Let’s revisit dental sleep medicine and what it means for dentists

We’ve talked about this before, but I think it is time we revisit what dental sleep medicine is and how dentists can take advantage of this unique opportunity. So, what is dental sleep medicine (DSM) exactly?

DSM is an area of dentistry focusing on the use of oral appliance therapy to manage sleep-disordered breathing. And that includes snoring and obstructive sleep apnea (OSA). When providing dental sleep medicine services, dentists will work together with sleep specialists to help identify the best treatment option for each patient.

What is the dentist’s role?

Dentists pioneered the use of oral appliance therapy for the treatment of OSA and snoring–cool, right? The use of an oral appliance allows for a more comfortable treatment option for many patients that might be CPAP inept. It is similar to a mouth guard for sports or an orthodontic retainer, which makes for an easier solution to a condition. A custom-fit oral sleep appliance is an effective treatment for preventing the airway from collapsing by supporting the jaw in a forward position–an easy solution for a complicated condition.

Dental sleep medicine specialists work with sleep physicians to gain a diagnosis after they might have noticed symptoms or signs of sleep disordered breathing or a patient’s responses to a questionnaire showed a possibility of this condition. From a diagnosis through a sleep physician, dentists can plan for proper treatment with oral appliance therapy.

Have you ever thought about providing your patients with dental sleep medicine services? Now is the time to get out there and gain a better understanding of this unique area of dentistry to help your patients live happy, healthy, well-rested lives.

For those with ALS, a sleep apnea diagnosis is more likely

I think it is important to remain up-to-date with advancements is care. This is the same for links in conditions, such as sleep apnea and ALS. In ALS News Today I read about a recent study that looked at the prevalence of sleep disturbances in ALS patients and how it might correlate with a patient’s overall neurological status, including disease duration, progression rate and respiratory muscle function.

What was the connection?

Results from this study showed that the prevalence of sleep apnea was increased in ALS patients compared to the general population. There were 40 percent of patients that experienced nocturnal hypoventilation. And more than 45 percent of them had more than fie apneas, a complete loss of breathing, a partial loss of breathing, per hour.

Additionally, 22 percent of ALS patients’  sleep apnea and nocturnal hypoventilation coincided. This was significantly more common in male than female patients, but researchers were unable to find any differences between genders in regard to age, disease duration, the amount of air that the lungs could expel after having been filled completely and ALS functional rating scale scores.

We can help

That’s right. While you might not feel like you can help, you can. We can provide those patients with sleep apnea treatment for improved care. Oral appliance therapy can be an effective way to treat OSA in these patients. However, it is important to work with their physician for the best care possible.

Watch Out for Sleep Apnea with New Hypertension Guideline

Since the new hypertension guideline from the American College of Cardiology and the American Heart Association was released in November 2017, the way physicians diagnose and treat high blood pressure has changed. And with the new guideline comes a section on sleep apnea. Have you seen this new guideline yet?  

What does the guideline say?

The new guideline lowers the blood pressure cutoff for a hypertension diagnosis from 140/90 mm Hg to 130/80 mm Hg. And instead of using the term prehypertension, they recommend using stage 1 hypertension for levels of 130 to 139 mm Hg systolic or 80 to 89 mm Hg diastolic pressure and 120 to 129 mm Hg systolic and diastolic of less than 80 as “elevated.”

For obstructive sleep apnea, it is a risk factor for several cardiovascular diseases, including hypertension, coronary and cerebrovascular diseases. Studies have shown that the presence of OSA is associated with an increased risk of hypertension. It has also been hypothesized that treatment for sleep apnea will have more pronounced effects on BP reduction in resistant hypertension.

What does this mean for dentists?

This means we need to be extra cautious of our patients. Now that the level for hypertension has lowered, we need to pay attention to how that affects sleep apnea and vice versa. The guideline also recommends CPAP therapy as an effective form of treatment for improving sleep apnea, but studies that have been conducted showed that its effects on BP were only small.

Through the guideline, we can accept that CPAP therapy is an option, but what about oral appliance therapy? With the number of individuals with hypertension now at almost 50 percent, we need to pay closer attention to OSA and how it affects hypertension and high blood pressure.

Talk to your patients, include information on the health questionnaire and provide educational materials so that you can continue to provide your patients with the care they need and deserve. On top of that continue to complete advanced education to remain up-to-date with important information.

Tell your patients driving while drowsy is dangerous

Driving while drowsy means our patients are about eight times more likely to cause an accident. These federal estimates were found in a study by the AAA Foundation for Traffic Safety. In their study, they used in-vehicle camera footage of thousands of drivers that agreed to participate. After reviewing the cameras and results, the study found that drivers are falling asleep at the wheel at an alarming rate. It’s more than we thought.

With more than 700 crashes examined in the study, about 9.5 percent were caused by a drowsy driver. Drowsiness also played a role in almost 11 percent of accidents that caused serious property damage. This means we need to educate our patients more than ever before about the detrimental effects of sleep apnea not only on their health, but their surroundings.

Encourage patients to get more sleep

If a patient just isn’t sleeping, tell them to get more sleep. The AAA Foundation recommends getting at least seven hours of sleep a night before driving. While that sounds like a great idea, it isn’t always going to happen. In fact, about 35 percent of U.S. drivers actually sleep less than seven hours a night according to the Centers for Disease Control and Prevention.

And if you sleep for just four or five hours, it can quadruple your risk for an accident. However, if the patient has sleep apnea, that might be a different story when it comes to getting enough sleep each night.

Provide treatment for sleep apnea

Part of the issue is that many of patients need a lifestyle change to be able to sleep more, while others suffer from sleep apnea and don’t even realize it. Sleep apnea can make our patients feel sleepy enough to be drowsy drivers. Even if they stop the car and take a short nap, odds are they will still feel tired.

Patients that suffer from sleep apnea and are often found driving can experience altered senses that are commonly used to drive safely. It will often be difficult for them to focus their eyes, remain alert and to react quickly during various driving situations.

To combat this, it is important to not only educate our patients on the risk of untreated sleep apnea, but to also be able to identify signs and symptoms so we can recommend proper treatment or a sleep physician for diagnosis.  

What are you doing to help your patients get the sleep they need to function daily?