When the face does not grow the way it should, and grows more downward and backward, the airway is often compromised. Both day and night, breathing can be compromised. For many, this leads to snoring during sleep, and even a medical problem called “Obstructive Sleep Apnea” (OSA). For others, sleep is interrupted without snoring or apneas, causing many problems. Interrupted sleep can affect fatigue, energy levels, memory, restfulness and more. When it worsens and becomes actual sleep apnea it is associated with many health problems, including: strokes, heart attacks, cardiovascular disease, high blood pressure, diabetes, GERD, depression, sexual dysfunction, and many other health problems.
When undiagnosed and untreated, OSA shortens lifespan by about 20%
How are breathing disorders diagnosed? Some signs are obvious, like mouth-breathing. Signs such as frequent snoring and daytime sleepiness, or another person seeing you stop breathing or gasp for air while sleeping, can all seriously point in the direction of OSA. Only a medical doctor can diagnose sleep breathing disorders. Generally, a sleep study is performed in a sleep lab, like a hotel room with a comfortable bed (bring your own pillow!), where medical monitors are used to check breathing, sleep levels, muscle movements, oxygenation and much more.
This is called a polysomnogram, and it’s the most accurate way for a medical doctor to diagnose the more advanced sleep disorders. Alternatively, some insurances only allow use of a monitor you take home and wear while you’re sleeping in your own bed (an “ambulatory sleep study”). Sleep breathing disorders in the early stages, such as Inspiratory Flow Limitation (IFL) and Respiratory Effort-Related Arousals (RERAs) can be trickier to diagnose, yet they are more common among thin, fit women and children.
How are breathing disorders treated?
Restore nasal breathing.
Over-breathing (hyperventilating) is a common breathing disorder. Yet it is very common. Nasal breathing can help, as can “breathing re-training.” Mouth breathing is like drinking unfiltered water: you don’t know what you’re putting in your system. The nose filters the air, warms the air, humidifies the air, speeds up the air to fill the lungs better, regulates the volume of air, and “super charges” the air with the natural dilator nitric oxide. Want to skip all that? Just mouth breathe.
Improve muscle function
When the muscles surrounding the top of the airway (the mouth and jaws) are weak, functioning improperly, uncoordinated, or restricted in movement by “tethered tissue” like tongue ties, the airway can be affected. Myofunctional Therapy and frenum revisions can help.
Open the airway temporarily.
When an immediate, although temporary, opening of the airway at night is necessary, this is sometimes possible with the option of wearing a certain kind of dental appliance while you’re sleeping. Over 200 different types of appliances have been approved for this purpose, so a skilled dentist is the one to help with this type of treatment.
• Advantages: An oral appliance can be as effective with mild to moderate sleep apnea for many patients. It’s more comfortable than CPAP (see below), and it’s less expensive and invasive than surgery.
• Disadvantages: Oral appliances will likely change your bite permanently, like in the picture above, and this may or may not be easily fixable with orthodontics. In the long run, these appliances might pull the upper jaw backward, part of the original problem that led to the obstructed airway.
Push harder on the air through the compromised airway.
This is the option of using Positive Air Pressure (CPAP and BiPAP), which is considered the “gold standard’ treatment for sleep apnea by the medical profession for the treatment of sleep apnea. For earlier stages of breathing problems, it is sometimes not recommended. CPAP and other PAP machines work by means of a pump hooked up to a mask that fits on your face, covering your nostrils, nose, mouth or all of the above. The pump pushes the air harder as you inhale, and it can help you get the oxygen and restful sleep you need.
• Advantages: CPAP avoids surgery or oral appliances, and medical insurance might help with it. When it’s used, it can be very effective.
• Disadvantages: Many simply do not wear it. After 6 months, most CPAP users give up. It can dry your throat (a humidifier can help), restrict your sleep position, feel claustrophobic, be a hassle to carry around, or have other disadvantages.
Open the airway more permanently.
There are ways that the airway can be increased more permanently: orthodontics, appropriate surgery, or both.
The same patient, before and after re-opening spaces where bicuspids had been extracted. Notice how much more room the tongue has. Why does this matter? Because the airway is more open when the tongue can come more forward.
• Advantages: Orthodontics to open up more tongue space can work for some people. When permanent teeth have been taken out – or even when they haven’t, opening up room for the tongue can help. Not having to depend on CPAP, or risk bite changes with an oral appliance, or undergo surgery are all advantages.
• Disadvantages: Orthodontics takes time and there’s always the possibility that it might not be enough. In that case, surgery might be the best option.
Possibly the most definitive solution for a small airway that’s causing breathing problems, is to move the jaws to the correct position in the face in order to open the airway. Like architects, jaw surgeons have many different ideas for how to “build the ideal.” These X-ray images are of results from surgery done by Dr. Reza Movahed of St. Louis, MO. Notice the bigger airway. When it’s done right, jaw surgery has the potential to really fix the problem. Patients can throw away the CPAP!!
• Advantages: Jaw surgery deals with the structural cause of the sleep apnea. It aims to fix the root of the problem. If the jaw joints have problems too, a surgeon like Dr. Movahed can treat them at the same time. If there are problems with the nasal airway, soft palate, etc., these can also be addressed.
• Disadvantages: Cost and hassle of surgery, as well as risks involved for any surgery.
If you believe that you have sleep apnea, call Dr. Hockel’s office at 925-478-7776 to learn more about our treatments and schedule your initial consultation with our dentists.
Dr. Brian J. Hockel and Dr. Rebecca Jardine are pleased to provide alternative treatments for Obstructive Sleep Apnea to patients from Walnut Creek, Clayton, and Concord, California, as well as from the greater San Francisco East Bay area and beyond.