Are you tired of being tired?

Is snoring adversely affecting your life?

Dr. Gerilyn Alfe and her Chicago Smile Spa team hear this all the time! We know that it’s unusual to talk to your dentist about how well you sleep and how rested you feel when you wake up. What you may not know is that there are many ways that Dr. Alfe can help you get a better night’s sleep, without surgery, uncomfortable machinery, or overnight stays in hospitals or sleep clinics. If you, or someone you know, are one of the estimated 15 million people who suffer from sleep apnea, call us for a consultation at 773-348-2704. Sleep apnea is a condition where you stop breathing for 10 seconds or longer. This can prevent you from experiencing deep sleep that allows you to feel rested. Read on for more information!

Sleep Apnea: What is it?

This is a much more serious condition than just snoring, although snoring can be the first obvious sign of someone having trouble breathing while asleep.

If you stop breathing for 10 seconds or more while asleep, you have sleep apnea. Obstructive Sleep Apnea Syndrome (OSAS) is one type of sleep apnea where the airway is blocked by any obstruction (tongue, tonsils, large amount of tissue in the uvula area, etc). Depending on the cause and severity of the obstruction, a dental appliance can work very well to alleviate this and allow the patient to breathe more easily throughout the night.

In some cases, sleep apnics will wake themselves up completely and in other cases, they will move from deep sleep to lighter sleep. These are the people who tell us that they sleep at least 6-8 hours/night yet they never feel rested. Sometimes they also report feeling the need to “catch up” on their sleep on the weekends. The reality is that an adult should feel very well rested after sleeping 6-8 hours/night and if you are not, you are probably not getting sufficient deep sleep throughout the night.

Sleep apnea: Is this another form of snoring?

While most people who suffer from sleep apnea do snore, not all people who snore suffer from sleep apnea. Snoring happens when there is a partial blockage of your airway, causing a muffled sound due to throat vibrations. When lying on your back especially, your tongue can fall toward the back of your mouth, thereby causing a breathing obstruction.

For sleep apnics who wake themselves up completely, this episode is often preceded by snoring, gasping, choking and/or gurgling. If you or someone you know is snoring, it may be more serious than just a noisy annoyance! Some sleep apnics can stop breathing as many as 60-100 times per hour!

If you or a loved one snores loudly at night, please have a sleep study done to rule out this potentially fatal condition. We have the Watch-PAT 200 sleep monitor which is a non-invasive home care device that is used with patients whom we suspect have sleep-related breathing disorders. After wearing the Watch-PAT 200 for only one night in the comfort of your own home, you can meet with Dr. Alfe and she can review your sleep study with you.

Some of the information she receives from the Watch-PAT 200 device are your pulse rate, oxygen saturation and desaturation, body position, presence or absence of snoring and not only how much you did sleep during the night, but also how much time you spend in each of the three important phases of sleep (light, REM and deep). Once she analyses your information, she can make a diagnosis and then recommend appropriate treatment for you.

You can follow this link for more information about our sleep monitor: http://www.itamar-medical.com/Product.asp?pid=3006

Sleep Apnea: Why is it a problem?

Disrupted deep sleep can affect your mood, your overall health and can be downright dangerous if it causes daytime sleepiness. Drowsy driving causes over 100,000 car crashes annually with 67,000 injuries and 1,500 deaths. These statistics are increasing every year. Most of these accidents occur between midnight and 8 am. AND being awake for 24 hours is equal to having a blood alcohol count of 0.10 which is over the blood alcohol limit in most states! While many of us are not up for 24 hours straight, having only 4 hours of sleep and one beer is equivalent to having 8 hours of sleep and drinking a six pack.

Drowsy Driving is only one of the dangers of sleep apnea.

Here are some more common ailments:

• High Blood Pressure
• Heart Disease
• Heart Attack
• Stroke
• Acid Reflux or GERD
• Diabetes
• Weight Gain or inability to lose weight in spite of diet and exercise
• Depression
• Lack of concentration
• Memory Loss
• Tooth Grinding
• Parkinson’s and Alzheimer’s
• Impotence and menstrual irregularities
• Decreased libido

It has even been shown to increase the risk of premature death. This doesn’t even take into account how snoring, choking or gurgling can constantly wake up the bed partner of a sleep apnic, thereby making him or her also sleep deprived. A condition knows as “secondary snoring” has been researched and has been shown to cost the bed partner on average, 1.5 hours of sleep loss each night! Snoring has also been shown to be a leading cause of divorce.

Even if you don't snore, you may have some form of sleep apnea. Based on an average 6-7 hours of sleep being normal for adults, some questions to ask yourself (or a loved one) are:

• How much caffeine do you need throughout the day to stay alert?
• Do you feel well rested when you wake in the morning?
• Do you feel the need to nap during the day on a regular basis?
• Do you use your weekends or vacations to “catch up” on lost sleep?
• Do you often feel sleepy while sitting and reading?
• Do you sometimes fall asleep while watching TV?
• Do you fall asleep when you are a passenger in a car, bus, train or plane?
• Have you ever dozed off while driving?

Sleep apnea: How do we treat it?

There are different options to treat sleep apnea. The recommended treatment is influenced by the severity of the apnea and well as what the patient wants to undergo.

Surgery to reduce the size of the tongue or uvula is an option but quite invasive. Tonsil or adenoid removal, when warranted, is another choice, but as with the tongue or uvula surgery, recovery can be quite painful for an adult.

Pillar implants can be placed in the soft palate to help better support the soft tissue in the back of the throat that may be blocking the patient’s airway. These should be placed by an experienced EENT or surgeon. A CPAP (Continuous Positive Airway Pressurize) Machine forces oxygen into the patient’s nose and mouth while he/she sleeps. While highly effective, they tend to be quite uncomfortable and patient compliance after 1 year is less than 70%.

Dental Mouthguards: For many, this is a much less invasive option! Dr. Alfe can make customized nightguards which will keep your lower jaw open and slightly forward to keep the airway open and the tongue out of the way. Patients have found these to be much more comfortable than many of the alternative treatments and compliance is very high for years after the fabrication of them. Dr. Alfe has been treating patients who suffer from migraines, headaches, TMJ pain and tooth clenching and/or grinding with the NTI nightguard for years. In very mild sleep apnea cases, the NTI may work well enough to help keep the airway open.

In one study, it was shown that the anterior mandibular positioning dental device (mouthguard) is actually more effective than surgical therapies. The same study stated that adverse health effects and appliance repairs were rare. Sleep apnea: Who suffers?

Most experts agree that even at 15 million sleep apnics identified, this has been an under diagnosed condition.
Some factors that increase your risk for sleep apnea:

• Gender-more males than females suffer with sleep apnea
• Obesity
• Deviated septum
• Large, scalloped tongue

Males with a neck size greater than 17 inches and females with a neck size greater than 16 inches….and this can be from either fat or from muscle. **Here’s some interesting information about that: A study of professional football players in the Super Bowl Study showed that 34% of linemen in that game were diagnosed with sleep disordered breathing. This is roughly 8 times more than average

• Childhood history of asthma and/or allergies
• Orthodontic (braces) treatment, especially as a child
• Large tonsils and/or adenoids that have not been removed
• Difficulty breathing through the mouth during the day and/or night
• Tongue/mouth jewelry/piercings
• Family history of sleep apnea
• Partial or complete tooth loss (edentulism)

Sleep apnea: How do you know if you are at risk?

There are two questionnaires that we have all our patients fill out, regardless of whether they discuss their sleep (or lack of it) with us. These are the Epworth Sleepiness Scale (which is filled out by the patient) and the Sleep Observers Questionnaire (which is filled out by the patient’s bed partner). Email us at DrGerilynAlfe@gmail.com and we will email you copies for you and your bed partner to fill out.

Sleep apnea: How does Dr. Alfe treat this?

Once Dr. Alfe has evaluated your sleep study, she will discuss your diagnosis with you and help you decide what is the best treatment for your particular situation. If she decides that an oral appliance is the best treatment for you, she will discuss different types of custom appliances with you, as each type acts differently to open your airway and reduce the severity of your sleep apnea.

One option Dr. Alfe may prescribe is the SomnoMed MAS is a Mandibular Advancement Splint. Over a period of time, the upper component is adjusted to allow the lower jaw to slide forward, opening the airway and allowing the patient to breathe better. In addition, this appliance can be fine tuned to help patients who also suffer from nighttime tooth clenching or grinding. The SomnoMed MAS can also be made for patients who are completely or totally edentulous (partially or completely without teeth).

One mandibular repositioning appliance Dr. Alfe prescribes is called the Thornton Adjustable Positioner (TAP) oral appliance. This has two separate components, one each for the top and the bottom jaws that are inter-connected to allow the lower jaw to slowly advance forward over time. During the initial treatment visits, Dr. Alfe will very closely monitor you to ensure that the amount of advancement that is happening is safe and comfortable for you.

The SUAD appliance lets the patient move his/her jaw more than the TAP or the SomnoMed MAS appliance as its coupling mechanism is less rigid and restrictive.

The OASYS Oral/Nasal Airway System is another appliance that helps with sleep apnea. This is the first dental device to be reviewed by both the dental and FDA divisions of the FDA. The FDA approved the OASYS to treat snoring and sleep apnea through mandibular advancement. It also acts as a nasal dilator to improve nasal air passage.

A more generic brand of dental appliance is the SILENT NITE device. It is slightly more comfortable than some of the other devices, but it also tends to be less sturdy than the others, requiring replacement on a more regular basis.

Sleep apnea: Who should treat you?

Finally, it’s important that you seek help from someone who has had advanced training in this field. Even though the field of sleep apnea treatment is still relatively new to dentistry, there are a number of dentists who have received advanced training in this.

Some questions to ask your dentist if you want help with treating your sleep apnea:

• How much advanced training have you received in treating sleep apnic patients?
• How much experience do you have with mouthguards/nightguards in general?
• What is your knowledge of occlusion (how the teeth bite together)?
• What is your knowledge of the TMJ (Tempero-Mandibular Joint) and TMD (Tempero-Mandibular Disorder)?
• Do you have equipment to measure and monitor my progress before, during and after treatment like TekScan to check the teeth and the bite and JVA to check the TMJ?
• Have you treated clenchers and grinders with other nightguards, and for how long?

Dr. Alfe and her Chicago Smile Spa team look forward to helping you get a great night’s sleep and improve your quality of life! Call us today at 773-348-2704 or email us at DrGerilynAlfe@gmail.com to reserve time for your appointment! You no longer have to sleep walk through your life!!