Dental Sleep Medicine is the dental management of sleep breathing disorders with Oral Appliance Therapy (Alameda & Lowe, 2009; Epstein et al., 2009; Lazard et al., 2009; Ng et al., 2005).
Let’s unpack the definition.
What is a sleep breathing disorder? According to the National Institutes of Health (NIH), a sleep breathing disorder, put simply, is any type or degree of obstruction that occurs in the nasal or oral airway while you sleep. This obstruction can vary in severity, and it can be caused by increasing age, malocclusion of the teeth, conditions such as hormonal imbalances, diabetes (Aronsohn et al., 2009) swollen adenoids and/or tonsils (Rahbar, 2004), or even simple weight gain. Waking up with headaches, sore jaw and/or teeth may be signs of sleep bruxism, a condition researchers think is associated with sleep breathing disorders, as well (Lavigne, 2007).
Much of the research on sleep breathing disorders has been performed on men (Young, 1996), with startling findings regarding its far-reaching implications for the male population. However, women and children are also now being found to be at-risk populations that also require examination. Pregnant women can experience serious health complications that affect the fetus (Franklin, 2000; Moulton, 2000; Aryim, 2009). Approximately 57% of children diagnosed with attention-deficit/hyperactivity disorder (AD/HD) suffer from sleep apnea or some other sleep disorder (Chervin, 2005), and treating the sleep breathing disorder is found to lessen the AD/HD symptoms (Gozal, 1998; Huang, 2007). A host of health problems can result from sleep breathing disorders, even death (Punjabi et al, 2009).
Snoring, a common sleep breathing disorder, is experienced by millions of people–men, women, and children. As a result, they can experience daytime tiredness and other adverse health complications (Young et al., 1993; Gottleib et al., 2000). Many people snore every night. Often, snoring marks the onset or existence of more serious sleep breathing disorders such as Upper Airway Resistance Syndrome, or worse, Obstructive Sleep Apnea.
Upper Airway Resistance Syndrome (UARS), another sleep breathing disorder, is found frequently in women and is associated with asthma, depression, and hormonal imbalances (Guilleminault, 2003). Women with UARS may be of normal weight and not show any physical symptoms of the disorder like a thick neck or high hip-to-waist ratio.
Although all sleep breathing disorders affect the body adversely, Obstructive Sleep Apnea (OSA) is the most serious of them (Kushida, ed. 2007). Unlike snoring and UARS, OSA is a condition in which the airway is obstructed completely, allowing no air to pass through the mouth or nose to the lungs. Apneic events, the times during sleep when the airway is closed completely, can happen for periods as long as a minute and hundreds of times during sleep.
Worst of all, the person suffering from OSA often is not aware of the severity of the condition. In fact, according to the American College of Physicians, 80-90% of people with OSA remain undiagnosed. Often, the bed partner is the one who identifies the condition, if at all. According to the NIH, people with OSA may be tired during the day, a condition called excessive daytimes sleepiness. Resistant hypertension that doesn’t respond to medication may also be a sign of OSA. Men with OSA may experience erectile dysfunction (Arruda-Olson, 2003) and women, sex hormone imbalances (Netzer, 2003) or weight gain. Overweight men and women are increasingly at risk as they age (Bixler, 1998). Women in peri- and post-menopausal stages experience increased risk for sleep breathing disorders such as OSA. Neurocognitive disorders such as Alzheimer’s disease are also being linked to OSA (Abrams, 2005) and preliminary findings show that treatment may help the dementia (Ancoli-Israel, 2008). According to the NIH, children can suffer from OSA as well; the NIH reports that the condition affects 18-20% of infants, 7-13% of 2-8 year-old children, and 3-5% of older children. Swollen tonsils and/or adenoids, hyperactivity, enuresis (bed-wetting), and stunted growth are all symptoms of sleep breathing disorders such as OSA in children.
Treatment options for sleep breathing disorders include lifestyle changes, Continous Positive Airway Pressure (CPAP), and surgery. However, Oral Appliance Therapy, a fourth option, is the gold standard for mild to moderate Obstructive Sleep Apnea as well as for patients who do not respond to or do not elect to use CPAP (Kushida et al, 2006). There are over 100 FDA-approved oral appliances, each with its own unique way of managing sleep breathing disorders.