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Dental Sleep Medicine

Dental Sleep Medicine is an area of practice that focuses on the management of sleep-related breathing disorders including snoring and obstructive sleep apnea through the use of oral appliance therapy and upper airway surgery.

Obstructive Sleep Apnea

Sleep apnea is a potentially life-threatening medical disorder that causes your body to stop breathing during sleep. The muscles in your throat relax and the tongue may fall back and block the airway as you sleep, reducing the amount of oxygen delivered to all of your organs including your heart and brain. People with sleep apnea may snore loudly and stop breathing for short periods of time. The breathing pauses from sleep cause your body to briefly wake while you remain unaware. This can happen hundreds of times per night, and you may wake up feeling unrefreshed.

In addition to snoring and excessive daytime sleepiness, sleep apnea can cause memory loss, morning headaches, irritability, depression, decreased sex drive and impaired concentration. When left untreated, sleep apnea can lead to hypertension, stroke, heart attack and sudden death while asleep.

Sleep apnea patient are often older, obese and have thick necks, but men and women of any age or body type can have sleep apnea. The sleep disorder progressively worsens with age and weight gain.

The vast major of sleep related breathing cases go undiagnosed and untreated. An Institute of Medicine report found that an estimated 50-70 million Americans suffer from chronic sleep disorders, including sleep apnea. Excessive daytime sleepiness alone costs the economy $150 billion in lost productivity and workplace accidents another $48 billion in medical expenses related to auto accidents involving drowsy driving. Nearly 1 in 5 car accidents causing serious injury are associated with excessive daytime sleepiness.

Dentists together with sleep physicians are challenged to respond to the health risks and economic impact of untreated sleep apnea and excessive daytime sleepiness. This partnership tasks physicians with the recognition and diagnosis of sleep disorders, while dentists provide the treatment.

Dental Sleep Specialists and Oral Appliance Therapy

Dentists have pioneered the use of oral appliance therapy for the treatment of sleep apnea and sleep related breathing disorders. An oral appliance is a device worn in the mouth only during sleep. The device fits like a sports mouth guard or orthodontic retainer and prevents the airway from collapsing by either holding the tongue or supporting the jaw in a forward position. With an oral appliance, dentists can minimize or eliminate the symptoms of sleep apnea in mild to moderate cases.

Based on recommendations from the American Academy of Dental Sleep Medicine and the American Academy of Sleep Medicine, a physician is responsible for the diagnosis of sleep disorders and for recommending a treatment. A board certified sleep medicine physician at an AASM accredited sleep center uses an overnight sleep study to detect and diagnose sleep apnea. Once a patient is diagnosed with sleep apnea or a sleep related breathing disorder, a dental sleep specialist may provide treatment. A dentist assists patients in the selection and fitting of an oral appliance and provides long-term follow-up care.

There are two tools that have been widely circulated and used over the course of the last decade to determine if a patient may be suffering from sleep apnea. The Epworth Sleepiness Scale and the Berlin Questionnaire are simple questionnaires focused on the risk factors (like high blood pressure) and chronic behaviors (like excessive loud snoring) that are indicative of the presence of a sleep disorder such as sleep apnea in a patient.

You can use the questionnaires on the following pages to identify potential problems with your sleep and to initiate a conversation with your doctor about your sleep-related concerns. The score for each questionnaire will tell you if you're at higher risk or lower risk for sleep apnea.

If you already know you have sleep apnea but haven't done anything about it, you should start a discussion about diagnosis and treatment with your doctor. Take these questionnaires with you to your next doctor appointment. The questionnaires might give you a feel for whether a family member, friend or acquaintance has sleep apnea or some other sleep disorder. If you know someone who may be at high risk for sleep apnea, but who hasn't been diagnosed with it, then send them a link to this site, and give that person the gift of knowledge.

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