Anyone who sleeps next to someone who snores knows this—snoring can range from being mildly annoying to being a major source of tension between sleep partners. Many people don’t know, however, that snoring can also be a sign of a serious health problem. It can lead to inflammation in the upper airway, and in about 50 percent of snorers, sleep apnea—a potentially life-threatening condition—is present. With sleep apnea, breathing actually stops during sleep, and in severe cases, can stop more than 100 times an hour, depriving the body of oxygen.
The following is based on a true story: Not long ago, I met a young mother (let’s call her “Jennifer”) who came to me on emergency due to tooth pain. I noticed she looked absolutely exhausted—unusually so, even for a young mother of three children. From the look on her face, I imagined that she might be one of the many dental phobics—those who have an irrational fear of dental care—who often seek our help. I found the source of her pain: a fractured molar. One whole side of her tooth had split off, and the crack went down the root, right into the nerve and the bone. Sadly, Jennifer was going to lose that tooth. I explained to her what needed to happen, and she was devastated. Her badly fractured tooth was a result of clenching and grinding her teeth, a direct and common response to emotional distress. When I asked if she had been experiencing a lot of stress in her life, she said: “I have three beautiful children, but my marriage is a wreck. I hate my husband for what he is doing to me.” For a moment I thought perhaps he was physically abusive. I asked if she wanted to share more. “I haven’t slept in years,” she said. “Really.”
She continued: “My husband’s snoring goes on all night long. I want to scream. Needless to say, all thoughts of romance and intimacy are gone. I am short-tempered with him, but worse yet, all day long, I lose my patience with the kids and end up screaming at them over the stupidest things. Lately, I’ve been sleeping in the van. Although I can’t hear [my husband], I am so uncomfortable that I am not sleeping anyway. I have no idea what I will do when the weather gets cold. I not only miss my sleep, I miss my bed, I miss fun times with my children, and I miss my husband. My life is falling apart.” She began to cry. Although Jennifer felt her husband couldn’t control the snoring, she was so angry with him for impacting her quality of life in that way. And not only was she not sleeping, she was losing precious teeth because of it!
About half of all people who snore have sleep apnea, many of them unaware of the risks.
That’s when I told her about the relationship between snoring and sleep apnea. Because the snorer is not conscious of his/her snoring or breathing interruptions, someone else must be available to note that these are occurring. If a person snores and shows signs of sleepiness or fatigue during the day, an overnight sleep study can be done in a sleep clinic. Or in some cases, depending on a patient’s current state of health, a simple FDA-approved sleep study can be done at home. In either situation, a sleep physician determine whether a diagnosis of sleep apnea is warranted.
The snoring Jennifer described, and the frequent snorts and gasps that she said accompanied it, sounded like signs of sleep apnea. Her husband was already suffering with diabetes and high blood pressure and had gained a lot of weight in recent years. His conditions are common among people with sleep apnea. Often, people with sleep apnea eventually have a massive heart attack or stroke in their sleep. And, as I explained to Jennifer, that could happen to her husband.
Soon Jennifer had all but forgotten her own tragic dental emergency. We removed her tooth, but afterwards, I shared with her more information about sleep apnea, including some of the treatment options.
My Dentist Can Treat That?
Treatments for snoring and sleep apnea are increasingly available from dentists, more and more of whom are seeking training in the physiology and treatment of these conditions. A custom-fitted oral device, made by a skilled dentist, can be highly effective in eliminating snoring; such a device can also be the first line of defense for mild to moderate sleep apnea, but only with a physician referral.
For patients with more advanced levels of sleep apnea, a “CPAP,” or breathing machine, is often the first approach to treatment. For these patients, a CPAP machine can be a literal lifesaver. However, scientific research shows that at least half of those who should be using a CPAP machine at night are not, probably due to the fact that CPAP devices—consisting of a face or nose mask, straps and a hose, all hooked up to an oxygen machine—can be uncomfortable, unwieldy and embarrassing. For people with more serious sleep apnea who can’t tolerate a CPAP machine, oral devices fitted by a dentist can provide an alternative treatment option.
These oral appliances are custom-fitted over the teeth and gently shift the lower jaw forward, moving the tongue with it and allowing air to freely flow between the mouth, nose and lungs. (In most cases of sleep apnea, the tongue is the physical obstruction that closes off the airflow.) An oral sleep appliance can be life-enhancing, even life-saving, for those who cannot or will not wear a CPAP machine due to physical, emotional or practical reasons. With over 80 different oral appliances to choose from, the treating dentist must understand how to select the right one for each patient. Although an oral appliance may not always prove to be as effective as a CPAP machine for treating sleep apnea, in the world of sleep medicine and sleep dentistry, it is commonly accepted that for those with sleep apnea who are not using a CPAP machine, “something” is clearly better than “nothing,” no matter how severe the sleep apnea.
So, back to Jennifer’s story. When she left our office that day, she had hope in her heart for the first time in years—hope not only for a good night’s sleep, but for better health and a renewed marriage. We offered a free snoring and sleep apnea screening to Jennifer’s husband and are looking forward to getting him to a sleep physician for his diagnosis so that a treatment plan can be developed for him—and her! When I decided to become a dentist more than 28 years ago, I knew practicing dentistry was going to be about saving teeth and recreating smiles; but I never imagined it could be about saving marriages—and even
saving lives.
