Quality of Sleep

The quality of your sleep affects your daily activities and has a huge impact on the overall quality of your life. If you are not getting an adequate amount of sleep during the night, then you and your body may suffer from sleep deprivation and be prone to daytime sleepiness. This may affect your:

• Productivity and performance at work • Increase your risk for injury or illness • Cause strain in personal relationships • Be a sign of a more serious health problem

Sleep Disordered Breathing (SDB)

Sleep disordered breathing (SDB) includes an array of breathing problems during sleep. Snoring, difficulty with breathing, and interrupted breathing are included.

Sleep disordered breathing is a spectrum of severity based on the collapsibility of the airway. Symptoms increase due to the increase in the disruption of airflow.

When the jaw opens and the tongue falls into the back of the throat, the airway narrows forcing air through the smaller opening. This creates vibrations in the throat known as snoring. Although snoring seems physically harmless, it can be a “red flag” for a much more serious and sometimes fatal condition called obstructive sleep apnea (OSA).

Obstructive Sleep Apnea

Obstructive Sleep Apnea (OSA) occurs when the tongue and soft palate collapse onto the back of the throat. This blocks the upper airway, causing air flow to stop. When the oxygen level drops low enough, the brain moves out of deep sleep and the individual partially awakens. The airway then contracts and opens, causing the obstruction in the throat to clear. The flow of air starts again, usually with a loud gasp. When the air flow starts again, you then move back into a deep sleep. The airway muscles collapse, as you awaken with a gasp. The airway clears once again as the process repeats itself. This scenario may occur many times during the night. The combination of low oxygen levels and fragmented sleep are the major contributors to most of the ill effects that the sleep apnea patient suffers. In addition to excessive daytime sleepiness, studies show that sleep apnea patients are much more likely to suffer from heart problems (heart attack, congestive heart failure, hypertension), strokes, as well as having a higher incidence of work related and driving related accidents.

Sleep apnea can cause:

• Chronic Sleepiness  • Strokes  • Heart Attack  • Heartburn  • Morning Headaches  • Depression  • High Blood Pressure  • Impotence

Diagnosis

How do you know if you have sleep disordered breathing (SDB)? The only way to be sure is to have a sleep test performed, either at home by a qualified sleep physician or in a hospital sleep center.

The Epworth Sleepiness Scale test asks questions such as how likely you are to fall asleep in different situations (watching TV, reading, etc.). If you snore or have been told that you awake gasping for breath, or if you are sleepy during the day, you should seek advice from your healthcare professional.

Since Obstructive Sleep Apnea (OSA) is a serious medical condition, it must be diagnosed by a physician. Diagnosis is based on the results of an overnight sleep study called a Polysomnogram (PSG). Other factors determining OSA are patient evaluation and history.

Treatment Options

Good sleep, weight loss, and exercise are some helpful OSA treatments a patient can practice on their own. However, medical and dental treatments include Continuous Positive Airway Pressure (CPAP), Oral Appliance Therapy, and surgery.  Oral Appliance therapy is the treatment performed in Dr. Bauer's dental office.

Continuous Positive Airway Pressure (CPAP)

Continuous Positive Airway Pressure (CPAP) is pressurized air generated from a bedside machine. The air is delivered through a tube, connected to a mask, covering the nose. The force of the pressurized air splints the airway open. The CPAP opens the airway like air into a balloon; when air is blown into the balloon, it opens and gets wider. This is exactly how CPAP clears the airway.

Oral Appliance Therapy

Oral appliances are worn in the mouth to treat snoring and obstructive sleep apnea (OSA). These devices are similar to orthodontic retainers or sports mouth guards. Oral Appliance Therapy involves the selection, design, fitting and use of a custom-designed oral appliance that is worn during sleep. With an oral appliance, throat structures move out of your air passage, allowing air to flow freely through your throat. Oral appliances may be used alone or in combination with other means of treating OSA. These means include general health, weight management, surgery, or CPAP.

Oral appliances work in several ways: • Repositioning the lower jaw, tongue, soft palate and uvula  • Stabilizing the lower jaw and tongue  • Increasing the muscle tone of the tongue

Surgical Procedures

In addition to Oral Appliance Therapy, dentists who are oral and maxillofacial surgeons may consider a variety of methods to evaluate, diagnose and treat upper airway obstruction. These dental specialists treat upper airway obstructive disorders by utilizing both minimally invasive procedures as well as more complex surgery, including jaw advancement. Additionally, an ENT specialist may evaluate you for other types of surgery, mainly the removal of the excess tissues in the throat. It may be necessary to remove tonsils and adenoids (especially in children), the uvula, or even parts of the soft palate and the throat.

Determination of Best Treatment

Dentists with training in Oral Appliance Therapy are familiar with the various designs of appliances. They can determine which one is best suited for your specific needs. The dentist will work with your physician as part of the medical team in your diagnosis, treatment, and on-going care. Determination of proper therapy can only be made by joint consultation of your dentist and physician and must combine objective evaluation of severity and patient preference.

Initiation of oral appliance therapy can take from several weeks to several months to complete. Your dentist will continue to monitor your treatment and evaluate the response of your teeth and jaws throughout the whole process.

2nd Hand Snoring

Sleeping with someone who snores cannot only be annoying, but it may also be detrimental to your physical and emotional health. Research shows that people who sleep next to a person who snores suffer from:

• Higher incidence of aches and pains  • Hearing loss, especially limited to the one ear most exposed  to the snoring  • High levels of fatigue and daytime sleepiness • Fibromyalgia • Depression or poorer mental health • Memory impairment

One Mayo Clinic study found that the bed partners of people who snore woke at least partially an average of 21 times per hour. This is nearly as often as the 27 times per hour that the “snorers” were awakened by their own documented sleep disorders (such as sleep apnea).

Both bed partners may be suffering from a sleep-disordered breathing and sleep deprivation although only one may have the real problem. Often those who snore do not take complaints from their bed partner seriously or act in denial, which further exacerbates the problem.

A Unique Approach

Snoring and sleep apnea are conditions inflicted during sleep. During the night, the normal tongue and jaw positions allow air to pass through the throat effortlessly. The tongue is forward, the jaw is closed and the airway is open.

When a person suffers from sleep apnea, his/her airway is blocked periodically through the night depending on the severity of the sleep apnea. The mouth is open, the tongue and soft tissue relaxes and collapses into the throat. This causes the person to snore and possibly have sleep apnea episodes.

The TAP® is based on the same principle as cardiopulmonary resuscitation (CPR). The airway must be open to allow air to pass through the throat. A constricted or collapsed airway causes snoring or sleep apnea.

The TAP® holds the lower jaw in a forward position so that it does not fall open during the night and causes the airway to collapse. The TAP® maintains a clear airway to reduce snoring and improve breathing.

The TAP^® 3

The TAP^® 3 appliance is a proven treatment modality for mild to severe OSA. It is currently being prescribed by over 7,000 dentists worldwide to cure snoring and sleep apnea. It has a technically simple design that attaches the upper and lower jaws together by utilizing a small hook and socket mechanism.

The single most distinguishing feature of the TAP^® is that it can be adjusted by the patient while in the mouth by the use of a small detachable key until the lower jaw is brought forward enough to ensure the airway remains open during sleep. Once a comfortable degree of protrusion is achieved, the key is removed and the patient can completely close their mouth with the appliance inside. This unobtrusive, self adjustability is one of the reasons TAP^® has a compliance rate of 95%. 

Patients are empowered to manage the degree of lower jaw protrusion over as many nights as it takes to achieve the optimal effect comfortably. The fact that TAP^® has a single point of adjustment prevents uneven bilateral adjustment which can create bite dysfunction.

The TAP^®CS (Chairside)

The TAP^®CS (Chairside) was introduced to the market in October 2009 and has been received with great enthusiasm by patients and dentists. The design of the TAP^®CS was inspired by the first generation TAP^® appliance. It has a permanent titration mechanism on the outside that allows for easy self adjustment by the patient. It operates on exactly the same principle as the custom TAP^® and allows the dentists to provide an immediate treatment for OSA that the patient can begin using the same night as their visit. Furthermore, since the TAP^®CS retails for about 30% of the custom model, it can be prescribed as a temporary or trial appliance to allow the patient to feel comfortable that the appliance is effective for them before they commit to a more costly custom appliance. Once the patient moves into a custom appliance, the TAP^®CS can be kept as a back up or secondary appliance. While the TAP^®CS is not considered a disposable appliance, it is also not intended for long term nightly use.

The TAP^® AM Aligner

TAP^®The purpose of the AM Aligner is to restore jaw alignment after using the TAP overnight. The forces that are inherent in repositioning the mandible forward are to incline the upper teeth towards the palate and the lower anterior teeth forward. This may also create inter-proximal spaces in the anterior teeth. The AM Aligner will offset these forces.

This tool is constructed from a thermoplastic material that, when heated, can be molded onto the upper teeth prior to a TAP being worn. This should then be worn every morning after wearing the TAP to reposition the teeth back to normal occlusion.