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Sleep Apnea

Dental Sleep Medicine in North Carolina: Raleigh, Durham, Cary, Greenville, Charlotte, & surrounding areas.

Have questions about sleep apnea? Our dentists took some time to share information and answer common patient questions to help educate about the causes and effects of sleep apnea on both adults AND children. View the table of contents below to learn more or find your question and get an answer from one of our dentists!

dr. andy ciecielski

 

 

The following content was provided by Dr. Andy Ciesielski, General Dentist and Dental Sleep Medicine Provider, and has been medically reviewed for accuracy. Some relevant links have been added to audio transcripts to provide resources for additional information.

What is sleep apnea?

Answer provided by Dr. Andy Ciesielski. Transcript included below.

Dr. Ciesielski:

Sleep apnea is a condition in which patients are either not breathing or breathing too shallow through periods of the night. That can be either obstructive in nature where the airway is either partially or fully closed off or it could be a improper relay from the brain to the pharyngeal dilators, diaphragm breathing muscles where your brain just doesn’t tell you to breathe. Most people who have apnea, it’s more obstructive in nature.

What causes sleep apnea?

Answer provided by Dr. Andy Ciesielski. Transcript included below.

 

Dr. Ciesielski:

There’s a lot of things that factor into sleep apnea. Most people, there’s four main. Okay. The four main things that are going to be contributing to an individual’s sleep apnea as opposed to just general risks would be their airway anatomy. Whether or not their airway is more or less likely to physically collapsed or partially collapse. There’s going to be the way that the brain recruits your breathing muscles, particularly muscles in your pharynx. So in general, when patients are sleeping, they lose muscle tone and as the muscle tone reduces, then their airway is going to be more likely to collapse.

Another one would be what’s called feedback loop gain, which basically an analogy would be like it’s your brain’s thermostat for how you breathe. And it’s going to have to do with how it’s picking up oxygen and CO2 and then trying to change the frequency with which you breathe. So somebody might have a tendency to breathe too much, their oxygen goes up really high. Then their brain says, “I can relax, I don’t need to breathe as much because oxygens are really high”. and then what will happen is that the CO2 will then raise, and by the time the CO2 raises, and you’ve been needing oxygen, potentially, your brain tries to catch back up, you breathe really quickly, and then you kind of cycle through that. So that can contribute to it.

And then the last thing that can really impact thing is what is called arousal index. So some patients just are able to get kicked out of sleep easier. Some patients stay in sleep easier. So that’s another factor. Those are the things that we’re really, that research is kind of looking into as modes of treatment would be arousal index, feedback loop gain, anatomy and pharyngeal dilator muscle recruitment, and a lot of things are impacted by things that patients do all the time, particularly medication. Some medications are going to impact one or more of those aspects of sleep apnea.

Other things that in general you’re looking at as far as risk factors would be patients that may be overweight, patients that might be very muscular and have very large necks. If there’s a genetic component, if your tongue is really big, if your airway’s really small, if your dental arches are very constricted, if you’re retrognathic, if your jaw is a lot smaller in general, those would have something to do with it.

In general, men are at greater risk than women. Age, as you age, you’re going to lose muscle tone in general, you’re going to lose muscle mass that can impact the anatomy. Those are a lot of ones that are popping up to the top of my head.

How do I know if I have sleep apnea?

Answer provided by Dr. Andy Ciesielski. Transcript included below.

 

Dr. Ciesielski:

Well the only way to know whether you don’t have sleep apnea for sure is to talk to a sleep doctor. We see a lot of patients for consults for oral appliance or sleep apnea, but as a dentist we would never diagnose sleep apnea. We don’t prescribe sleep studies. What we generally do when we see a patient who has not been diagnosed with apnea but they’re concerned that it may be an issue for them is we train to evaluate risk factors in office and then we have a conversation whether or not we feel like they should try and see a sleep expert, I.E. A sleep doctor.

So we’re going to be looking at a lot of those things that we just discussed. Gender, neck size, airway, tongue size, dental arches, jaw anatomy, evaluating if they’re bigger, or older, male, female, if they’ve got high blood pressure, if they snore. Those are a lot of big things. So if patients have a lot of those risk factors or in general if they just feel like they don’t sleep, if somebody came in and saw us and they had no risk factors, but they said that they don’t sleep well, they’ve never slept well, they don’t know why and they’ve never seen a sleep doctor. I would recommend anybody that feels like they get poor quality sleep to see a sleep doctor. So that’s a long way of saying the only way to know if you have sleep apnea is to see a sleep doctor.

What does a CPAP machine do? Are there alternatives to a CPAP machine?

Answer provided by Dr. Andy Ciesielski. Transcript included below.

 

Dr. Ciesielski:

Yeah, so if we’re thinking about obstructive apnea being the airway partially or fully closed off, if you can imagine the airway as a tube, the CPAP is a machine that would sit over the nose and or mouth to basically increase inspiratory pressure so that the added air pressure basically inflates your airway. It prevents your airway from collapsing. It’s been the gold standard since the eighties. Works really, really well if it can be tolerated. Depending on an individual’s level of apnea, it may be the absolute go-to. It may be an option one of many. So CPAP can work really, really well. In general, a lot of patients find them to be uncomfortable for a number of reasons. In general, if a patient has difficulty acclimating to wearing a CPAP, then they may want to consider a different option.

One of the options would be oral appliances, which help to hold the jaw forward so the tongue can come forward and the airway can stay more patent. Options past CPAP and oral appliances generally are going to include various forms of surgery. There’s a lot of different surgeries out there with varying levels of success. Some newer forms of surgery actually include hypoglossal nerve pacemakers that have a very high success rate, and then there’s other surgeries where they are going to be removing part of the pallet or part of the tongue or changing the jaw position that can have varying degrees of success.

How do I know I should see a sleep doctor? What are the signs that I need to see a sleep doctor?

Answer provided by Dr. Andy Ciesielski. Transcript included below.

Dr. Ciesielski:

The biggest and most obvious one, and I would feel like this applies to anybody, is if they feel like they in general have poor quality sleep, don’t sleep well, regular fatigue and they don’t know why.

If you slept great for years and you just had your first kid and they’re three weeks old and they’re getting up 10 times a night and you’re feeling exhausted, it’s almost certainly that. If you don’t have anything in life that might be an obvious reason why you’re not sleeping well and in general you’re just tired all the time and don’t know why. I would recommend you go talk to a sleep doctor. If you snore a whole lot. If you have a exam with a healthcare professional and your healthcare professional’s concerned that something may be going on. They have a conversation with you that it might be time to go and see a sleep doctor.

Most of it from a patient standpoint though, without any outside input, is probably going to be based more on anything that’s impacting your life, which is going to be restfulness fatigue, if you have a bed partner that’s complaining of your snoring, those are the biggest things.

Can kids get sleep apnea? How do I know if my child has sleep apnea?

Answer provided by Dr. Andy Ciesielski. Transcript included below.

 

Interviewer:

Is it possible for kids to suffer from some of these same issues?

Dr. Ciesielski:

It is. It’s much less likely. Kids, the incidents of sleep apnea can be, I think one to 4% and adults estimates can be anywhere from 15 to 30%, but yeah, kids can have apnea. It’s much less common and it’s a little tougher to diagnose. Well, not necessarily diagnose, but it’s tougher to recognize because a lot of times the symptoms that kids might display are different than the symptoms that an adult might display. Typically, an adult that is really fatigued and doesn’t sleep great is going to be tired and lethargic and they’re going to be talking to you about it and that’s what you’re going to be looking for. With a kid, a lot of times they don’t really act super tired during the day.

Some of the things you’re going to be seeing or be concerned about is if they’re hyperactive, actually. I’ve got a couple small kids and my three old, if she gets exhausted, she doesn’t go and lay down, she gets super cranky and she’s running around all the time and that’s when I know it’s time for her to go to bed. So kids that are very hyperactive, snoring in kids is pretty uncommon. Snoring would be a big concern for a kid. If kids grind, that can also be a sign of sleep apnea, especially if they snore and they grind. Grinding can be a bunch of different things. Maybe a kid grinds and there’s not apnea. It’s certainly worth looking into, but if a kid had sleep apnea, two of the things that would be very common would be snoring plus grinding.

And then again, we’re looking for ADHD, poor attention in school, if they wake up a lot at night and you don’t necessarily know why. A lot of things, other things can go into it. Frequent bed wetting, night terrors, nightmares, those are all very common. And with kids, sleep apnea is a significant condition for anybody because it impacts a lot of different things, increases your risk for a lot of other conditions that you don’t want. But with kids, sleep is so important because that is going to be one of the times where they’re producing most of their growth hormone and it’s going to potentially make a big impact on how their brain develops and how their body develops if they don’t get proper sleep and with an adult, if you’ve got sleep apnea, it gets identified and treated, great. You lower your risk for a stroke and cancer and Alzheimer’s, heart attack, a bunch of things.

But if you’ve got untreated apnea in a kid, if it’s undiagnosed, untreated, I mean you’re impacting how they develop and how their brain is going to potentially function, how their body’s going to develop. I mean there’s more long term negative side effects. So with kids, if it’s suspected, then we very strongly recommend you go talk to a sleep doctor or their pediatrician or usually both. Now treatment for kids is a lot different. Typically, you’re not going to put a kid on CPAP or an oral appliance. Typically, the end route is going to probably be seeing an ENT for tonsil and adenoidectomy and then if that’s not effective enough, then it would be a conversation for the sleep doctor and the pediatrician to you, kind of quarterback from there. But yeah, that’s a good question. Sleep apnea is definitely possible in kids and very important to try and identify and treat.