What Causes Snoring?

Snoring is essentially the vibration of airway tissues in the back of the throat during obstructed breathing that typically occurs while sleeping. When the air flows through the tissues it creates a sound that is often more of a nuisance than anything else. Although snoring may be corrected by losing weight, limiting alcohol and smoking, or changing the position of your head while sleeping, more than 50% of the people who snore may have some level of a potentially more serious condition called sleep apnea.

The second consequence of snoring is carotid atherosclerosis – which is a blockage of the artery to the brain potentially leading to a stroke. The third consequence is separate bedrooms. The ONLY way to differentiate between the two is via a SLEEP STUDY at home or in a sleep center.

What is Sleep Apnea?

The most common type of Sleep Apnea is Obstructive Sleep Apnea – when breathing actually gets disrupted many times during the night because of relaxed throat muscles collapsing and blocking the airway. When the soft palate relaxes and the tongue falls back in their throat it blocks the airway. In severe cases this can be more than one hundred times in an hour!

Central Sleep Apnea is when the brain doesn’t send a signal for the body to breath thereby lowering the oxygen to the brain and the rest of the body organs.

Mixed Sleep Apnea is when you have some combination of both Central and Obstructive Sleep Apnea. If it is not properly diagnosed, a Continuous Positive Airway Pressure (CPAP) can potentially make things worse. On the other hand, an Oral Appliance could help with this condition.

Please NOTE: The final decision of a treated sleep physician’s recommendations will determine your options based upon a Sleep Study Test.

What are Some of the Consequences of Sleep Apnea?

  • Frequent Headaches
  • Heart Disease / High Blood Pressure (number one cause)
  • Liver Problems
  • Obesity
  • Diabetes
  • Snoring
  • Dementia
  • Depression / Anxiety / Irritability
  • Daytime Sleepiness / Difficulty Staying Asleep
  • Lower Workplace Performance
  • Forgetfulness
  • Difficulty Concentrating
  • Much, much more…

The incidence of Sleep Apnea in the US population is much higher than most people realize. As many as one in three people have some degree of sleep apnea. It has a higher rate among families, if one person has it. As suggested prior, medications, repositioning your head, sleeping on your side and losing weight can help with mild sleep apnea.

Commonly observed conditions by a dentist used to identify patients with sleep apnea include:

  • Obesity
  • Large tongue
  • Large tonsils or adenoids
  • Large neck size
  • Advanced age
  • Bags under eyes or a tired look
  • Male
  • Family history
  • Snoring
  • Signs of tooth grinding
  • High blood pressure – the number one contributor to heart attacks
  • Patient mentions they fall asleep in lectures or watching TV

Please note that you could have sleep apnea and have NONE of these observable conditions as well! Even children can have sleep apnea – most often related to swollen tonsils or adenoids. Sometimes expanding the upper arch will help make more room to breathe.

Patients with mild to moderate sleep apnea can be treated by a dentist using an oral appliance that is custom-made to adjust the position of the lower jaw forward such that the airway is opened allowing for easier breathing at night. An appliance like this can also help with the snoring noise.  A patient with severe sleep apnea who can’t or won’t use a CPAP can still be helped with an oral appliance or combination therapy.

How Does the Oral Appliance Work?

After the proper diagnosis is made, impressions of your teeth are made. This is sent to a special lab that fabricates a custom-made removable appliance that fits over your teeth and helps keep your airway open while you sleep. It gently repositions your lower jaw forward and prevents your tongue from blocking the airway. This should also correct the snoring.

We always do a follow-up visit by testing the effectiveness of the appliance after a couple weeks and sometimes even a few weeks later to check it again. Minor modifications can assist with the comfortable fit or effectiveness of the appliance. After we see it is working effectively, we like to check again in six months and then annually to make sure it is fitting properly and still functioning properly. At our office, we have home sleep study units that our patients can use to monitor the effectiveness overnight. We also use and instrument called a pharyngometer to measure the amount of opening of the airway. It accurately measures a cross section of the airway and helps identify the right amount of opening for the airway.  It helps determine the best position for the lower jaw to maximize airway space. Typically, it will be around 75% of the maximum protrusion to correct it, but either way, it needs to be monitored after two weeks and then again in six months. You can’t just arbitrarily move the lower jaw forward.

One additional product we advise is using a jaw repositioner in the mornings to help retrude the lower jaw back into its “normal” position. When the jaw has been in a forward position for a while, fluid can build up in the jaw joint and therefore, wearing the repositioner when you first wake up for 5-10 minutes or in some cases up to 30 minutes or more may be helpful to bring the jaw back into a comfortable position.

For any of our patients who potentially need a night guard for clenching at night, we also like to test for sleep apnea since grinding is one of the symptoms of sleep apnea. Some dentists might make a night guard and stop with that. Without proper diagnosis, you could actually be masking another problem which could lead up to a heart attack or daytime drowsiness – leading to falling asleep in the middle of the afternoon or even while driving!  One of the top causes for high blood pressure is sleep apnea, yet most medical doctors end up frequently giving blood pressure medication instead of looking into the possibility of sleep apnea.

Two dental challenges to wearing an oral appliance: If you are wearing braces and your teeth have brackets and wires on them and the teeth are moving, it might be better to utilize the CPAP during the orthodontic treatment. In addition, doing an arch expansion during orthodontics might correct and open up the air space. Secondly, if you wear an upper denture, you may still wear the appliance as long as you have a stable solid ridge for resistance to push the lower jaw forward.

Dr. James. R. Donley of Lumbertown Dental Wellness in North Muskegon, Michigan has been treating sleep apnea patients in his practice for over 11 years. He is a member of both the American Academy of Dental Sleep Medicine as well as the Academy of Clinical Sleep Disorders Disciplines. It has become one of his passions to treat since is it very impacting on the overall health of an individual and it is life changing. Dr. Donley would know, because he has personal experience of the benefits of wearing an oral appliance himself!