Sleep apnea remains one of the most frequently diagnosed yet consistently underdiagnosed conditions in U.S. adult medicine. In Nashua, NH, Dr. Neveu and his team at New Hampshire Smile Co. treat sleep apnea as the significant whole-body health condition that it is, rather than simply a snoring nuisance to be masked with a device and ignored. Because Dr. Neveu has received comprehensive training in airway-focused dentistry and dental sleep medicine, New Hampshire Smile Co. acts as an engaged medical resource, evaluating and diagnosing sleep-disordered breathing. Dr. Neveu is able to work directly with other physicians in order to facilitate the delivery of the best possible treatment to each individual.
Sleep apnea is a disorder of sleep-disordered breathing that involves frequent pauses during sleep. These interruptions in breathing lead to poor sleep quality and a host of negative side effects that accumulate over time, including fatigue, memory loss, high blood pressure, and heart attacks. Apnea events occur when the airway becomes blocked, either partially or completely, while a person is sleeping. In response to an event, a person is partially aroused from sleep, and their breathing is reestablished. This arousal process interrupts the restorative sleep a person requires. People can go through dozens or hundreds of these events throughout the course of a night without being aware of the sleep disruption or the negative consequences to their health.
Types Of Sleep Apnea
There are three different types of sleep apnea. The types have different mechanisms, and therefore each type warrants a different approach for treatment:
- Obstructive sleep apnea: In this case, the throat tissues of the tongue collapse in an individual’s mouth and block their airway during sleep, even if they are trying to breathe. Obstructive Sleep Apnea (OSA) is the most common form and is the one most closely related to dental care, and OSA can be treated with oral appliances.
- Central sleep apnea: This rare form of sleep apnea is caused by brain signals sent to the body being impaired. In this condition, a patient’s airway may not be compromised at all. Patients diagnosed with Central Sleep Apnea require medical treatment, since oral appliances will not help them.
- Complex sleep apnea: This condition involves elements of both types of sleep apnea, and treatment requires the expertise of both a sleep doctor and a dentist.
Signs & Symptoms Of Sleep Apnea
During a dental visit, it is often difficult to know what to tell your dentists and hygienists about the health of your sleep. A few of the common signs that a person has sleep apnea are listed below:
- Loud or regular snoring: This is the most noticeable sign, and the sign most typically complained about by bed partners.
- Observed apnea events: This occurs when sleep is interrupted by apnea, and a person’s breathing is not immediately resumed, and they then gasp or snort for breath.
- Chronic tiredness or feeling tired upon waking: Poor-quality sleep means a person is likely not to feel refreshed, even if they have slept the proper number of hours.
- A dry mouth or headache when awake in the morning: This is usually the result of having to breathe through the mouth during sleep.
- Difficulty focusing, forgetfulness, or moodiness: These can all be associated with chronic fatigue or unrefreshing sleep.
Diagnosing Sleep Apnea
A diagnosis of sleep apnea should involve a sleep study, which measures the rate of apnea events during the night. At New Hampshire Smile Co., Dr. Neveu will coordinate sleep studies as part of our airway-centered medical services. In-lab polysomnography, which remains the gold standard for the diagnosis of sleep apnea, is a full night in a sleep center where physiological monitoring captures all of your sleep cycles, breathing, oxygen saturation, and brain waves. This study may be best for patients with complex presentations, or when the suspicion for central or complex sleep apnea is high.
Home sleep testing is an alternative to an in-lab sleep study and uses a machine that can be worn at home, which measures your breathing and is typically used to diagnose obstructive sleep apnea. As the technology continues to improve, at-home sleep testing is becoming the diagnostic testing of choice for more and more people, especially with a typical obstructive sleep apnea presentation. Dr. Neveu will work with sleep study doctors and facilities to ensure that you get a sleep test most appropriate for your clinical presentation and that subsequent treatment recommendations are based on a proper diagnosis.
Risk Factors For Sleep Apnea
There are various factors that may lead to a diagnosis of obstructive sleep apnea. At New Hampshire Smile Co., Dr. Neveu includes an airway screening of all these factors at every comprehensive oral evaluation. These factors include being overweight, especially excess weight around the neck; a small jaw, crowded upper jaw or airway, large tonsils, tongue, or uvula; age, with increased risk as the soft tissues of the airway lose tone with age; male gender; large neck circumference (over 17 inches for men or 15 inches for women); family history of sleep apnea; and the use of alcohol or sedative medications.
Health Risks Of Untreated Sleep Apnea
The systemic health impacts of untreated obstructive sleep apnea are significant. One of the most important things that Dr. Neveu does at all his appointments regarding the topic of sleep apnea is to educate his patients on their increased risks for medical diseases, including cardiovascular risks from oxygen deprivation and stress on the nervous system during the sleep cycle. Hypertension gets worse because of the physiological stress response that untreated sleep apnea causes during sleep. Higher risk of stroke and arrhythmias — especially atrial fibrillation. Metabolic dysregulation, such as insulin resistance and higher risk of type 2 diabetes due to the hormonal effects of disturbed sleep, and reduced oxygenation. Diminished daytime cognitive performance, reaction time, focus, and, hence, work, driving, and general function. Depression and anxiety that accompany and are made worse by chronic sleep deprivation caused by untreated sleep apnea.
Sleep Apnea Treatment
The sleep apnea treatment recommendations at New Hampshire Smile Co. reflect the collaborative, whole-person treatment approach of Dr. Neveu, and are tailored to the individual: based on each patient’s sleep apnea type, severity, anatomic structure, and personal preference.
CPAP Therapy
For many patients with moderate to severe obstructive sleep apnea (OSA), the most effective treatment continues to be CPAP therapy, which delivers a steady stream of pressurized air and, in this way, keeps the airways from collapsing at night. We are frank with patients with moderate to severe OSA and let them know that CPAP therapy remains the gold standard, and we will discuss CPAP therapy, even when we are recommending oral appliance therapy for sleep apnea.
Positional Therapy
Devices that encourage side-sleeping (and discourage back-sleeping) can be very helpful, on their own, or in addition to other treatments for those patients whose sleep apnea mostly develops when lying on their backs.
Weight Loss
Weight loss can reduce the severity of OSA in many patients, and we are candid in discussing weight loss during the comprehensive health discussion at New Hampshire Smile Co.
Surgical Treatment
Surgical treatment may need to be recommended as a part of the treatment plan when anatomic factors like large tonsils, a deviated nasal septum, and craniofacial abnormalities are contributing to airway obstruction and sleep apnea.
Sleep Apnea With Oral Appliance Therapy
Oral appliance therapy for sleep apnea at New Hampshire Smile Co. is a comfortable, non-invasive, and effective option for many people with mild to moderate obstructive sleep apnea (OSA). Additionally, oral appliance therapy may serve as an alternative to CPAP therapy for patients with moderate to severe OSA who may struggle with the tolerability of CPAP therapy or other options. Custom-made oral appliance therapy advances the mandible during sleep. A device that advances (moves forward) the mandible opens the airway behind the jaw to reduce the tendency for soft tissue to collapse and keep the airway open during sleep. Each oral appliance that we make is fabricated from digital 3D impressions from an iTero or TRIOS intraoral scanner. This results in a precise fit, which is the first step to comfortable and effective nightly appliance use.
Appliances require titration (gradual advancement) to arrive at the ideal setting for each individual patient over the first weeks of therapy. Follow-up sleep testing is performed to evaluate the effectiveness of treatment and help guide further titration to maximize the result. We also provide regular follow-up visits at New Hampshire Smile Co. to track the appliance, compliance, and effectiveness throughout the course of long-term treatment of OSA in Nashua, NH. Please call our office or make an appointment online with us today.