Dentist visit can help uncover sleep problems

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There are certain health issues that may come to the attention of a dentist who would then refer them to a medical specialist.

Sleep apnea is one such health concern. Dr. Stephen Chung from the sleep center at the Walla Walla General Hospital has kindly consented to answer a few questions as they relate to this condition.

First of all Dr. Chung, could you give the readers an idea of what the symptoms of sleep apnea are?

There are two different kinds of sleep apnea. The more common type is called obstructive sleep apnea. As the name of this condition implies, this disease causes obstruction of the upper airways behind the tongue when one is sleeping.

This is seen most frequently in loud snorers. There is breathing disruption (where one repeatedly stops breathing) during sleep and subsequently sleep is frequently disrupted. Therefore, the most common symptoms are loud snoring, daytime sleepiness, fatigue and sometimes insomnia.

How would a person know if their symptoms were serious enough to require an evaluation with a sleep specialist?

If your family member notices that you doze off easily when you are sitting or resting and you snore loudly when you sleep, there is a good chance you have obstructive sleep apnea. The risk is even higher if you are overweight, have a large neck size, have high blood pressure, or are taking blood pressure medication.

What things might an individual's dentist see that would prompt a referral to your office for an evaluation?

Your dentist may observe that you have a small or crowded airway when you are being examined and might question about your sleep and day time functioning.

Your dentist might also notice enamel eroded off of the lower back teeth as a result of nighttime acid reflux. Another big tip-off is if the patients' spouse asks the dentist if they can make an appliance to help their loved one stop snoring.

If you have some risk factors for sleep apnea, this may prompt your dentist to refer you to a sleep specialist for evaluation. Sleep apnea does not only cause day time fatigue, but can lead to heart attack, stroke, diabetes, and motor vehicle accidents which are among the more serious consequences of this condition.

Sleep apnea can also contribute to reduced productivity, depression, and even attention deficit hyperactivity disorder in children, among many other symptoms.

In general, what are the treatments for sleep apnea?

Treatment would be focused on keeping the upper airway opened so that sleep apnea (or airway obstruction) does not occur during sleep. This can be accomplished in various different ways. The most successful and most studied treatment is called CPAP therapy, which stands for continuous positive airway pressure therapy.

This therapy involves a small electric medical device that keeps the upper airway pressurized through a mask over the nose to "splint" the airway open during sleep. Another treatment option includes an oral appliance that a specially trained dentist can make. It is placed in the mouth at bedtime for sleep.

This advances the lower jaw forward to give more room behind the tongue, which keeps the airway open. A new device called Provent is gaining popularity because of its simple micro-valve design that tapes onto the nostrils at bedtime and keeps the airway pressurized when you breathe out.

This device is rather new and new data are still coming out. Keeping the nasal airway opened by treating allergic rhinitis is important to prevent the upper airway from collapsing. And finally, surgery is sometimes used to correct anatomical irregularities to keep the air passage from collapsing and therefore obstructing the airway. Surgery is generally reserved as a last resort.

When would you recommend that an oral appliance be made by a dentist trained in sleep appliance therapy?

Oral appliance for obstructive sleep apnea would be appropriate in certain patients who have failed CPAP therapy.

Will you be writing future articles on the subject of the health effects of poor sleep?

Yes. There is a great lack of knowledge about the importance of maintaining appropriate sleep (whether because of bad habits or sleep disorders). Both proper amount of sleep and good quality of sleep is important to maintain good health and livelihood. I am planning to write a series of articles to address this matter.

Thanks for contributing and if people want to get in contact with you how would they do that?

Our Sleep Center at Walla Walla General Hospital phone number is 509-527-8050. We have a wonderful secretary who can assist in answering questions about how to make appointments at our Sleep Center. Thank you for inviting me to discuss on this important topic.

Dr. Eric Gustavsen practices dentistry at Southpoint Dental Center, 1129 S. Second Ave. More information on his practice can be found at www.southpointdentalcenter.com.

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