Sleep apnoea is a sleeping disorder which affects a third of the population. Those that are affected by the condition are often unaware of their condition. The ill effects associated with sleep apnoea include excessive day time sleepiness, inability to concentrate and focus, irritability, and in most cases depression. News.
Why bother treating or managing obstructive sleep apnoea?
1. Snoring can be very loud to keep bed partner from having a good night sleep.
2. Sleep apnoea has been linked to cardiovascular disease ie. heart attacks and strokes.
3. Depression is strongly associated with sleep apnoea.
4. Difficulty controlling diabetes.
5. Poor ability to focus and concentrate does increase the risk of motor vehicle accidents.
What are the signs and symptoms of Sleep Apnoea?
1. Snoring loud enough to be heard through closed door.
2. Gasping or choking sounds whilst sleeping.
3. Episodes of no breathing during sleep.
4. Difficulty concentrating during the day.
5. Feeling sleepy during the day in spite of 7-8 hours of sleep (for an adult).
6. Nodding off to sleep whilst watching TV or reading a book or newspaper.
One of the presenting signs of sleep apnoea is snoring during sleep. Snoring does not always mean you have sleep apnoea but the presence of snoring is a sign of obstruction of the airways and is a significant symptom of obstructive sleep apnoea. Sleep apnoea involves the body not getting enough oxygen during the night from episodes of breathing cessation.
Sleep apnoea has been linked to cardiovascular disease including high blood pressure, heart attacks and strokes. Poor control of diabetes can also be associated with sleep apnoea. The medical fraternity has acknowledged that sleep disorders have a significant impact on other medical conditions.
The only way sleep apnoea can be objectively diagnosed and the severity determined is by seeing a sleep physician who will order a sleep study. Following the sleep study, results will indicate if there is a risk of sleep apnoea and what the severity is but it also will determine if there are other underlying sleep conditions.
The gold standard for management of moderate to severe sleep apnoea is the use of CPAP (continuous positive airway pressure). However in most cases individuals find the use of a mask to sleep quite obtrusive. In such cases the sleep physician will recommend a mandibular advancement splint. This is a device which is worn at night to posture the lower jaw forwards opening the airways. This is a very good device to reduce or in some cases eliminate snoring completely.
There are many mandibular advancement splints available on the market, an example of a custom made MAS is seen in figures 3 and 4. Some are bought over the counter. But if the splint is not properly fitted and made there can be significant dental side effects. The splint needs to be custom fitted so that all the teeth are sitting properly in the splint. If this is not done the teeth can move leading to teeth becoming painful. Also the jaw needs to be pulled forwards slowly which means the device must be titratable. The mechanism in the splint which we provide can be adjusted in tenths of a millimeter each time so that the jaw has time to adjust to the changes. This reduces the risk of side effects associated with the jaw joint.
The provision of the mandibular night splint is not just a piece of plastic placed in the mouth. It is a form of therapy which must be managed and to ensure the desired results are achieved but reducing the risk of dental complications. These complications include the change in the bite, teeth moving, pain in the jaw joints and muscles. The most qualified person to provide oral appliance therapy is a dentist. Because the appliance has a large impact on the dental structures and knowing what to do when complications arise is important. But more importantly knowing what not to do is necessary if we are to safeguard the patient from any long term dental side effects.
At ProCare Family Dental Dr Roland Chong has undergone further training for oral appliance therapy and continues to update his knowledge in sleep medicine in order to provide the best care for our patients.