Sleep, Snoring, Dentistry, and your health
A loud snort or quiet snuffle while sleeping may lead to a painful elbow strike to your side, but beyond the annoyance and interruption to a quiet night of sleep, snoring may be a sign of a serious health issue.
According to Johns Hopkins, an estimated 45 percent of adults occasionally snore, while 25 percent snore regularly. It is also estimated that 10 percent of children snore regularly. Not all snoring is serious as most people go through periods of snoring due to allergies or a cold.
A sleep study should be performed to determine if snoring is causing serious health issues. Sleep studies are typically prescribed by a physician and conducted as an overnight evaluation of your sleep in a lab. Take-home sleep studies are becoming more common as the technology to monitor oxygen levels, heart rate, blood pressure, breathing rates, and duration have improved.
Sleep apnea is a disorder that sleep tests are used to diagnose. Apnea is the temporary cessation of breathing which causes a drop in oxygen in the bloodstream. When the level drops far enough the brain forces the body out of deep sleep. This can happen 20-30 times a night, leading to many health issues due to the lack of good sleep and the release of adrenaline each time the body is jolted out of deep sleep. The heart is forced to work harder due to the lower oxygen levels.
The consequences of sleep apnea can be an increased risk of an irregular heartbeat, high blood pressure, heart attack, stroke, diabetes, and motor vehicle accident due to daytime sleepiness.
Dental consequences of sleep apnea include an increased risk of dry mouth leading to gum disease and cavities, worn teeth from grinding from the body attempting to open the airway, and changes in the shape of the jaw and alignment of teeth due to mouth breathing.
Anyone who snores should bring the issue up with their physician to evaluate. If you are found to have sleep apnea you may be prescribed a CPAP (continuous positive air pressure) device to sleep with, which is the gold standard of treatment. Patients who are unable to tolerate a CPAP with severe apnea or those who have mild to moderate apnea may be referred to a dentist for an oral appliance.
Dental sleep medicine has been around for several years but is a rapidly changing area of dentistry. The traditional sleep appliance fabricated is a mandibular advancement appliance that moves your lower jaw out and forward. This opens the throat slightly and moves the tongue forward allowing more airflow which can decrease the number of apnea events, but typically only in mild cases. These appliances can be quite expensive depending on the type fabricated. Therefore, depending on individual circumstances, a step-up approach is recommended in many situations.
The first step is simply using tape to keep the mouth closed and force nasal breathing. This can be effective in up to 50% of people with snoring, but only if there are no anatomical problems such as nasal blockages or a deviated nasal septum. The next step is to add a mouthguard with tape which slightly opens the jaw. The mandibular advancement appliance is the last option if this doesn't work. Not everyone can tolerate a sleep appliance or the CPAP and is forced to consider surgical interventions.
For those who snore but don’t have sleep apnea, dental interventions are the same as previously listed with taping of the mouth, adding a mouthguard, or using a mandibular advancement appliance.
Other tips and tricks to decrease snoring include avoiding alcohol, sleeping pills or sedatives before bed as they relax the throat muscles which increases the likelihood of snoring. Smoking irritates the membranes of the throat and nose, so smoking cessation can decrease snoring. Exercising and eating properly can also help with snoring as overweight people have excess fatty tissue in the back of the throat which can cause snoring.
This article focused on adults. Children and snoring can also be serious, but the science is not well-established regarding treatment options, therefor the topic is best for another day. As research and treatment options continue to improve, don’t be surprised if snoring or sleep is discussed by either your physician or dentist depending on if you have any signs or symptoms.