Sleep Apnea - Let's wake up and do something about it!

I just returned from an in depth course about sleep apnea and the dental management of it. Sleep has become a huge area of interest in medicine over the last few years ... and rightly so. Poor quality sleep and apnea affect so many different areas of our health that it should really be of interest to everyone. I will briefly mention a few things about sleep apnea. Apnea occurs in our sleep and it refers to an episode where we stop breathing for 10 seconds or more. When a person has an overnight sleep study this is one of the parameters that is measured. During the study the number of times a person stops breathing is totalled along with some other breathing issues. A calculation is then done to determine how many times a person has breathing issues per hour. This is know as the AHI and the degree of severity is scored as follows. AHI less than 5 is normal. From 5 to 15 is mild, 15 to 30 is moderate, and above 30 is severe. I have a patient who stopped breathing more than 80 times per hour. Consider that 80 X 10 is 800 seconds per hour that he was not breathing fully. That is more than 10 minutes per hour! This places a huge strain on the heart which must work harder to ensure that the person gets enough oxygen to their system. This could be an explanation for why some people have heart attacks in their sleep. Poor oxygen uptake can impact the endocrine system ... our production of hormones of particular interest is stress hormones and insulin which is related to diabetes, our moods ... people who don't sleep well can be very grumpy and short-tempered which in turn impacts their outlook on life and their relationships (of interest to psychiatry) to name a few. Over-tiredness can make it very dangerous to operate machinery such as automobiles (can lead to more motor vehicle accidents), airplanes - I wouldn't want a tired pilot, transport trucks, trains etc. ... The toll that improper sleep takes on society is enormous. How is it that dentistry has become involved in this area? If you think about it, the mouth is an opening to the upper airway. It can play a major role in creating airway resistance. It is also below the nose and the anatomy of the mouth has a direct impact on the nasal passages. It can have a dramatic impact on nasal resistance, snoring, and sleep apnea. It should come as no surprise that dentistry plays an important role in the treatment of Obstructive Sleep Apnea (OSA). The standard medical solution for OSA is CPAP (continuous positive air pressure) which is the gold standard for apnea treatment. Many people do not find it comfortable however, and it is good to know that there is an alternative in the form of Oral Appliances which are very effective for the treatment of mild to moderate sleep apnea, and can be useful in combination with CPAP for more severe forms. I hope you found this interesting and of value. I believe that it would be important for every adult and some children to have sleep studies to evaluate their sleep quality. I'll be back soon with more information from the world of dentistry ... Dr. Marty Frankel, 5775 Yonge Street, Suite 1000 Toronto, Ontario M2M 4J1 416-770-8526 drmartyfrankel@rogers.com