| Fig. 1 -- Snoring is an extremely common challenge, not only for the snorer, but also for all those who have to sleep in the same environment. |
You are certainly correct! Sleep medicine has had major visibility lately. The additional activity can be attributed to many sources, one of which is probably the desire of health practitioners to help the high number of patients with these problems. Another is because it is a significant source of not only patient service, but potential practice revenue.
I will include in my answer to you an overview of the subject, and also my own views on how important sleep medicine can be for dentists.
One of the major reasons I like this topic is because it is a significant area of health care in which physicians need dentists and dentists need physicians in order to effectively treat patients. A physician can no more provide oral appliance therapy to a patient than a dentist should diagnose sleep apnea. A prerequisite to successful oral appliance therapy is cooperation between dentists and physicians.
Why is this true?
In a position paper, the American Academy of Sleep Medicine created guidelines about which some practitioners have little knowledge. This position paper is very important to dentists who want to become involved with sleep medicine. What follows in the next few paragraphs is a critical part of the paper as it relates to dentists getting into this area.
When a dentist or dental specialist becomes educated in sleep medicine and announces that their practice includes sleep medicine, many patients are interested. It is a well-known fact that 40% to 50% of people snore. This is an obnoxious condition that is offensive to anyone sleeping near the snorer, and it is known to cause many psychological and physiological problems, including marital problems. (Fig. 1) Can dentists assist in reducing or eliminating snoring? The answer is a resounding YES! Dentists are essential for this task!
BUT, can there be negative clinical side effects when snoring is stopped or reduced with use of an oral appliance? YES, a very serious and potentially life threatening condition, sleep apnea, can be increased when an occlusal snore appliance is placed without patient or practitioner knowledge of the presence of sleep apnea. Unfortunately, the described procedure is a common occurrence for some dental practitioners who place oral appliances before a sleep study has been accomplished.
This scenario exemplifies the necessary and desirable interaction of dentists and physicians. Before an oral appliance is used, a board-certified sleep physician, usually associated with a sleep clinic, should evaluate the snorer to determine if the person has other interrelated breathing problems.
A sleep study can be accomplished in a sleep clinic, with the results analyzed by the sleep physician, or by having the patient use a home sleep-testing device, and having the data analyzed by a board-certified sleep physician associated with the specific company or an individual practitioner.
Here are some home sleep-testing devices. You can find additional pertinent information by investigating these companies online.
- ARES from Watermark Medical
- Bruxism Sleep Monitor from DDME
- Embletta X100 from Sleep Group Solutions
- WatchPAT from Itamar Medical
What information will be found in the sleep study? (Fig. 2)
- The frequency and intensity of snoring
- The presence, frequency, and length of pauses in breathing or sleep apnea (Fig. 3)
- The type of sleep apnea
-- Obstructive (airway blocked)
-- Central (central nervous system does not stimulate breathing on a constant basis)
-- Complex (a combination of obstructive and central)
- The frequency and intensity of bruxism (available from DDME Inc. mentioned above) (Fig. 4)
| Fig. 2 -- Normal breathing can be significantly influenced as the tongue and associated structures partially close off the airway and snoring occurs. When the airway is completely blocked by these structures, the dangerous condition sleep apnea, or pauses in breathing, occurs. |
