It is estimated that one-third of the U.S. population suffers from sleep disorders. Approximately 40 million individuals are chronic sufferers, yet less than 10% have been diagnosed or sought treatment. If you experience daytime sleepiness, irritability, or high levels of fatigue you may be one of them.

Regardless of the type of sleep disorder, the impact on individuals is considerable. Clinically, people suffering from sleep disorders have an increased likelihood of heart disease, hypertension, diabetes, and increased mortality. At the same time, these individuals experience reduced cognitive performance that lowers job performance, decreases their quality of life and makes them ten times more likely to be in an automobile accident. These individuals are more susceptible to work-related injuries, depression and family discord, too.

Economically, sleep disorders in the U.S. are estimated to cost $60 - $115 billion annually for medical and indirect expenses. Sleep studies and therapies alone cost an estimated $5 billion per year. Individuals with undiagnosed sleep disorders have also been documented as heavy users of medical services.

Several types of sleep disorders occur. Among these are circadian rhythm disorders, central sleep apnea, Cheyne-Stokes respiration, parasomnias (like bruxism), restless leg syndrome, snoring and obstructive sleep apnea.

Obstructive Sleep Apnea (OSA)

Obstructive sleep apnea (OSA), is more common in the U.S. than asthma or diabetes. Generally, the disorder strikes men more often than women and it progressively worsens with age and increased weight. Post-menopausal women also become a high-risk population. Basically, during sleep, relaxed muscle activity leads to a closing of the throat and airway, which deprives the individual of oxygen. The brain sensing low oxygen levels stimulates the fight or flight response (ie. The sympathetic nervous system) to continue breathing. This cycle repeats throughout the night, preventing the individual from getting a restful, deep sleep. The fight or flight response causes an increase in norepinephrine and epinephrine which can increase heart rate and increase blood pressure. The patient only gets into the lighter levels (Stage 1 & Stage 2) and is unable to get into Delta or (Stage 3 & 4) restorative sleep. By the way stage 2 sleep is where bruxism occurs so an Obstructive Sleep Apnea can be detrimental to the TMJs as well as teeth.

Clinical signs and symptoms of OSA include:
• Intermittent snoring with pauses
• Awakenings with gasping or choking
• Gastro-esophageal reflux (GERD)
• Fragmented, non-refreshing, light sleep
• Excessive daytime sleepiness
• Poor memory and/or clouded intellect
• Irritability
• Morning headaches
• Decreased sex drive or impotence
• Depression

Leading risk factors for OSA are obesity, increasing age, male gender, anatomic abnormalities of the upper airway, a family, alcohol or sedative use, and smoking.

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Diagnosis & Treatments

The only way to diagnose OSA (or any sleep disorder) is to catch them when they are happening. The only way to diagnose them is at an attended sleep study in an accredited sleep lab.

At the TMJ & Sleep Therapy Centre of Monmouth, we merely screen for sleep disorders with our equipment. One of these is the Watch-Pat 100 device, this provides an ambulatory sleep study which fits comfortably over the patient’s hand and is worn for one night. The resulting data reveals key information, including the number and length of periods that the patient’s sleep was interrupted with apnea (a cessation of breathing for 10 seconds or longer or hypopnea (which is an oxygen saturation below 97% associated with shallow or decreased flow). We then use this data, combined with other screening tools, to determine the effectiveness of our treatment. Acoustic Reflection Technology (Eccovision) is also the delivery of sound waves which are reflected back and determine the anatomy of the nasal airway (Rhinometry) and of the oropharyngeal airway (Pharyngometry). We also use this to see the airway improvement that an FDA approved oral appliance can provide.

Treatment options for OSA fall into three major categories:

1. Lifestyle Changes. Many individuals can relieve the symptoms of OSA by increasing exercise and losing weight. Among other improvements, this reduces fat and increases muscle tone in the throat, which lessens any airway constriction. Lifestyle changes are recommended even in cases when they, alone, will not resolve the problem.

2. Medical Interventions. Many OSA sufferers experience improvements using an at-home sleep device that delivers Continuous Positive Airway Pressure (CPAP). The patient wears a mask to sleep that is attached to a hose and a pump, which supplies air at a stable pressure level to prevent the airway closure that leads to apnea . While effective, the machine can be noisy and cumbersome. In fact, 80% of patients are non-compliant after one year.

The only other medical intervention is surgery. This is an option of last resort. During the surgery, portions of the uvula and wall of the throat are removed This procedure is called a uvulopalatopharyngoplasty (UPPP). This is a radical procedure with a lot of post-operative discomfort. Removal of the pharyngeal tonsils is another option. More conservative surgical procedures such as the Pillar Procedure involves insertion of fibers in the soft palate to prevent its collapse. Although most patients will not chose a surgical procedure from the onset, there is a place when appliance therapy alone does not provide an adequate solution or where the patient is CPAP non-compliant.

3. Dental Orthotic. At the TMJ and Sleep Therapy Centre of Monmouth, Dr. Kulaga prefers to use non-invasive, customized and affordable dental orthotic appliances whenever possible to reposition the jaw in a way that helps prevent airway closure. The tongue is moved forward and muscle tonus is increased in the soft palate and pharynx.In 2005, the American Academy of Sleep Medicine supported the use of oral appliances as first line treatment option for patients with mild to moderate obstructive sleep apnea and snoring. These portable devices are placed into the patient’s mouth and worn throughout the night. They are easy to clean and maintain and are noiseless. As a result, many patients prefer the dental orthotics over CPAP. There is no need to wear a mask, or to deal with noise or hoses. The oral appliance is easy to travel with.