Sleep problems, such as snoring and insomnia, are signs of a sleep disorder called sleep apnea. Sleep apnea can contribute to oral health problems and dental problems can also cause sleep apnea. Sleep apnea is a very common sleep disorder many people. It is characterized by repeated breathing interruptions (apneas) during sleep cycles. Apneas are caused by tissue collapses of the airway related to weak airway muscles, a large tongue, being overweight, or other risk factors. Apneas prevent oxygen from reaching the lungs.
Because sleep apnea disrupts the sleep cycle, this zaps daytime energy and mental performance and affects long-term health. Untreated sleep apnea can be fatal because it can cause oxygen drops, increased blood pressure, and heart strain.
What Are the Types of Sleep Apnea?
There are three types of sleep apnea:
- Obstructive sleep apnea (OSA): OSA occurs when the airway at the back of the throat becomes physically blocked. That obstruction causes temporary lapses in breath.
- Central sleep apnea (CSA): CSA happens because there is a problem with the brain’s system for controlling muscles involved in respiration, leading to slower and shallower breathing.
- Mixed sleep apnea: When a person has both OSA and CSA at the same time, it is referred to as mixed sleep apnea or complex sleep apnea.
Because the underlying causes are distinct, there are important differences in the symptoms, causes, and treatments of OSA and CSA.
What Are the Symptoms of Sleep Apnea?
All three types of sleep apnea share certain common symptoms:
- Disrupted breathing in which a person’s respiration can become labored or even stop for up to a minute at a time
- Excessive daytime sleepiness
- Morning headaches
- Limited attention span or difficulty thinking clearly
Many of these symptoms arise because of poor sleep and decreased oxygen levels that occur as a result of interrupted breathing.
Some additional symptoms are connected to obstructive sleep apnea:
- Snoring, including snoring that is especially loud and involves gasping, choking, or snorting that may cause a person to briefly wake up
- Morning sore throat or dry mouth
- Frequent need to wake up to urinate6(nocturia)
Chronic snoring is the most common symptom of OSA, but that doesn’t mean that everyone who snores has sleep apnea. Snoring is not a frequent symptom in people with CSA.
In general, a person with sleep apnea is not aware of their breathing problems at night. For that reason, they often only find out about the issue from a bed partner, family member, or roommate. Excessive daytime sleepiness is the most likely symptom to be noticed by people with sleep apnea that live alone.
What Are the Causes of Sleep Apnea?
Obstructive sleep apnea occurs when a person’s airway becomes blocked during sleep. Multiple factors have been found to increase the risk of blockage and OSA:
- Anatomical characteristics. The size and positioning of a person’s neck, jaw, tongue, tonsils, and other tissue near the back of the throat can directly affect airflow.
- Being overweight is a leading cause of OSA and may be an underlying risk factor in up to 60% of cases. Obesity contributes to anatomical narrowing of the airway, and research has found that a 10% increase in weight can equate to a six-fold increase7 in OSA risk.
- Use of sedatives. Sedative medications and drugs can cause tissue in the throat to relax, making it easier for the airway to become obstructed.
- Family history. People who have one or more close relatives with OSA are more likely to develop OSA themselves.
- Cigarette smoking. People who smoke, especially heavy smokers, have been found to have OSA at a higher rate than people who don’t smoke.
- Sleeping on your back. This sleeping position makes it easier for tissue to collapse around the airway and cause blockages.
- Nasal congestion. People whose ability to breathe through the nose is reduced because of congestion are more likely to experience OSA.
- Hormone abnormalities. Hormone conditions like hypothyroidism (underactive thyroid) and acromegaly(excess growth hormone) may increase the risk of OSA by causing swelling of tissue near the airway and/or contributing to a person’s risk of obesity.
In CSA, breathing is affected in a different way than in OSA. Instead of an obstruction causing breathing lapses, the problem arises in how the brain communicates with the muscles responsible for respiration. In particular, the brain stem fails to adequately perceive the levels of carbon dioxide in the body, leading to breathing that is slower and shallower than it should be.
CSA is typically connected to an underlying medical condition. For example, a stroke, infection of the brain, or in rare cases a brain tumor may damage the brain stem. Pain medicines like opioids can also interfere with this normal process of breathing.
Heart failure is considered to be a risk factor for CSA, and CSA can also arise when a person’s oxygen levels are thrown off because they are at high altitude.
Connection to Oral Health
Good, quality sleep keeps you healthy and reduces bad breath, mouth ulcers, and development and progression of periodontal disease (gum disease). Dental problems associated with sleep apnea include TMJ disorders, bruxism, and mouth breathing.
Evidence suggests temporomandibular joint (TMJ) disorders and sleep apnea go hand-in-hand. The TMJ connects the lower jaw to the upper jaw. You have two TMJ joints, one on each side of your face.
Symptoms of a TMJ disorder include:
- Jaw pain
- Pain throughout the head, neck, and shoulders
- Problems chewing
- Jaw joints that make clicking or grinding sounds
- Locked jaw (the inability to open or close the mouth for a period of time)
One study found people who were more likely to have sleep apnea (based on risk factors) were also three times more likely to suffer from a TMJ disorder. The study also found people with two or more signs of sleep apnea had a 73% higher risk for a TMJ disorder regardless of their age, race, smoking history, or weight.
Bruxism is simply a fancy name for grinding the teeth or clenching the jaw. While it can happen at any time, it frequently occurs while a person is asleep. Bruxism has negative effects on your sleep, including waking up unrefreshed and with headaches and neck and jaw pain. Research suggests bruxism may affect up to 31% of adults, and at least a quarter of them may have sleep apnea.
Bruxism is considered a sleep-related disorder because it causes uncontrolled and involuntary movement of the jaw during sleep.
It is quite possible you may not even know if you suffer from bruxism, but your dentist may discover evidence during a cleaning exam.
Signs can range from loose teeth to eroded tooth surfaces, or cracked, chipped, and broken teeth. If your dentist observes symptoms, he or she may ask about muscular pain in your head, neck, face, and jaw, as well as dryness of your lips, mouth, and throat upon awakening.
Sleep apnea causes a person to breathe through the mouth (mouth breathing). Mouth breathing results in dry mouth and leads to tooth decay. Additional consequences of dry mouth are plaque, mouth sores, gingivitis (gum inflammation), and periodontal disease.
According to researches, periodontal disease affects 62.3% of people with sleep apnea and gingivitis accounts for 34.1% of people with sleep apnea.
The Effects of Sleep Apnea on the Body
Many health conditions are linked to sleep apnea, including obesity and high blood pressure. These conditions, coupled with the lack of sleep, can harm many different systems in your body.
By depriving your body of oxygen while you sleep, sleep apnea can worsen symptoms of asthma and chronic obstructive pulmonary disease (COPD). You might find yourself short of breath or have more trouble exercising than usual.
People with sleep apnea are more likely to develop insulin resistance, a condition in which the cells don’t respond as well to the hormone insulin. When your cells don’t take in insulin like they should, your blood sugar level rises and you can develop type 2 diabetes.
Sleep apnea has also been associated with metabolic syndrome, a cluster of heart disease risk factors that include high blood pressure, high LDL cholesterol levels, high blood sugar levels, and a larger-than-normal waist circumference.
If you have sleep apnea, you’re more likely to have fatty liver disease, liver scarring, and higher-than-normal levels of liver enzymes.
Apnea can also worsen heartburn and other symptoms of gastroesophageal reflux disease (GERD), which can interrupt your sleep even more.
Circulatory and cardiovascular systems
Sleep apnea has been linked to obesity and high blood pressure, which increase the strain on your heart. If you have apnea, you’re more likely to have an abnormal heart rhythm such as atrial fibrillation, which could increase your risk of a stroke. Heart failure is also more common in people with sleep apnea.
One type of sleep apnea, called central sleep apnea, is caused by a disruption in the brain’s signals that enable you to breathe. This type of sleep apnea can also cause neurological symptoms like numbness and tingling.
Sleep apnea can reduce your desire to have sex. In men, it could contribute to erectile dysfunction and affect your ability to have children.
Other common symptoms of sleep apnea include:
- dry mouth or sore throat in the morning
- trouble paying attention
How Is Sleep Apnea Diagnosed?
A diagnosis of sleep apnea begins with a complete history and physical examination. A history of daytime drowsiness and snoring are important clues. Your doctor will examine your head and neck to identify any physical factors that are associated with sleep apnea. Your doctor may ask you to fill out a questionnaire about daytime drowsiness, sleep habits, and quality of sleep. Tests that may be performed include:
- EEG and EOM
- Pulse Oximetry
- Arterial Blood Gas (ABG)
The goal for treatment of sleep apnea is to make sure airflow isn’t obstructed during sleep. Treatment methods include:
Weight loss gives excellent relief from the symptoms of sleep apnea.
Nasal decongestants are more likely to be effective in mild sleep apnea. They can help relieve snoring.
Continuous Positive Airway Pressure (CPAP)
Continuous positive airway pressure (CPAP) therapy is the first line of treatment for obstructive sleep apnea. CPAP is administered through a facemask that’s worn at night. The facemask gently delivers positive airflow to keep the airways open at night. The positive airflow props the airways open. CPAP is a highly effective treatment for sleep apnea. A dental device may also be necessary to keep the lower jaw positioned forward.
Bilevel Positive Airway Pressure (BiPAP or BPAP)
Bilevel positive airway pressure machines are sometimes used for the treatment of OSA if CPAP therapy is not effective. BiPAP machines have settings, high and low, that respond to your breathing. This means the pressure changes during inhaling versus exhaling.
Oral devices (also called oral appliances) are sometimes used to treat obstructive sleep apnea (OSA). They push the tongue and jaw forward, which makes the airway larger and improves airflow. This also reduces the chance that tissue will collapse and narrow the airway when you breathe in. Examples include a mandibular repositioning device (MRD) or a tongue-retaining device.
Oral breathing devices are sometimes a reasonable alternative to continuous positive airway pressure (CPAP). Although oral breathing devices generally do not work as well as CPAP, they may be considered for people who:footnote1
- Have mild or moderate sleep apnea.
- Prefer not to use or who have failed CPAP treatment.
- Had surgery that did not work.
- Tried behavioural changes that did not work.
- Are at a healthy weight.
Choose a dentist or orthodontist who has experience fitting these devices. And go back to your dentist for regular check-ups to make sure the device still fits well. Oral breathing devices can improve sleep quality and reduce daytime sleepiness.footnote2 The use of oral devices reduced the episodes of abnormal breathing in about half of the people who used them.
Possible problems with devices that fit inside the mouth include:
- Buildup of saliva in the mouth, requiring frequent swallowing.
- Discomfort, especially in the morning. The devices can be uncomfortable, and people tend not to use them over the long term.
- Damage to teeth, soft tissues in the mouth, and the jaw joints. So it is important that a skilled dentist or orthodontist fit the device to prevent these problems.
If you use an oral breathing device to treat sleep apnea, use it every night. Excess saliva in your mouth and mild discomfort should become less bothersome with regular use.
An oral breathing device used for a child with sleep apnea must be refitted periodically as the child grows. People who use an oral device for sleep apnea may have a repeat sleep study to make sure it is working well.
Since sleeping on the back (supine position) can make sleep apnea worse for some people, positional therapy is used to help those with sleep apnea learn to sleep in other positions. Positional therapy and the use of CPAP can be discussed with a professional at a sleep center.
Uvulopalatopharyngoplasty (UPPP) involves removal of extra tissues from the back of the throat. UPPP is the most common type of surgery for OSA, and it helps relieve snoring. However, this surgery hasn’t been proven to totally eliminate sleep apnea, and it can have complications.
Tracheostomymay be done as a procedure of last resort. Tracheostomy punctures an opening in the windpipe that bypasses the obstruction in the throat.
Other surgical procedures may be required to correct structural problems in the face and elsewhere when sleep apnea doesn’t respond to treatments such as CPAP. About 75 percent of children with OSA due to enlarged tonsils or adenoids get relief from surgery. the American Academy of Pediatrics has endorsed surgical removal of tonsils and adenoids as the treatment of choice for children with sleep problems due to enlarged tonsils or adenoids.
Oral hygiene and sleep apnea
The question is: how can I improve my oral hygiene to sustain a healthy body and mind?
- Brush twice a day for two minutes. Using a pea size amount of toothpaste, make certain to brush your teeth consistently.
- Search for a dentist. There are many problems available if you need help financially with dental visits. But first, you need to do some research and reach out to local dentists. Preventative care is the best care!
- Use the right tools. For those with eroding gums, a soft toothbrush works best. Circle brushing works best starting from the front to the back of the mouth.
- Everyone hates to think about picking the junk between your teeth but it leads to fewer cavities and less tartar. Once tartar finds a home in the teeth, it can only be removed by a hygienist or dentist.
- Rinse with mouthwash. Therapeutic mouthwash is designed to strengthen teeth and treat plaque, cavities, and gingivitis. Though it does not remove everything, it is a step towards a healthier mouth.
If you’re concerned you have sleep apnea you should contact your local sleep clinic to schedule a consultation with a sleep specialist or talk with your primary care physician about your sleep troubles. Be sure to ask them about all of the available treatment options and dental devices and inquire which may be best suited for you.
What Is the Outlook for Sleep Apnea?
You should always talk to your doctor if you’re experiencing daytime drowsiness or consistently having problems sleeping. Sleep Apnea has many different treatment options that can make symptoms manageable. Your doctor will create a treatment plan that combines lifestyle changes and other therapies.