Because dental treatment of sleep disorders involves alterations in jaw position during sleep, an understanding of jaw function, especially the potential for problems that can develop with the temporomandibular joints, is essential. This has been the focus of Dr. Higdon’s practice for over 30 years.
• Our Need for Restorative Sleep
Restful, restorative sleep is essential for optimal physical and mental health. Although scientists aren’t entirely sure why we sleep, we know that going without sleep for too long makes us feel terrible, and that getting a good night’s sleep can make us feel ready to take on the world. (read more)
In studies of humans and other animals, scientists have discovered that sleep plays a critical role in immune function, metabolism, memory, learning, and other vital functions. It may not be surprising that it is more difficult to absorb new information following a night of inadequate or disturbed sleep. But in addition, it is just as important to get a good night’s sleep after learning something new in order to process and retain the information that has been learned.
• Sleep Requirements and Disease Risk
Sleep science indicates that we all need from 7 to 9 hours of restful sleep every night. The price of insufficient sleep may be poor health. In the short term, a lack of adequate sleep can affect judgment, mood, ability to learn and retain information, and may increase the risk of serious accidents and injury. In the long term, chronic sleep deprivation may lead to a host of health problems including obesity, diabetes, high blood pressure, cardiovascular disease, and even early mortality.
• What Are Sleep Disorders?
If you routinely experience excessive daytime sleepiness, you may have a sleep disorder. The good news is that most sleep disorders are highly treatable.
Although there are several types of sleep disorders, the more serious ones are referred to as Sleep Disordered Breathing (SDB). This group of disorders includes Upper Airway Resistance Syndrome (UARS) and Obstructive Sleep Apnea (OSA). Both of these disorders involve a narrowing or collapse (obstruction) of the airway during sleep.
• Upper Airway Resistance Syndrome (UARS)
When narrowing of the airway occurs but does not collapse, this causes resistance through the airway that is enough to disrupt the quality of sleep, this is referred to as “Upper Airway Resistance Syndrome” or UARS. Although usually not as severe as Obstructive Sleep Apnea, UARS can also contribute to the development of a number of diseases and disorders.
• Obstructive Sleep Apnea (OSA)
This condition occurs when an individual’s airway becomes partially or completely blocked many times during a night of sleep, leading to repetitive arousals.
As we sleep, muscles in the throat relax. In some people this relaxation causes tissue at the back of the throat, or the tongue, to block the airway, causing the individual to wake up enough to reestablish muscle control in the throat and to reopen the airway. Surprisingly, despite frequent arousals per night, most individuals with OSA have no recollection of these events. In someone with a severe form of OSA, this may occur hundreds of times per night, interrupting breathing for 30 seconds or more during each instance. The result of this interrupted breathing pattern is severely disrupted and insufficient restorative sleep. For the patient experiencing OSA, often the only evidence of this serious condition is daytime fatigue, drowsiness, and reports of loud snoring from a bed partner.
Risk factors for sleep disorders include obesity, inherited traits, such as small jaw size or a large overbite, as well as behavioral factors such as the use of alcohol before sleep. UARS and OSA are serious conditions that can lead to a variety of serious health problem, including high blood pressure, heart disease, diabetes, and mood and memory problems.
• Dental Treatment for Sleep Disordered Breathing — UARS & OSA
Patients who have mild to moderate UARS or OSA may be candidates for Oral Appliance Therapy (OAT) for these conditions. This treatment has been recommended by the American Academy of Sleep Medicine. When these conditions have been medically diagnosed by a sleep doctor, often a treatment called Continuous Positive Air Pressure (CPAP) may be tried first. But CPAP is frequently not tolerated well by the patient, for several reasons, making OAT the next most effective treatment option. OAT involves wearing a device in the mouth that brings the lower jaw forward. This also brings the tongue forward and opens the airway. The jaw is held in this forward position during sleep. Most people tolerate OAT quite well and there are few side effects. However, for a person who already has a jaw problem, the potential for a problem with the jaw joints is a possibility and should be identified before the OAT treatment is undertaken.
Dr. Higdon’s Experience and Unique Perspective
Although most patients with UARS or OSA tolerate OAT well, there are very real potential problems that can develop with the use of the oral appliance. Although these problems do not occur frequently, they may include the development of pain in the jaw joints and/or jaw muscles, and sometimes may cause a change in the bite as a result of wearing the oral appliance. These conditions are broadly referred to as “TMJ” or temporomandibular disorders (TMDs).
Because of the potential for these problems to develop, any patient who is being considered for OAT should be carefully screened for these potential problems. Because most dentists who provide OAT have not been trained in how to thoroughly screen patients for these conditions, they often have little understanding of how to identify them before OAT is undertaken or how to treat them, should they develop. For more on TMD screening, see “Screening for TMD in Dental Practice”
Dr. Higdon’s practice, for over 30 years, has been specifically focused on providing treatment for temporomandibular disorders, as well as sleep disordered breathing problems, such as UARS and OSA. Patients with TMD and sleep disorders are frequently referred to him by other dentists and sleep physicians. He is widely recognized in the community for his unique understanding of these conditions. For any patient who is referred for OAT, as a part of the initial evaluation and prior to initiating treatment, Dr. Higdon will do a thorough screening for any potential for the patient to develop a TMD. He will then discuss the implications of this risk with the patient before undertaking OAT for the sleep disorder. If the risk of a TMD is identified, this may need to be treated before OAT treatment for the sleep disorder can be considered.
