SLEEP BETTER

In March I completed a “mini-residency” program at Tufts in dental sleep medicine. In a nutshell, dental sleep medicine is the dentist’s participation in the treatment of sleep breathing disorders such as obstructive sleep apnea. Although the concept seemed relatively simple to me at the beginning of my journey, there is always more to the story.

About 7 years ago, I took a one-day class in dental sleep medicine. I found it intriguing how many signs and symptoms dentists see on a daily basis which could be relative to possible sleep breathing issues. For most of us, when we are “asleep”, we are unconscious and have no idea what is going on behind the scenes. However, a lot can be learned by observation and some simple questions.

The more I learned, the more I had trouble ignoring the many red flags I was seeing in patients. Wanting to delve deeper, I signed up for the program at Tufts. The program consisted of a rather intense literature review of the subject and many hours of lectures by both dentists, who have been in the field of dental sleep medicine since its start about 30 years ago, as well as sleep medicine physicians. Many sleep medicine physicians are ENTs or pulmonologists. Since the program at Tufts, I have also joined a national dental sleep medicine mentoring group to continue to learn more.

Incorporating what I have learned to help patients has been slow. Dentists and physicians don’t typically have a lot of interactions together. However, the relationship between the two is very important in the treatment of obstructive sleep apnea.

Obstructive sleep apnea is a medical problem and needs to be diagnosed by a physician. Of the many things I have observed in my short time treating patients in this arena, one thing is clear: patients do not talk to their doctors or dentists about sleep very often. Many of the issues that people live with (snoring, fatigue, grinding/clenching, hypertension, TMJ issues, etc.) deserve a conversation in relation to sleep.

When I ask patients about snoring, for example, I often hear, “I don’t think I snore but my husband/wife snores like crazy”. Just because you and/or your spouse snores, does not mean you have sleep apnea. Benign snoring is simply fluttering of soft tissue in the back of the throat with no obstruction of the airway space. However, it still is a medical diagnosis and in most cases cannot be established unless some form of sleep monitoring is done. Both sleep apnea and benign snoring are treatable….and it should be treated because it is disrupting to others.

Witnessed apnea events, on the other hand – that is a person visually and/or audibly witnesses a bed partner pause breathing during sleep – are a significant sign that there very well may be a sleep breathing disorder. Oxygen to the body may be depleted during these events. This should be discussed with your physician.

The key takeaway this week is to have a conversation with your doctor if you don’t feel you are sleeping well. If your bed partner is consistently snoring loudly or pauses breathing during sleep, have a conversation with your bed partner and decide if this is an issue which should be addressed. If there is no one sleeping in the room with you, email me and I’ll give you an app to evaluate how much noise you are making.

Sleep breathing issues are very much underdiagnosed, can be dangerous, and are very treatable. Talk to your physician and dentist about it.