What obstructive sleep apnea is

Muscle tone falls during sleep. The soft palate, tongue and throat walls relax, and every breath pulls them inward. A narrowed airway makes the tissue vibrate, which is snoring. An airway that closes for ten seconds or longer is an apnea, and a partial collapse with a drop in oxygen is a hypopnea. Either way oxygen falls, the body responds with a surge of adrenaline, the airway stiffens and you surface briefly without waking. Sleep is broken in a way that rarely registers as insomnia, which is one reason apnea can go unrecognized for years.

Anatomy is the largest factor: a large tongue, a set-back lower jaw, a long soft palate, large tonsils, a blocked nose, or extra weight around the neck. Alcohol, sedatives and sleeping flat on your back can all make it worse. Central sleep apnea, where the brain does not signal the body to breathe, is a different condition, and an oral appliance does not treat it.

Common symptoms

The person with apnea is often unaware of it, so much of the useful history comes from whoever sleeps in the same room.

  • What a partner notices. Loud snoring most nights, pauses that end in a gasp or a snort, restless movement, and repeated trips to the bathroom.
  • How you wake up. A dry mouth or a raw throat, a dull headache in the first hour, and the sense of having slept badly regardless of how long you were in bed.
  • How the day goes. Dozing off in front of the television, drowsiness while driving, relying on caffeine to stay alert, a short temper, and losing your train of thought mid-sentence.
  • What your physician may already be watching. Blood pressure that needs more than one medication, an irregular heartbeat, blood sugar that is difficult to control, and reflux at night.

Any one of these has other explanations. Several of them together are a good reason to ask your physician about a sleep study.

Signs noted during a dental examination

Some findings show up often enough in people who are later diagnosed that we make a point of mentioning them. When we see them, we'll suggest you talk with your physician about a sleep study, and your physician takes it from there.

A scalloped tongue
Wavy indentations along the sides where the tongue presses against the teeth. It often accompanies a large tongue in a jaw with limited room for it.
Worn and cracked teeth
Grinding and disordered breathing during sleep often appear together, though how closely the two are connected is not settled. Flattened cusps, cracked fillings and morning jaw soreness are all things we'd like to hear about. See TMJ and jaw pain.
A crowded throat
A long soft palate, a low-hanging uvula, large tonsils, or little space visible behind the tongue when you open wide.
Dry mouth and gumline decay
Breathing through the mouth all night dries the tissues, and saliva is a large part of what protects teeth overnight. New decay along the gumline in an adult who cleans well gets followed up at exams and cleanings.

How testing works

Testing is more straightforward than it once was. Your physician orders the study, and home testing is widely used.

  1. A home test or a night in a lab

    A home test records airflow, breathing effort, oxygen and pulse. An in-lab study adds brain activity, sleep stages and leg movements, and is used for more complicated cases.

  2. The result comes back as an AHI

    The apnea-hypopnea index is the average number of breathing events per hour of sleep, and the higher the number, the more severe. Your physician places it in a mild, moderate or severe band and reads it alongside your oxygen levels.

  3. The physician chooses the therapy

    CPAP is first-line treatment for moderate to severe apnea and can work at any severity. An oral appliance is generally considered for mild to moderate disease, or when CPAP has proven hard to tolerate.

  4. If an appliance is part of the plan, we make it here

    We take the records, fit the appliance and adjust it gradually, then your physician arranges a repeat sleep test to confirm it's working. See oral appliances.

CPAP and oral appliances compared

People looking for a sleep apnea dentist in Oakhurst often want an alternative to CPAP. The two treatments work differently, and which one suits you depends on how severe your apnea is and on what your physician recommends.

Consideration CPAP Oral appliance
How it works Pressurized air delivered through a mask holds the airway open from the inside. A custom device holds the lower jaw slightly forward, which draws the tongue away from the back of the throat.
Where it fits First-line therapy for moderate to severe apnea, and effective at any severity when it is worn. Usually mild to moderate apnea, difficulty tolerating CPAP, or snoring once apnea has been ruled out.
How well it works Controls breathing events reliably when it is worn all night, every night. Helps many people, though not everyone. A follow-up sleep study shows how well it is working for you.
The drawbacks The mask, the pressure, the noise and the dryness lead some people to stop using it, and it only works on the nights it is worn. Jaw soreness and tooth tenderness are common early on, and the bite can shift over years of use.
Day to day Needs power, a hose, filters and regular cleaning. Fits in a small case and needs no power.

Common questions about sleep apnea

I snore. Does that mean I have sleep apnea?

Not necessarily. Some people snore without having apnea, and some people with apnea barely snore. Snoring does mean the airway is narrowing, which is a good reason to be tested.

Can a dental exam tell me whether I have it?

The diagnosis comes from a sleep study your physician interprets. What we can do at an exam is notice the signs, a scalloped tongue, a long palate, worn teeth, and suggest a sleep study is worth discussing with your physician. Many people first hear the suggestion in a dental chair.

I can't tolerate my CPAP. Can I switch to an appliance?

Please talk with your physician before you stop using it, especially if your apnea is moderate or severe. Difficulty tolerating CPAP is a recognized reason to consider an appliance, and any change to CPAP therapy is your physician's decision to make with you. If an appliance is the answer, we're glad to make it.

Is a sleep appliance a dental benefit or a medical one?

Usually a medical one, because the condition is medical. How an individual plan handles the claim varies, so check the details with your plan, and call us with any questions. See insurance.

In this area of treatment

Each of these has its own page with the detail that does not fit here.