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Sleep apnea is a common sleep disorder that affects approximately 200,000 people in the U.S. every year. The disorder is caused by a blockage in the upper airway while sleeping, which results in breathing that repeatedly “stops” and “starts.” Many times, people with this disorder do not know they have it. For example, those who snore loudly at night or are constantly tired after a full night’s rest may have the disorder. The most common reason why people develop sleep apnea is due to age or weight gain.
Many people visit a doctor for treatment. However, dentists are also highly qualified and trained in treating these disorders caused by other oral health conditions. For example, poor oral health and habits can be to blame for sleep apnea, including:
Tooth grinding (bruxism) is often one of the first signs of sleep apnea. A dentist checks for worn-down teeth, damaged surfaces, and inflamed gums. Many times, patients grind their teeth at night without knowing, which is often caused by a sleep apnea disorder, snoring, or both.
An abnormal increase in cavities is often associated with bruxism. As the teeth wear down due to excessive grinding (bruxism), they are more susceptible to the buildup of cavity-causing bacteria.
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A smaller jaw is also associated with sleep apnea and breathing heavily at night. A small jaw disrupts the upper airway passages, especially while sleeping, which can lead to mouth breathing, teeth grinding, and snoring.
Another abnormality that may indicate sleep apnea includes redness in the throat caused by irregular breathing at night. If your tongue has scalloped edges caused by excessive snoring, this may also be an indicator of the disorder.
Other causes of the disorder are not entirely associated with a patient’s oral health status. For example, other causes may include:
There are three main types of sleep apnea, including:
OSAS is the most common. It is characterized by repetitive apneas (no breathing) and hypopneas (shallow breathing) while sleeping. In addition, OSAS develops due to the partial or complete collapse of the upper airway, which causes a decrease in oxygen levels.
CSA is similar to OSAS because it is characterized by repetitive apneas and hypopneas. Although, the length of time where an individual doesn’t breathe (apneas) is much longer. CSA occurs when the brain does not transmit signals to the breathing muscles in the mouth and jaw. Additionally, people with CSA wake up with shortness of breath and often gasp for air.
CompSAS is a rare and distinct form of sleep-disordered breathing. It occurs when a patient has both OSAS and CSA. The disorder is typically diagnosed during initial treatment with a continuous positive airway pressure (PAP) device.
Devices, surgery, and therapy are commonly used to treat the disorder. However, in some cases, other forms of treatment may include weight loss and nasal decongestants.
Dentists only treat the obstructive form of sleep apnea, so anyone with Central or Complex needs to see a board-certified sleep physician.
There are a few different types of treatment available depending on patient needs and the severity of the disorder:
CPAP devices are typically provided by doctors, rather than dentists. This type of treatment uses a machine to pump air pressure into a patient’s airways, which keeps the windpipe open while sleeping. This reduces the chance of airway collapse, skipped breathing cycles, and other problems associated with obstructive, central, or complex sleep apnea. CPAP devices do not cure sleep apnea, but they help reduce symptoms over time.
Advantages of CPAP devices include:
Oral appliance therapy (OAT), also called a sleep apnea mouth guard, is an alternative to CPAP sleep apnea therapy. Dentists specialize in this type of treatment because it is similar to mouth guards and clear aligners.
OAT effectively treats excessive snoring, bruxism related conditions, and OSA. The mouth guard is custom-made for each patient, which helps improve comfortability, sleep cycles, and concentration. In addition, these devices reduce the negative side effects associated with sleep apnea. Although mouth guards do not cure these disorders, they do help decrease symptoms over time.
Advantages of OAT’s include:
Unlike CPAP devices and oral appliance therapy, oral surgery is the only cure for the disorder. Although, it is not commonly recommended unless a patient doesn’t respond to other treatments (CPAP and OAT). It is considered “the last resort treatment” because surgery has more side effects and risks. The most common types of sleep apnea surgery are jaw advancement surgery and uvulopalatopharyngoplasty (UPPP).
Other minor forms of treatment include nasal and throat surgeries. Both surgeries involve removing tissues in the oral cavity, which increases breathing spaces in the throat. Oral and maxillofacial surgeons typically perform these procedures.
The incidence of relapse after these surgeries is relatively high. However, mandibular advancement (jaw surgery) has the highest success rate for opening the airway permanently.
Since CPAP and OAT sleep apnea treatments are medically necessary, they are covered by insurance and Medicaid. Supplies for a CPAP device or sleep apnea mouth guard are covered separately, and the amount of coverage varies by state. Jaw, nasal, and throat surgeries are more expensive, but part of the procedure cost is typically covered with a good insurance plan. The prices below reflect treatment costs without insurance:
$1000-$3000 (per machine)
Oral Appliance Therapy
Nasal or Throat Surgery
Up to $10,000
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Friedman, Michael. Sleep Apnea and Snoring: Surgical and Non-Surgical Therapy. W B Saunders Company, 2009.
Hollins, Carole. Basic Guide to Dental Procedures. John Wiley & Sons, Inc., 2015.
“Sleep Apnea.” Mayo Clinic, Mayo Foundation for Medical Education and Research, 25 July 2018, www.mayoclinic.org/diseases-conditions/sleep-apnea/symptoms-causes/syc-20377631.
Wang, Juan, et al. “Complex Sleep Apnea Syndrome.” Patient Preference and Adherence, Dove Medical Press, 3 July 2013, www.ncbi.nlm.nih.gov/pmc/articles/PMC3704546/.