What are the ABCs of dental sleep medicine?

What do the airway, bruxism and craniofacial pain all have in common? It might seem like nothing, but there is a lot more than you might realize. And while we have discussed this previously, I think it is important to continue to revisit this area of dentistry to further help our patients.

A lot of dentists don’t know that much about these areas of the dental specialty, so you’re not alone. However, because of this, dentists are unable to recognize the risk of sleep apnea, let alone manage patients with oral appliances, which is the same for craniofacial pain and bruxism. Each of these conditions are often overlooked and our patients are suffering.

By taking the steps toward a better understanding of the unique connections between the airway, bruxism, craniofacial pain and other conditions, dentists can create endless opportunities for services in diagnosis and treatment options within their practice. To help, let’s examine the ABCs of advanced dental services.

Airway. This is commonly referred to in sleep disordered breathing disorders, such as obstructive sleep apnea (OSA). Dental practices are in a unique position to identify patients at risk for conditions involving the airway. Understanding the airway and how it can affect a patient’s sleeping patterns due to sleep apnea and other sleep disordered breathing conditions is vital in maintaining your patients’ health and improving service offerings. It can also help in treating other conditions when there is a clear link available.

Bruxism. This is the gnashing and grinding of teeth that occurs without a functional purpose. When a patient is suffering from bruxism, it can cause a lot of problems (as you know). Whether it is due to a nervous habit, stress or unknowingly grinding teeth at night, bruxism can cause damage to not only a patient’s teeth, but their overall health as well. Due to the breakage of dental restorations from bruxism, tooth damage, induction of temporal headaches and temporomandibular joint disorders (TMD) can occur.

Craniofacial Pain. We come full circle with craniofacial pain, as it covers a wide spectrum of symptoms exhibited in many areas of the head and neck. In particular, a majority of craniofacial pain complications can be associated with temporomandibular joint disorder (TMD). Can you see the pattern? Because of this, an essential part of routine dental examinations for all patients should include an evaluation for TMD, including a patient’s history, clinical examination, and imaging when appropriate.

What is the connection? While it might not be found in every patient, there are still some individuals that require further attention because there is an apparent connection. As a dentist, it is important to understand that clenching or grinding of one’s teeth can be a way for the brain to protect itself from suffocation during sleep–it connects the ABCs.

Educate yourself by completing continuing education courses and attending lectures or seminars. While it might not occur in every case, it is vital that we as dentists understand it for those certain individuals suffering from all three conditions.

Comparing sleep apnea and quality sleep

There are about 90 million Americans that suffer from snoring during sleep. About half of these people are “simple snorers,” or primary snorers, while the other half might actually have obstructive sleep apnea (OSA). Knowing that so many patients might be suffering from OSA, it is important to help them understand how much quality sleep helps improve their health and well-being.

With so many people misdiagnosing themselves and inaccurately describing their condition, we need to continue to provide proper education for their reference. Understanding the differences between sleep apnea, snoring and quality sleep is important for our patients to better understand their condition.

To help your patients, I have created this infographic that looks at the differences between sleep apnea and quality sleep. Feel free to share it with them so they can see the impact of quality sleep versus sleep apnea on their health.  Take a look.

What other ways are you helping to educate your patients? I am always interested in hearing more from other dentists. Share your thoughts in the comments below.

Don’t hop aboard the medical marijuana train for sleep apnea

Lately we have been seeing a lot of news articles about medical marijuana. We have new states popping up every month in support of the legalization of marijuana. While we continue to learn more about the benefits and hear various opinions, let’s look at sleep apnea. Many people believe medical marijuana is a good option for patients with sleep apnea. It might be possible, but I don’t think we’re ready to jump on that train just yet.

Medical marijuana and sleep apnea

According to the American Academy of Sleep Medicine (AASM), medical marijuana should not be used to treat sleep apnea. The AASM warned that the drug and its synthetic extracts have not been shown to be safe, effective or well-tolerated by patients with sleep apnea.                     

The important thing to note here is that, until further research and evidence is found on the use of medical marijuana for treatment of sleep apnea, we should be avoiding this subject. Be sure to discuss proven treatment options with your patients. However, if your patient does bring this idea up for treatment of sleep apnea, provide proper education and inform them that there has been no proof just yet.

This does not mean it will never be approved, but, for now, we need to do our due diligence to protect our patients and have their best interest in mind.

States discuss qualifying conditions

Many states have discussed adding obstructive sleep apnea as a new qualifying condition for their medical marijuana program, such as the Minnesota Department of Health. However, the AASM’s statement in the Journal of Clinical Sleep Medicine, urged states to exclude sleep apnea from the list of chronic health issues that might be included in medical marijuana programs.

Current treatments for sleep apnea still include CPAP therapy and oral appliance therapy, but should not include medical marijuana (at least not yet). While medical marijuana runs the risk of daytime sleepiness and other side effects, further studies are needed to determine the effectiveness.

Until there is significant scientific evidence of the safety and efficacy of medical marijuana, we should avoid this as a potential treatment for sleep apnea.

Study suggests hypoxia is the main cause of BP rise in sleep apnea

Patients who had previously used continuous positive airway pressure (CPAP) for the treatment of sleep apnea, found that it helped to eliminate their morning blood pressure elevations. It also substantially reduced hypoxia. In a recent study in the American Journal of Respiratory and Critical Care Medicine, relative to treatment with supplemental air, pure oxygen was associated with a 6.6 mm Hg decrease in systolic and 4.6 mm Hg decrease in diastolic pressure.

What is the connection?

Obstructive sleep apnea has been known as a risk factor for hypertension and cardiovascular disease. However, it was not clear if that risk was associated with recurrent arousal or intermittent hypoxia, according to the study.

Understanding that supplemental oxygen reduced intermittent hypoxia but had only a minor effect on markers of arousal, makes a strong case for intermittent hypoxia being the dominant cause of daytime BP increases in patients with sleep apnea.

This study shows us that by blunting the dips in oxygen levels, the use of oxygen can have a positive effect on a person’s BP. We can start to look at patients with sleep apnea who have experienced high blood pressure that is not adequately treated with hypertension medication. According to this study, that specific group of patients should benefit from the use of oxygen therapy.

Oxygen improves BP

In this double-blinded study, CPAP was withdrawn for 14 nights during each treatment arm. During this time, participants received supplemental oxygen or regular air overnight through a face mask. The primary outcome was the change in home morning BP following the withdrawal of CPAP. Secondary outcomes included oxygen desaturation index, apnea hypopnea index, and subjective and objective sleepiness.

The use of supplemental oxygen significantly improved measures of intermittent hypoxia. There was also a significant reduction in heart rate rises index. While additional studies are needed to determine the best candidates for supplemental oxygen therapy, it is important to note these findings.

We, as dentists, can continue to treat sleep apnea patients with oral appliance therapy, but we should be mindful to other treatment options and what a sleep physician suggests for the best outcomes.