What is Dental Sleep Medicine?
Dental Sleep Medicine is the screening, assessment, and management of sleep-related breathing disorders, including Snoring, Obstructive Sleep Apnea (OSA) with Oral Appliance Therapy (OAT). Although sleep apnea (OSA) must be diagnosed by sleep physicians, dental practitioners are able to screen and provide treatments for suffering patients. Want to improve the quality of your sleep and overall health?
The Dental Practitioner's Role
- Recognize oral signs and symptoms
- Screen patients for medical co-factors and symptoms
- Educate patients on potential sleep breathing disorders and their risks
- Provide referral for appropriate testing by a certified sleep physician
- Selection, fitting, adjustments, and follow-up care of oral appliances
- To liaise with medical/dental team, including dentists, physicians, oral surgeons, ENT and sleep specialists to best improve your patients’ quality of life, sleep, and overall health
Dr. Kreuz is one of two dentists in Alberta who has obtained Diplomate status with the American Board of Dental Sleep Medicine. She has successfully managed several patients with obstructive sleep apnea or sleep disordered breathing with oral appliance therapy.
Dr. Kreuz has dedicated herself to an ongoing pursuit of professional education and development and continues to build a network of medical professionals with whom to consult and refer.
In addition to implementing a screening protocol in her own practice, Dr. Kreuz welcomes referrals from CPAP retailers, general physicians, sleep physicians, and ENT specialists for their patients who may benefit from oral appliance therapy. OAT may be helpful for snoring, sleep apnea, upper airway resistance, and CPAP non-compliance.
If you are a medical or dental practitioner and wish to refer your patients, click here for a referral form.
Your overall health is important to us!
If you have questions about sleep breathing disorders such as snoring and sleep apnea, please ask Dr. Kreuz and her team.
We are pleased to offer a complimentary snoring and sleep apnea consultation.
What's all the noise about?
Snoring can be more than bothersome to your bed partner!
Snoring is a common problem in 30 to 50% of the population and can affect not only your health and the quality of your sleep but also that of your bed partner.
Health effects can be seen due to frequent sleep interruptions common in snore sufferers.
Why do we snore?
In our upper airway, air must pass through many soft structures in our nose, mouth, and throat. When we are asleep, the muscles in our throat, neck, and tongue relax and for some, narrow or obstruct the passage of air.
Snoring is a partial blockage of air and produces vibrations in these tissues that we hear as snoring. The volume of snoring can vary from a quiet purr to a freight train, but all signal a reduction in the passage of air and oxygen.
What is OSA?
Obstructive Sleep Apnea (OSA) is a sleep-related breathing disorder that involves a decrease or complete halt in airflow despite an ongoing effort to breathe. Sleep apnea can pose significant health risks and affect your overall quality of life. Obesity, family history, and anatomy are some of the few causes for sleep apnea. Some risks include: congestive heart failure, high blood pressure, and diabetes.
Who is at risk?
Approximately 25% of the population suffer from sleep apnea and over 80% of sleep apneics are undiagnosed!
Some studies show one in five adults may have OSA. Nine percent of middle-aged women and 25% of middle-aged men may have sleep apnea.
Present estimates are 80-90% of sleep apnea is undiagnosed.
Dental professionals with specific dental sleep medicine training like D. Kreuz are in a unique position to identify and help patients at risk. Patients at higher risk may include:
- Middle aged to older men
- Post-menopausal women
- Larger neck sizes (17"+ in men, 16"+ in women)
- Tongue and jaw size anomalies
- Enlarged tonsils, adenoids, uvula
- Limited nasal airway due to anatomy, injury or allergies
- Family members with OSA
- Snoring. Some studies point to a link between snoring (partial airway obstruction) and increased risks for cardiovascular, but more research is underway. More seriously, snoring may progress to, or is often a symptom of, a life threatening sleep breathing disorder known as Obstructive Sleep Apnea.
When does it happen?
OSA occurs when the muscles relax during sleep, causing soft tissues in the back of the throat to collapse and block the upper airways. This leads to partial reductions (hypopneas) and complete pauses (apneas) in breathing the last at least ten seconds during sleep. Most pauses last between ten and 30 seconds, but some may persist for a minute or longer. This leads to abrupt reductions in blood oxygen, putting strain on your brain and cardiovascular system. Oxygen levels can fall as much as 40% or more in some case.
Your body reacts to the lack of oxygen by alerting the body, causing a brief arousal from sleep that restores normal breathing. This pattern can occur dozens to hundreds of times in a single night. You may or may not be aware of these arousals, as some awake fully, while others will be affected in their deepness of sleep only. The result is a fragmented quality of sleep that often produces an excessive level of sleepiness that often produces an excessive level of sleepiness during the day. It can also produce other serious health effects.
Most people with OSA snore loudly and frequently, with periods of silence when airflow is reduced or blocked. They then make choking, snorting, or gasping sounds when their airway reopens. Other symptoms include:
- Mouth breathing
- Morning headaches
- Chronic cough or sore throat
- Difficulty concentrating
- Grinding or clenching
- Frequent waking or urination at night
- Memory problems
- Dry mouth
- Irritability, mood changes
- Poor performance
- Weight gain
How do I know if I have OSA?
Your dental sleep medicine professional, Dr. Kreuz, and her team, may perform periodic screening to assess your risk. This would include a questionnaire, a medical history review, and an oral examination. Based on her findings, she will discuss with you her clinical assessment and make recommendations for further screening, and/or referral to a sleep physician for additional testing.
Dr. Kreuz may recommend, in some cases, a take-home evaluation using a portable sleep monitor. It is self-administered with detailed instructions to help you. The results are reviewed by a third party sleep physician and recommendations are forwarded to Dr. Kreuz to review with you. This may be option if your risk is assessed as low and you are considering a simple snoring appliance.
We currntly use the MATRx plus home sleep testing system, invented by local sleep specialist, Dr. John E. Remmers. The revolutionary MATRx plus device allows us to predict whether a patient will respond to oral appliance therapy (OAT) with success.
How is OSA treated?
The following options may be recommended for Obstructive Sleep Apnea:
Continuous Positive Airway Pressure (CPAP)
CPAP is the standard treatment for moderate to severe cases of OSA. CPAP provides a steady stream of pressurized air to patients through a mask that they wear during sleep. This airflow keeps the airway open, preventing pauses in breathing and restoring normal oxygen levels. This amount of pressure required is carefully determined and adjusted based on the severity of the obstructive apneas.
Surgery is effective only when there is an obvious deformity that can be corrected to alleviate the breathing problem. This may require a referral to an ENT (ear, nose, and throat) Specialist to assess for the removal of nasal blockages (deviated septum) or removal of excess tissues in the upper airway and throat (tonsils, adenoids, uvula, soft palate).
Oral Appliance Therapy (OAT)
Dr. Kreuz offers complimentary consultations to determine if you are a candidate for oral appliance therapy. Treatment with an oral appliance is supported by published research, “Clinical Practice Guideline for the treatment of Obstructive Sleep Apnea and Snoring with Oral Appliance Therapy: An Update for 2015,” which reported that oral appliances are indicated as treatment for patients with primary snoring and for patients with obstructive sleep apnea who are intolerant of CPAP or who prefer alternative treatment.
Oral Appliance Therapy is an effective option to treat the following:
- Mild to moderate Obstructive Sleep Apnea patients who prefer it to CPAP
- Patients who are unable to successfully comply with CPAP therapy
- Patients with upper airway resistance
After a thorough screening, and reviewing your medical history and symptoms, Dr. Kreuz will perform an oral evaluation for other signs of snoring and sleep apnea. She may recommend further testing to confirm the absence or severity of the snoring obstruction.
If a dental oral appliance is recommended to address snoring or mild to moderate sleep apnea (as diagnosed by a certified sleep physician), we will begin steps to fabricate a custom appliance.
There are many types of dental devices that can be used to alleviate sleep breathing disorders. Patients who wear snoring or sleep apnea appliances often report that they stop loud snoring, feel more rested in the daytime, and are much more comfortable going to sleep.
Oral Appliance Therapy (OAT) works by positioning your jaw further forward to pull your tongue away from the throat and the soft palate, thereby opening your airway. This allows for better air exchange at night while you sleep. For many, it eliminates or reduces snoring. Your compliance may require adjustments over time and ongoing assessments to ensure your airway is functioning in the healthiest way possible.
Vivos DNA Appliance