Snoring and Obstructive Sleep Apnea (OSA)
Snoring and Obstructive Sleep Apnea (OSA)
If you’re reading about our sleep apnea services, chances are you or someone you’re close to is snoring excessively at night, sleeping restlessly, or waking up tired, and you are wondering if sleep apnea might be the cause. It is estimated that 22 million Americans suffer from sleep apnea, 80% experiencing moderate to severe cases. If you, your significant other, or your child is a part of this figure, we hope to shed some light on sleep apnea for you and present some viable treatment options for you to consider.
Many Americans who suffer from sleep apnea use uncomfortable, CPAP (continuous positive airway pressure) machines to treat their condition. Although effective, CPAP treatment is hard to adhere to and does not address the root cause of sleep apnea for long-term relief. We’re here to tell you that it doesn’t have to be that way!
There are many comfortable, non-surgical treatment options available to adults and children who suffer from sleep apnea that DO NOT INVOLVE CPAP and that address the root cause of the condition. As an integrative dentist, Dr. Mandanas uses non-invasive treatments that consider all of the factors at play and work naturally with the body rather than against it. Learn more about what makes her approach different and how you might be treated at her office.
Sleep Apnea: What Integrative Dentists Look For
Integrative dentists like Dr. Mandanas look at more than just the symptom to assess the likelihood of sleep apnea. Although snoring, choking sounds at night, and chronic exhaustion during the day are important signs that should not be ignored, a major cause of sleep apnea is poor alignment in the anatomy of the jaw and the tongue. Below are some of the anatomical misalignments that integrative dentists look for in sleep apnea patients:
Retrognathia: Poor Alignment of the Lower Jaw
In a properly aligned jaw, you can set a ruler against the chin, the lips, and the nose such that all three of these facial features touch the ruler in a slightly-angled, almost perfect line with each other. Retrognathia is poor alignment of the lower jaw where the chin and the lower jaw are pulled back rather than lined-up with the lips and the nose. This misalignment pushes the tongue and the pharyngeal tissue in the throat backwards, blocking the airway and causing difficulty breathing at night (known as sleep apnea) as well as during the day. Retrognathia is a developmental deficiency, but it can easily be treated with mandibular advancement (see Integrative Treatments for Sleep Apnea Patients below).
A “High Tongue”
Another one of the first things Dr. Mandanas will look for in a sleep apnea patient is a higher than average tongue level. When we sleep, the muscles in our mouth relax and our tongue collapses into the back of our throat. If our tongue is larger or set higher than usual, it is more likely that our tongue will block our airways while we are sleeping. A high tongue will also affect our breathing efficiency during the day. It is worthy to note here that the airway obstruction inherent in sleep apnea is almost always 95% the fault of the tongue and only some of the obstruction is caused by the pharyngeal tissue. A high tongue can also be treated using mandibular advancement.
If someone is a mouth-breather, it is more than likely that they, A) Have a bad habit that has affected their breathing efficiency, causing sleep apnea at night, or, B) Have a developmental deficiency that causes mouth breathing and sleep apnea. Developmental deficiencies that cause mouth breathing include a misalignment of the upper jaw or a collapsed arch that affects the structure of the nasal passages, making mouth breathing easier than breathing out of the nose. The habit of mouth breathing is often developed by allergies or sickness that started mouth breathing where the mouth-breather never learned to stop.
If sleep apnea is not already present with mouth breathing, it can cause problems in this area. The tonsillar tissue in the back of the throat is a lymphatic filter, designed to catch bacteria and fight it off. The more it is used, the more it swells, blocking the airways.
Nose breathing is the most natural form of breathing and also the most efficient. Many people who get swollen tonsils and adenoids removed surgically could have avoided surgery by learning to breathe out of their nose as kids. The benefits of nose breathing include:
- Nose hairs are made to filter out bad bacteria before they enter the airway
- Nitric oxide gas in the nasal passages kill bad bacteria
- Nasal passages warm the air to prepare it for the body
When you visit Dr. Mandanas, she will assess your situation and connect you with a local physical therapist or a speech therapist if training in nose breathing is needed. If the sleep apnea is due to a developmental deficiency, she may prescribe exercises for alignment or a dental appliance.
Just as the jaw has a proper place to rest, the tongue should naturally rest on the top palate, on the rough “rugae” just behind your front teeth, which is where it goes when you make the “n” sound. The tongue is a powerful muscle, and what it does determines the shape of the entire mouth, including the parts of the mouth that affect the presence of sleep apnea. By applying gentle pressures over a long period of time, the tongue shapes the mouth, especially the upper jaw and arch. People who do not exercise proper tongue positioning are often mouth-breathers who have collapsed arches, both of which can cause sleep apnea. For patients who suffer from improper tongue positioning, Dr. Mandanas provides tongue retraining exercises.
Integrative Treatments for Sleep Apnea Patients
As we mentioned from the start, many patients treat their sleep apnea using CPAP machines, however, these are uncomfortable and difficult to adhere to. Many of our patients are what we call “CPAP rejects,” people who “cannot tolerate CPAP.” For these patients, we prescribe a mandibular advancement device (MAD) that is worn during sleep, much like the CPAP machine. However, unlike the CPAP machine, patients are not restricted to lying on their back—they can roll over in a MAD appliance. Most find the MAD appliance to be far more tolerable than CPAP.
Mandibular advancement devices are custom-made and work by preventing the lower jaw from slipping backward and allowing the tongue to collapse in the back of the mouth. As the patient’s jaw progresses forward, they come in for minor adjustments to keep progressing. A couple of the brands of MAD appliances we use include no metal Panthera and SomnoDent.*
*Dr. Mandanas is currently studying Advanced Light Force (ALF) therapy for patients who need more than mandibular advancement. The ALF device works by training the tongue to adjust the cranial bones, enacting neurological as well as physical changes by using the natural forces of the body for advanced sleep apnea patients.
When you come in to visit Dr. Mandanas, she will discuss your treatment options with you after assessing the root cause of your sleep apnea. The integrative treatment options discussed above are covered by most insurances, although coverage depends on the nature of your sleep apnea. If you or someone you know suffers from sleep apnea and you are interested in Dr. Mandanas’ approach as an integrative denist, contact us during office hours to schedule an appointment! We look forward to seeing you.