Category: Sleep Apnea

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Sleep Apnea Treatment in Glendale, CA

There is, according to Dr. Sarkissian, probably no other condition that impacts general health as much as sleep apnea does. Imagine that during your sleep someone chokes you for a whole minute, and repeats this every 5 minutes throughout the whole night. Worst of all, you are not aware of this happening.

In our office we take sleep apnea very seriously, mainly because it seems to be an underlying factor for many conditions. Furthermore, I have noticed that most of our patients who have had braces as teenagers after having had four sound teeth extracted for the purpose of “creating space,” invariably suffer from a multitude of deleterious effects, such as excessive tooth wear, orthodontic relapse, stunted jaw growth, jaw-joint dysfunction, a mid-face deficiency, flat face with lack of proper lip support, insufficient jaw sizes to accommodate proper tongue position, snoring, and sometimes sleep apnea. Many times sleep apnea is an accompanying condition in these patients, due to the fact that the smaller jaws will just not accommodate the tongue, which tends to fall back and obstruct the airway during sleep. As dentists we have to be able to identify the incidence of this serious disorder, and offer treatment after obtaining a diagnosis by a physician.

ADULT SLEEP APNEA FACTS:

  • Obstructive Sleep Apnea, or OSA for short, afflicts 20 million Americans. 9% of men and 4% of women have OSA.
  • Statistically, most heart attacks happen in the early morning hours. Many of these can be blamed on O.S.A.
  • The Anales Medicina de Interna reported in 1999 that patients with untreated sleep apnea have a 37% chance of dying within 8 years.
  • Nasal breathing and an ample oxygen supply encourages nasal and sinus epithelium to produce Nitric Oxide, a tissue mediator which prevents the blood from clotting, protects arteries and dilates blood vessels.

CHILDHOOD SLEEP APNEA FACTS:

  • Most growth hormone is produced during the first few hours of sleep.
  • 90% of growth and tissue repair happens during NREM stage 4 sleep.
  • According to the American Academy of Pediatrics, all children should be screened for sleep apnea and treated immediately.
  • Chronic tonsil and adenoid enlargement is the most common cause of childhood sleep apnea
  • Since enlarged tonsils and adenoids are a major cause of sleep apnea and mouth breathing in children, consequentially smaller jaws and dental crowding are also common findings.
  • A survey in the journal Pediatrics from 2001 determined that children who snored during early childhood tended to show poor performance in middle school.

 

HIGH RISK FACTORS FOR O.S.A.

  • Being overweight
  • Snoring (not all snorers are sleep apneics)
  • Small or underdeveloped jaws
  • Lower jaw too far back in relation to the upper jaw.
  • Narrow upper airway diameter
  • Increasing age
  • Alcohol/tobacco/sedative use

SIGNS OF O.S.A.

  • Snoring, intermittent, with occasional gasping for air
  • Excessive daytime sleepiness
  • Non-refreshing sleep
  • Fatigue and irritability
  • Morning headaches
  • Gastro-esophageal reflux

CONSEQUENCES OF O.S.A. – sleep apnea is considered an independent risk factor for the following conditions

  • Poor memory
  • Increased auto and work-related accidents
  • Poor performance
  • Depression
  • Decreased quality of life
  • Heart problems, increased chances for developing high blood pressure, arrhythmias or stroke
  • Increased risk for adult type II diabetes

Diagnosis of OSA

Because OSA is a life-threatening medical condition, a multidisciplinary approach is necessary to address it. A physician should be involved in diagnosing the presence and degree of sleep apnea. A physician should also conduct an examination to determine if other correlated health conditions exist, such as hypertension, cardiovascular disease, diabetes and chronic fatigue.

Watch-PAT100

We are proud to carry this FDA approved, compact and ambulatory system of sleep monitoring.
In the comfort of your own home, it is a welcome alternative to a stressful and expensive hospital-based sleep study. Based on the results of this study, an on-line pulmonologist’s diagnosis is obtained which allows us to implement treatment much sooner.

Treatment of OSA
For mild to moderate cases of OSA, a dentist may fabricate an oral appliance to allow the airways to remain open for sufficient air to flow into the lungs during sleep. This treatment is far more tolerable than the conventional CPAP machine, which many patients of OSA find very cumbersome to use. (A CPAP is still a requirement for severe sleep apnea cases). In our office, we conduct a thorough evaluation of the multiple contributing factors and signs of sleep apnea, including daytime sleepiness and nighttime sleep evaluation scores. Homeopathic and naturopathic treatment many times provides additional support in improving sleep quality or addressing the hormonal, biochemical and physiological ravages of this condition.

Sleep hygiene
Among other things, the following habits should be implemented to improve sleep quality.

  1. Do not eat dinner within 3 hours preceding bedtime.
  2. Follow a regular sleep routine by not staying up late and not oversleeping.
  3. Cut back on alcohol, soda and caffeine.
  4. Take an herbal supplement or a hot herbal relaxing tea half an hour before bedtime.
  5. Take a warm bath before bedtime.
  6. Do not eat snacks, watch TV or read in bed.
  7. Follow a light and individualized exercise routine, preferably in the morning, and one hour before dinner.
  8. Do not engage in activities that are stressful or mentally challenging before bedtime.
  9. Shut off all lights.
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Mouth Breathing

Mouth breathing is a serious matter. In children of growing age, it may have devastating effects on general health and growth. Many seemingly unrelated conditions are related to mouth breathing.

CAUSES:
Chronic allergies, tonsil hypertrophy, nasal polyps, deviated nasal septum, constricted upper airways, a backward positioned lower jaw caused by thumb sucking, excessive pacifier use or insufficient suckling as an infant.

Signs in Mouth Breathers

  • Long, narrow face
  • Difficulty breathing through nose
  • Retarded physical growth
  • Dry lips
  • Dark circles under eyes
  • Excessive creases between lower lip and chin
  • Allergies
  • Smaller jaws with crowded teeth
  • Swollen tonsils

Consequences of Mouth Breathing

  • Jaw deformity
    The jaws and subsequently the whole facial structures grow in an altered fashion, resulting in long faces, constricted arches, tooth crowding, a narrowed nasal airway passage, and an altered head posture. The lower jaw remains too far behind in its growth, producing a small chin, dental malocclusion, a large overjet, and an unfavorable profile. If the mouth breathing is addressed, these children can often be treated for their malocclusions and skeletal growth discrepancies by a dentist or orthodontist who follows a functional-orthopedic approach.
  • Compromised airway
    Caused by: 1. the lower jaw being positioned too far back, along with the tongue, thereby constricting the upper airway. 2. Enlarged tonsils and adenoids due to chronic allergies may be the primary cause for mouth breathing, however mouth breathing in itself will also cause a further increase in tonsil size, thus constricting the airway to such an extent, that normal nasal breathing becomes an impossibility.
  • Altered head, neck and body posture
    The unnatural and unphysiological process of breathing through the mouth, which in many children looks like they are “gasping” for air, produces a reflex forward head posture. This puts a large load on the upper back and neck muscles, which if sustained, will cause permanent posture changes, such as abnormal curvatures in the cervical and thoracic vertebrae, and an altered shoulder posture. Ultimately, we see a domino effect affecting hips, knees and feet. In adults, Jaw joint dysfunction (TMJ problems).
  • Bad breath and gum disease
    Caused by the shift in the bacterial flora in the mouth.
  • Lowered immune system and poor health
    Nasal breathing produces a tissue hormone that regulates normal blood circulation. It also filters, warms and moisturizes the air. The lack of oxygen in mouth breathers, who usually snore at night and struggle for air, weakens the immune system, disrupts deep sleep cycles, and interferes with growth hormone production.
  • Obstructive sleep apnea (OSA)
    In newborns, this is thought by many researchers to be related to SIDS, or Sudden Infant Death Syndrome. In children, this is manifested as snoring, bed-wetting, poor quality of sleep, obesity, and ultimately behavioral symptoms resembling ADHD.
    In adults, OSA is a silent killer. Snoring is a manifestation of a blocked airway, which in essence is a milder version of sleep apnea. Most snorers, however, may not be aware that they may be suffering from OSA. On average, snorers are more likely to suffer from cardiovascular disease and stroke, and carry an increased risk for obesity, high blood pressure, stroke, severe obstructive sleep apnea, and diabetes.
  • Poor performance
    The same lack of oxygen and other hormonal factors make these children tend to be overweight, tired, and not perform well at school. Physically they are not athletic.

Mouth breathing in children should be addressed as soon as possible by consulting a physician, a dentist, a myofunctional therapist or an ENT specialist, who are experienced in treating this condition.

For recommendations to handle mouth breathing please view and download the article Recommendations for Mouth Breathers.