Snoring and Sleep Apnoea

Dentists are playing an increasing role in identifying patients with sleep disorders.

Sleep disorders can range from mild snoring to life-threatening obstructive and central sleep apnoea.

While dentists may be important identifiers of the patients suffering from sleep disorders, they are not qualified to diagnose the specific disorders and therefore should not be treating them in the absence of a diagnosis from a sleep physician, who will usually get the patient to have a sleep-study to enable him to make the correct diagnosis.

For the more severe cases, CPAP is the usual treatment of choice.

Some patients need surgery, usually diagnosed and performed by an Ear, Nose and Throat Specialist (ENT).

A narrow, high-vaulted palate can also cause or contribute to the airway obstruction. Patients with this problem usually require orthodontic treatment to widen the palate.

For patients with mild sleep apnoea and for people who snore with no other signs of apnoea, dentists can provide great help in the form of a Mandibular Advancement Splint / Device, commonly abbreviated as MAS or MAD.

The diagnosis of sleep disorders requires a multi-disciplinary approach, with the dentist often being a critical member of the team.

Besides the reduction in quality of life for both the snorer and their bed-partner, the fatigue caused by poor sleep is a major cause of industrial and motor accidents.

To help screen patients who might have sleep disordered breathing problems, we have a Konica-Minolta 300i pulse-oximeter that we lend to patients. By recording their blood oxygen saturation levels and their heart rates, we can get a better idea of whether or not they need further investigation by a sleep physician

Our Konica-Minolta 300i pulse-oximeter

Mandibular Advancement Splint

Have you ever blown up a balloon and squeezed the opening while letting the air out? Remember the noise it made? Snoring is similar. In the same way as the air rushing through the narrow opening in the balloon causes the floppy walls of the balloon to vibrate, thereby causing the noise, if the tissues of the airway (nose and throat) are floppy and the airway is narrowed, the air passing through the partial blockage when breathing will make a noise.

The turbulence usually occur in the soft palate, the uvula and the base of the tongue, but can originate anywhere from the tip of the nose down to the level of the vocal chords.

While not common, soft snoring can actually occur when awake. This is most common in very obese people, and is often referred to as ‘wheezing’. The accumulation of fat in the neck, combined with lax tissues, restricts the airway, causing the noise even while the person is awake.

When asleep, the muscle tone is reduced. When the tissues collapse, the airway narrows and the snoring starts.

Snoring itself is not dangerous, but the reasons why one snores certainly can be dangerous. The reduced airflow to the lungs can lead to a reduction in the level of oxygen in the blood. That means less oxygen to the tissues, and especially to the brain!

To try to compensate for the decreased oxygen reaching the brain, the body increases the heart rate to try to pump more blood to the brain so that it can get sufficient oxygen.   Starving your brain of oxygen and making your heart beat excessively fast are both dangerous. The end result (literally and figuratively) in extreme cases can be stroke, heart disease and even death.

Mild or moderate sleep apnoea is the partial (and occasional complete) blockage of the airway; snoring is the noise that results from the air moving past the partial blockage.

Apnoea is the total lack of air movement through the airway. The most common form of apnoea is Obstructive Sleep Apnoea, where there is an obstruction in the airway that stops the air flow. Less common is Central Sleep Apnoea, where the brain does not send the required signals to the rest of the body to stimulate breathing.

With Obstructive Sleep Apnoea, one tries to breathe but the air can’t flow; with Central Sleep Apnoea one doesn’t even try to breathe!

The base of the tongue is attached to the inner surface of the front of the mandible (lower jaw). The splints pull and hold the mandible forward which, in turn, pulls the tongue forward. As the tongue is pulled forward the airway is widened, reducing the obstruction, and the noise from snoring.

In some cases, it is obvious because the patient falls asleep during treatment.

When looking in the mouth, the two most common indicators of a sleep related problem are damage to the teeth from grinding (bruxism) and from erosion by stomach acid (reflux).

Facial and oral shape are often clues that there might be breathing and sleep related problems – Long, narrow faces; narrow upper jaws with high-vaulted palates; mouth-breathing.

Children, from birth, can have sleep apnoea or other forms of sleep disordered breathing. The effects can be quite devastating for the developing child, especially in behaviour and IQ.

A child suffering from sleep apnoea may present with all or some of the following signs.

  • Snoring, pauses in breathing and difficulty breathing during sleep
  • Choking, gasping or snorting while asleep
  • Restless sleep
  • Sweating when asleep
  • Sleeping  in unusual positions e.g. propped up high on pillows
  • Mouth breathing – children with Obstructive Sleep Apnoea may breathe through their mouth when sleeping
  • Waking up feeling tired
  • Waking with headache
  • Poor appetite
  • Behavioural problems (can resemble ADD/ADHD)
  • Learning difficulties
  • Reduction in IQ!  There are a number of studies that show lower IQs in children with sleep apnoea.  For example, a study from John Hopkins Medical Institute found “Children with OSA had lower mean IQ test scores (85) than children without OSA (101).”

The most common causes of OSA in children are enlarged tonsils and adenoids in the back of the nose. These tissues grow most quickly between the ages  2-7 years old. Having the tonsils and adenoids removed can cure OSA in 80-90% of children. Sometimes,  adenoids grow back. If the symptoms return, your child may need more surgery.   

Obesity is another, unfortunately increasingly, common cause of childhood Obstructive Sleep Apnoea.

Long-term allergies may also cause OSA. They are usually adequately treated with medication.

Certain medical conditions associated with weak muscles or low muscle tone, such as Down syndrome, can increase the risk of OSA.

Small jaws, especially narrow upper jaws, are very common causes of OSA. Treatment by an orthodontist is usually required to correct the problem. Children with flatter faces may also be at increased risk.

Dentists play a critical role in identifying the patients at risk.

Unlike adults, for whom mandibular advancement splints can significantly help snoring and mild to moderate sleep apnoea, these splints should not be used in children, whose jaws are growing.

Need more information?

For more information about our dental practice in general, or if you have a specific question about your dental care needs, please call us on (02) 8883 4560, email our dental practice at [email protected] or send us a message below and we will do our best to help you.

    Are you at risk of having sleep apnoea?

    Answer our two questionnaires to find out.

    STOP-BANG Questionnaire

    Epworth Sleepiness Score Questionnaire

    How can our dental practice help you with your dental care needs?

    Whether your dental care needs are a regular dental check-up or you require more comprehensive dental care, the team at our dental practice will do our best to provide you with the best possible advice and care.

    Dr. KEN LIPWORTH, BDSDentist
    DEBRA EGELTONPractice Manager

    Want more information about our dental practice?

    For more information about our dental practice in general, or if you have a specific question about your dental care needs, please call us on (02) 8883 4560, email our dental practice at [email protected] or send us a message below and we will do our best to help you.