep Apnea and Dentistry

At Markiewicz Dental of Mundelein, Drs. Anthony and David Markiewicz are dedicated to providing comprehensive dental services and treatments to improve not only your smile, but also your overall quality of life.  What sets us apart, is how we continually strive to offer new treatment options for our patients.

How's your Sleep Hygiene?

Anyone who has suffered a stuffed-up nose, can attest to the connection between breathing sleep.  If you can’t breathe through your nose, it’s tough to get a good night’s sleep.

Why is Sleep Important?

Simply put, sleep is the foundation of healthy living.  It is important to eat the right foods, get enough physical activity, and refrain from unhealthy habits, but if you don’t get 7-8 hours of uninterrupted refreshing sleep every night, it becomes very difficult to remain healthy.  Many Americans are suffering from a lack of sleep.  Some studies estimate as many at 35% of Americans suffer from some sort of sleep issue.   Often, sleep problems are related to breathing disorders.  These conditions are commonly known as Sleep Disordered Breathing (SDB).  They describe a variety of problems that occur as a person tries to breathe while sleeping, such as obstructive sleep apnea (OSA) and upper airway resistance syndrome (UARS).

How often do you awaken feeling refreshed?

If you frequently awaken feeling tired and find yourself having to navigate the day in a haze, you are not alone.  According to a poll conducted by YouGov, only 4 in 10 Americans wake feeling refreshed each day.

Lack of quality sleep can result in:

  • Frequent fatigue, excess daytime sleepiness, or lack of feeling refreshed after a night’s sleep
  • Hypertension (high blood pressure)
  • Congestive heart failure along with nocturnal angina or cardiovascular disease
  • Contribute to  being overweight or obese
  • Loud snoring, or pauses in breathing during sleep
  • Waking up frequently, especially with choking
  • Cognitive problems such as memory loss
  • Depression, irritability, moodiness
  • Poor performance at work or in school
  • Frequent need to urinate throughout the night

What is Sleep Apnea?

Sleep Apnea is a serious but common disorder that causes breathing to become shallow or even pause altogether. These lapses in breathing can last from a few seconds to a few minutes and can occur up to 30 times each hour. Normal breathing often resumes after a loud snort or choking noise.

Obstructive Sleep Apnea (OSA), is only one of the medical conditions referred to as Sleep Related Disorders (SRD).  Sleep Related Disorders are a group of medical conditions that are characterized by abnormalities in the quality or pattern of breathing during sleep. These include snoring, upper airway resistance syndrome (UARS), and the most serious, (OSA) obstructive sleep apnea.  Early recognition of these conditions can often prevent progression to the Sleep Apnea.

All of these conditions involve restriction of the airway and compromised breathing. These conditions also always involve mouth breathing.  With snoring and upper respiratory resistance syndrome (UARS), the airway is partially blocked but the nervous system remains functioning properly. If diagnosed early, these can be treated before they become apnea and prevent more significant health consequences.

Obstructive sleep apnea (OSA) is characterized by pauses in breathing, known as apneic events. During these events, the blood oxygen level drops, and often called the response known as "fight or flight response releases releasing adrenalin, raising blood pressure, and increasing heart rate. The patient rarely awakens fully during these events, and therefore is not consciously aware that breathing stopped. However, he or she experiences the same physiological effects that accompany panic, resulting in fragmented sleep.  Numerous health problems can be prevented or alleviated by addressing the Sleep Related Disorder.

What Does Dentistry Have to Do with Sleep?

At Markiewicz Dental of Mundelein, when our patients complain about “bad sleep” we pay particular attention to their teeth and jaw. What state is their enamel in? If the enamel is worn down it’s either a sign that our patient is grinding their teeth in their sleep or indicative of acid erosion, possibly from an airway issue. We also observe our patient’s jaw – does it seem properly aligned or is it misaligned which could lead to snoring or sleep apnea?  Both of these conditions result in poor sleep both for our patient and perhaps their bedmate.

If we suspect that snoring, sleep apnea, or other sleep disordered breathing is the culprit for you, we will ask you questions regarding your recent well-being: Do you ever wake up with a dry mouth? Do you suffer from insomnia? How often do you feel fatigued all day long? As well as many more that provide insight into what might be occurring for you.

An accurate diagnosis is imperative to successful treatment.  We examine your teeth, jaw, tongue, tonsils and airway and x-rays for up-to-date images of your entire mouth structure. We may also recommend you take home our home sleep screening test which collects data and depending on the results, we may recommend you take your report to your MD for further testing or recommend you begin the Seattle Protocol.

The treatment of Sleep Related Disorders is a rapidly evolving.  As Dentists, we routinely treat the more serious SRD known as Sleep Apnea using a variety of Oral Appliances.  A dentist can fabricate a sleep appliance when prescribed by a physician after a sleep study and a diagnosis have been obtained.

Often, we can detect and treat less serious SRD before they progress to OSA.  Current research demonstrates how Obstructive Sleep Apnea develops over time.  As most airway issues are environmental, not genetic, things in our life experience create the problem.  The foods we eat, the air we breathe, and possibly the most important, how we breathe (Mouth vs. nasal breathing) all can contribute to SRD. This also means that we can influence their development back to the way it was intended, if we do the right thing. The first steps would be to return to nasal breathing and open the airway.

Oftentimes, we will see a patient in distress with probable apnea and the related complications. However, often we will discover a patient with no obstruction, but rather flow limitation issues. This condition is called Upper Airway Resistance Syndrome (UARS), which also has serious medical and social consequences due to inadequate sleep. Screening for these conditions provides an efficient, non-invasive and cost-effective way to uncover and treat patients when the condition is more manageable.  At Markiewicz Dental of Mundelein, we have screening tools to help uncover and help prevent disease progression.  We can improve patients’ lives and potentially prevent diseases both now and in the future. The goal is detecting, understanding and managing SDB to optimally improve the quality of a patient's life.

Who suffers from Sleep Related Disorders?

It is not just the older, heavier individual:

  • Children-If recognized early, we can improve the lives of children.   Children who can’t breathe struggle.  Airway issues affect development and have been linked to issues such as ADHD.
  • The mature, over weight individual.
  • The younger, fit individual who may suffer from headaches, tooth grinding, gastric reflux, and jaw pain.

Screening patients is within the scope of work for dentists.  As the American Dental Association states, dentists should:

  • Assess patient risk for sleep-breathing disorders as part of a comprehensive medical and dental history and refer affected patients to appropriate physicians.
  • Evaluate the use of oral appliance therapy and provide it for mild and moderate OSA when CPAP fails.
  • Identify and address the side effects of oral appliance therapy.
  • Communicate patients’ treatment progress with referring physician and other healthcare providers.

If an SRD is uncovered, appropriate referrals to ENT, orthodontists, oral surgeons and sleep specialists may be necessary.

Current research also shows the relationship between dentistry and breathing related disorders.  In children, breathing issues will affect development of the jaws and facial structures and in adults, dental conditions can affect breathing and breathing difficulties can affect dental health.  Breathing disorders and dental conditions also interrelate. Clenching and/or grinding the teeth, sensitivity, receding gums, periodontal disease, and tooth decay are the dental problems which can be related to compromised airway.

Early intervention can prevent the progression of sleep-related diseases and the negative toll it takes on patients’ overall health, growth, and development. As more research is published about the progressive nature of SRD, dental care providers are on the forefront for early detection. Many signs and symptoms of SRD begin in early childhood and can be uncovered dental visits.   At each dental visit we must look for signs of erosive or destructive wear and be aware of mouth breathing.  It is possible that possible causes for chronic pain and headaches could be related.

Seattle Protocol

At Markiewicz Dental of Mundelein, we are excited to have implemented Airway Screening, testing, and the Seattle Protocol.

The Seattle Protocol was pioneered by two dentists in the Seattle, Washington, area. The six-step process helps patients who struggle with obstructive sleep apnea or other sleep disordered breathing conditions like upper airway resistance syndrome.

For some, thinking of sleep apnea conjures up visions of a restless night’s sleep and CPAP machines. While these are certainly the experiences of some patients with this condition, the Seattle Protocol can help many patients with sleep disordered breathing determine if an airway compromise is contributing to their ailments.

At Markiewicz Dental of Mundelein, we utilize the SleepImage® System.  It is an FDA cleared Medical Software that accurately and objectively measures sleep quality, sleep duration and sleep pathology based on single-lead electrocardiogram (ECG) recordings.  It is a simple at home testing system. 

Seattle Protocol Step 1: Nose Breathing and Mouth Taping

The first step in the Seattle Protocol is to gently train your body to breathe through your nose, not your mouth. Breathing through your mouth during sleep can lead to snoring and dry mouth. The Seattle Protocol encourages nose breathing by adding a strip of paper tape vertically across the center of your lips. The light adhesive of the tape keeps your lips together but is easy and painless to remove.

Step 2: Temporary Splint for Lower Jaw and Mouth Taping

Once you’ve adjusted to the mouth taping, the second step of the protocol adds a temporary splint for your lower jaw while you sleep. Adding this splint increases the vertical dimension of your jaw and allows more airway space.

Step 3: Temporary Splint for Lower Jaw with Lower Jaw Pulled Forward and Mouth Taping

If adding the lower splint only isn’t giving you the restful sleep you deserve, we move onto the next stage of the protocol. In this step, we add an element that pulls your lower jaw forward. This realigns your jaw and increases your airway space not only vertically, but horizontally as well. This also can give your tongue more of the space it requires.

Step 4: Temporary Splint for Lower and Upper Jaw with Mouth Taping

With all steps of the Seattle Protocol, if you aren’t getting relief from the previous step, we move on. In this step, we remove the forward jaw posturing component and add a splint for your upper jaw. You then go to sleep with splints on your upper and lower teeth and your jaw is free to move. This stage allows for additional vertical height, opening up your airway, but without restricting the jaw muscles into any one strict position.

Step 5: Temporary Splint for Lower and Upper Jaw with Lower Jaw Pulled Forward and Mouth Taping

If you need to continue in the protocol, step five again adds a horizontal component by linking the upper and lower splints together and moving the lower jaw forward. The intent, as always, is to continue to open your airway more and more.

Step 6: Temporary Splint for Lower and Upper Jaw with Lower Jaw Progressively Pulled Forward and Mouth Taping

If you still aren’t getting that good night’s sleep, we move to the final stage of the Seattle Protocol. In this stage, we keep moving your lower jaw forward, incrementally, until you feel well-rested.

While there are six steps in the Seattle Protocol, you may not necessarily go through the entire process. The purpose of the protocol is to help us understand which step provides the best relief. Typically, the further you progress in the process, the more help your airway needs. If we find that you only get positive results in steps 4, 5, or 6, then looking at oral surgery options to expand your airway might be the best long-term solution.

The Seattle Protocol is a gradual, gentle, and reversible process that helps us identify solutions for our patients with airway issues. It not only can help you get a better night’s sleep, but it can lead to an excellent path to better overall health and wellness. If you snore, spend your nights tossing and turning, have anxiety or depression, have acid reflux, or just simply feel tired all the time, we may recommend starting with the Seattle Protocol to help improve your life!

Nasal Breathing

Normal breathing is done through the nose. The nostrils  filter, warm, moisturize, dehumidify and smell the air.

Babies are born nose breathers, but somewhere along the way nose breathing can change to mouth breathing, with negative consequences. The most obvious adverse effect of mouth breathing is dryness of the mouth, leading to inflamed tonsils, tonsil stones, dry cough, swollen tongue, bad breath, swollen gums and cavities.

Normal respiration follows a gentle wave pattern with 10 to 12 breaths per minute. Mouth breathers take too many breaths, with rates from 12 to 20 breaths per minute or more. Breathing delivers oxygen to the cells of the body and removes excess carbon dioxide.  Carbon dioxide triggers breathing, maintains blood pH and prevents smooth muscle spasms. All of these functions are reduced or impaired in mouth breathers.

Surprisingly, oxygen is absorbed on the exhale, not on the inhale. The back pressure created in the lungs with the slower exhale of nose breathing allows more time for the lungs to transfer oxygen to the blood. This exchange requires carbon dioxide. Exhaling through the mouth blows the carbon dioxide out too quickly, resulting in less oxygen being absorbed. The reason nasal breathing results in more oxygen being absorbed is nitric oxide is released in the nasal cavity and inhaled with nose breathing. Nitric oxide increases the efficiency of oxygen exchange by 18 percent. There is no nitric oxide inhaled with mouth breathing, therefore less oxygen is absorbed.

Reduced oxygen absorption leads to a cascade of sleep, stamina, energy level and ADHD problems. Children diagnosed with ADHD may in fact be mouth breathers who are simply sleep deprived.  Mouth breathing related problems of skeletal development will set children up for obstructive sleep apnea later in life. In addition to changes in development of the jaws, the airway is constricted, predisposing the child sleep problems.

It may seem logical that mouth breathing occurs because the nose is congested, but that is not always the case. The brain of a mouth breather thinks carbon dioxide is being lost too quickly from the nose and stimulates the goblet cells to produce mucous in the nose to slow the breathing. This creates a vicious circle of mouth breathing triggering mucous formation, nasal passages blocking, leading to more mouth breathing. So in fact, mouth breathing can cause nasal congestion leading to more mouth breathing.

If you need help with Sleep or Breathing related issues, schedule an appointment. At Markiewicz Dental of Mundelein, what sets us apart is our commitment to you, our valued patients. We focus on delivering the kind of outstanding experience that exceeds your expectations. Not only do we strive to make every phone call and every office visit an exceptional experience, but we also strive to make every dental restoration exceptional.

Contact our Mundelein office or schedule an appointment online.

 

At Markiewicz Dental of Mundelein, we help you achieve good oral health and good overall health.

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