SLEEP APNEA AND ITS EFFECTS written by our hygienist, Dona Fujioka

SLEEP APNEA is the frequent stoppage of breathing caused by relaxed tissues in the throat during sleep. The breathing pauses may last between 10 to 20 seconds and can occur up to hundreds of times per night.95% of the millions of people who suffer from apnea have not and may never be diagnosed.

TYPES OF SLEEP APNEA

OBSTRUCTIVE- most common type. Occurs when the soft tissue in the back of your throat relaxes during sleep, causing a blockage of the airway (snoring).

CENTRAL- less common type. Involves the central nervous system. It occurs when the brain fails to signal the muscles that control breathing. People with central sleep apnea seldom snore.

COMPLEX- a combination of obstructive and central sleep apnea.

Untreated sleep apnea results in daytime sleepiness, fatigue, slow reflexes and poor concentration. It can also lead to serious health problems including diabetes, high blood pressure, heart disease, stroke and weight gain.

SIGNS AND SYMPTOMS

- LOUD AND CHRONIC SNORING
- LONG PAUSES OF BREATHING
- CHOKING, SNORTING, OR GASPING DURING SLEEP
- DAYTIME SLEEPINESS

SIGNS AND SYMPTOMS OF SLEEP APNEA IN CHILDREN
- continuous loud snoring
- may adopt strange sleeping positions
- bedwetting
- excessive perspiration at night or night terrors
- CHANGES IN DAYTIME BEHAVIOR:
o Hyperactivity or inattention
o Developmental and growth problems
o Decreased in school performance
o Irritable, angry, or hostile
o Breathing through mouth instead of nose

NOT EVERYONE WHO SNORES HAS SLEEP APNEA, AND NOT EVERYONE WHO HAS SLEEP APNEA SNORES.

• THE BIGGEST TELLTALE SIGN IS HOW YOU FEEL DURING THE DAY.*
Scientists are now examining the relationship between heart disease and sleep apnea.

These are known:

People with coronary artery disease whose blood oxygen is lowered by sleep disordered breathing may be at risk of ventricular arrhythmias and nocturnal sudden death. CPAP treatment may reduce this risk.

Apnea may cause coronary artery disease and hypertension

In obstructive apnea, the right side of the heart may suffer damage because it has to pump harder to support the extra effort of the lungs trying to overcome the obstruction of the airway.

Central apnea may cause high blood pressure, surges of adrenaline, and irregular heart beats.


RISK FACTORS FOR OBSTRUCTIVE SLEEP APNEA

Overweight
Male
Related to someone who has sleep apnea
Over the age of 65
Black, Hispanic, or a Pacific Islander
Smoker

PHYSICAL ATTRIBUTES THAT CAN CAUSE SLEEP APNEA

Thick neck receding chin
Deviated septum enlarged tonsils or adenoids (common
In children)


LIFESTYLE CHANGES THAT CAN HELP SLEEP APNEA

Lose weight avoid alcohol, sleeping pills, and sedatives
Quit smoking avoid caffeine and heavy meals
Maintain regular sleep hours

BEDTIME TIPS FOR PREVENTING SLEEP APNEA

Sleep on your side prop your head up
Open your nasal passages try the tennis ball trick

MEDICAL TREATMENT FOR CENTRAL AND COMPLEX APNEA

Treating the underlying medical condition causing the apnea
Oxygen while sleeping
Breathing devices

CPAP- Continuous Positive Airflow Pressure- most common treatment for moderate to sever obstructive apnea.

DENTAL DEVICES FOR SLEEP APNEA
Mandibular repositioning device
Tongue retaining device
SURGERY

May remove tonsils, adenoids, or excess tissue at the back of the throat or inside the nose, or reconstruction of the jaw to enlarge the upper airway.

SOURCES: Melinda Smith, M.A.
Lawrence Robinson
Robert Segal, M.A.

HPV and Oral disease

With all the recent dialogue about the HPV virus I felt it would be good to clarify why your dentist is concerned.

The Human Papilloma Virus (HPV) is a common sexually transmitted disease that has been associated with cervical cancers in woman. There are two vaccinations that are currently available for girls before they become sexually active. Although these vaccines appear safe the decision should be run by your doctor to determine whether they should be administered.

Evidence is growing that shows a strong correlation of cancer of the mouth and throat associated with HPV. The rate of increase is alarming and seems to be a result of the increase in oral sex. In fact there are more oral cancers detected every year than cervical cancer. Experts estimate over 34,000 cases of oral cancer detected every year. More than half of these are HPV related.

Your dental team should be performing a visual oral cancer exam on a regular basis. Beginning cancers usually are not detected by the individual who has it and it can be very difficult to spot in the back of the mouth. There are several diagnostic tests your dentist can perform to make this detection easier to accomplish.

If a warty bump appears your dentist may elect to observe it for a while to see if it will disappear on its own or recommend a biopsy. Although biopsy is the most definite way to confirm the nature of the bump we certainly do not want to biopsy everything we see in the mouth. Again, there are tests available help make this determination easier by “looking” under the primary layer of tissue with dyes and fluorescent lights.

Oral cancer exams are no longer performed on middle aged smokers and drinkers. They should be performed on young adults who have no history of smoking. In the future I expect an oral diagnostic test will be readily available for HPV.

Your dentist (me included) does not encounter HPV lesions very often in the general practice. The numbers will confirm that it is still not a very frequent occurrence. The alarming factor is the upward trend of HPV related STD’s and what it may mean in the future. As a precaution it is best to submit to a quick visual inspection of oral cancers by your dental team. Hopefully, the exam and test will be uneventful.