About Sleep Apnoea

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Snoring is the noise of obstructed breathing during sleep. While snoring may be harmless (benign snoring), it can also be the sign of a more serious medical condition, which progresses from upper airway resistance syndrome (UARS) to obstructive sleep apnoea (OSA).

When you breathe normally, air passes through the nose and past the flexible structures in the back of the throat such as the soft palate, uvula and tongue. While you are awake, muscles hold the airway open. When you fall asleep, these muscles relax, but, normally, the airway stays open.

Snoring occurs when the structures in the throat are large and when the muscles relax enough to cause the airway to narrow and partially obstruct the flow of air. As air tries to pass through these obstructions, the throat structures vibrate causing the sound we know as snoring. Large tonsils, a long soft palate and uvula and excess fat deposits contribute to airway narrowing.

When obstructive sleep apnoea occurs, the tongue is sucked against the back of the throat. This blocks the upper airway, causing airflow to stop. When the oxygen level in the brain becomes low enough the sleeper partially awakens, the obstruction in the throat clears, and the flow of air starts again – usually with a loud gasp. People with obstructive sleep apnoea (OSA) have disrupted sleep, and low blood oxygen levels.

OSA has been associated with high blood pressure, cardiovascular problems and excessive daytime sleepiness. The condition known as upper airway resistance syndrome (UARS) lies midway between benign snoring and true obstructive sleep apnoea. People with UARS suffer many of the symptoms of OSA but normal sleep testing will be negative.

Snoring not only affects the health and well being of the person snoring but can also effect the health and well being of his or her bed partner. This can lead to relationship difficulties due to the disruption caused by excessive noise to a bed partner’s normal sleep patterns.

The Role of Dental Sleep Medicine

Dental Sleep Medicine is a sub-specialty, which has emerged to address the growing significance of the prevalence of this condition.

Guidelines exist for the provision of dental services and oral appliances to assist in the management of snoring and obstructive sleep apnoea (OSA).

Provision of an oral appliance therapy is recommended only after patient consultation with the relevant sleep physician who has responsibility for making the medical diagnosis.

Scientific literature has demonstrated that oral devices can be considered as first-line treatment for snoring and mild Obstructive Sleep Apnoea (OSA), but they are not recommended for moderate to severe OSA patients. They can however be prescribed in cases where patients do not respond to controlled positive airway pressure (CPAP) therapy or are CPAP intolerant.

On referral from the relevant medical physician or surgeon a dental evaluation is carried out to determine an individual patient’s suitability for appliance therapy. Customisation of appliances is necessary to meet specific anatomical and treatment requirements.

More Medical Facts About Sleep Apnoea

Obstructive sleep apnoea syndrome (OSAS) is a common disorder reportedly effecting at least 4% of men and 2% of women in the developed world. This indicates a prevalence figure of up to 60,000 adults in Ireland having this disorder.

The condition is characterised by repeated episodes of upper airway or pharyngeal obstruction during sleep that lead to intermittent hypoxia sleep fragmentation and excessive daytime sleepiness.

Obesity and dietary problems continue to contribute to an increasing prevalence and significance of this important medical condition.

While snoring has been known to cause numerous problems like sleepiness and fatigue current research now indicates that several cardiovascular diseases may be linked to snoring and Obstructive Sleep Apnoea Syndrome (OSAS). New studies report the significant effect of sleep apnoea on drivers behaviour.

Other Sleep Related Dental Conditions

Sleep Bruxism is excessive tooth grinding which is an unconscious activity which occurs during sleep and can be very destructive to natural teeth and dental restorations. Evidence of a Sleep Bruxing habit can be damage to the teeth and existing dental work characterized often by shape altering tooth wear and fractures and sometimes loosening of the teeth. This condition can be treated with a bite appliance but also sometimes requires extensive dental restoration (prosthodontic treatments) of the teeth. Sleep Bruxism is often associated with sleep related breathing disorders.

Sleep Gastric Reflux Disease or GORD (Gastro-oesophogeal reflux disease)is another condition commonly associated with Sleep Apnoea and Sleep Bruxism. This condition can have significant effects on the teeth themselves resulting in very destructive erosion of tooth enamel. This erosion can alter the tooth colour and shape and sometimes also requires extensive dental restoration (prosthodontic treatments) of the teeth.

For more information on sleep related issues visit www.irishsleepsociety.org