Sleep is as important to your health as diet and exercise. Without enough sleep, it's impossible to live your life to its fullest. By the most basic definition, anyone who doesn't get enough quality sleep has a “sleep disorder” – a broad term that is used to identify a range of problems.
Sleep problems have many causes:
It could be a problem with your airway and/or your breathing, such as snoring and obstructive sleep apnea. It could be a problem with the way signals travel to and from your brain, such as narcolepsy. It could be a condition that causes uncontrollable leg movements at night – that is, restless legs syndrome. Or it could be one of the many problems that lead to insomnia, such as stress.
Sleep apnea is a sleep disorder marked by interruptions and pauses in breathing during sleep. Obstructive sleep apnea is caused by obstructions in the airway, such as the tongue rolling back in the throat or collapsed tissues in the airway. Untreated sleep apnea can contribute to several serious health conditions, including heart disease, high blood pressure, and liver problems.
When the muscles of the jaws, soft palate and the tongue become too relaxed during sleep, they can sag and partially or completely block your airway. As you struggle to breathe, your body becomes distressed and you become partially awake, nearly every time this event occurs. These episodes can occur hundreds of times each night, keeping you from reaching the deep, restorative sleep your body requires and putting a great deal of stress on your heart.
Children can also snore and suffer from obstructive sleep apnea. Often they are highly allergic and their airway is blocked due to enlarged adenoids, tonsils or swollen nasal mucosa. The snoring or labored breathing can also be due to structural problems of the jaw and teeth. Restful sleep is essential to your child's health. Snoring and open-mouth breathing at night are detrimental to a child’s growth, development and cognitive functions. Children should have the best quality of sleep and need ten-to-sixteen hours of high-quality sleep each night for proper development. Undiagnosed and untreated pediatric sleep disorders have been linked to a spectrum of health and behavioral issues.
Sleep apnea must be diagnosed by a Sleep Physician. We recommend that you set up a consultation here at Revive, as well as with your primary care physician, if you suffer from the symptoms of sleep apnea. Common signs of sleep apnea include:
Extreme drowsiness during the day
Personality changes and irritability
Difficulty staying asleep
Awakening with a very dry or sore throat
Frequent morning headaches
Unlike adults, children who suffer from sleep-disordered breathing are often likely to exhibit hyperactivity during the day.
Below are some of the ways we are improving the amount of sleep and quality of sleep for our patients here at Revive Orofacial Therapy and Wellness Center:
Orofacial Myofunctional Therapy
Muscle weakness within the tongue, mouth, and upper throat may lead to snoring and obstructive sleep apnea. This may be improved with strengthening exercises, techniques, and behavior modifications called Orofacial Myofunctional Therapy. Current literature demonstrates that Orofacial Myofunctional Therapy decreases apnea-hypopnea index by approximately 50% in adults and 62% in children. Lowest oxygen saturations, snoring, and sleepiness outcomes show improvement in adults when they undergo Orofacial Myofunctional Therapy. Orofacial Myofunctional Therapy can also serve as an adjunct to other obstructive sleep apnea treatments.
Orofacial Myofunctional Therapy is concerned with the importance of oral rest posture, (referring to the proper resting place of the tongue in the oral cavity) which is against the palate, with the sides of the tongue contained by the teeth. Without proper development and function of the tongue, there is also improper development of nasal passages, the airway, as well as muscle and bone development. If the width of the upper airway is decreased due to abnormal development from tongue placement, there is an increased chance of collapsibility of the airway.
This treatment modality is aimed at developing and enlarging the airway space by expanding the transverse (side to side) and anterior (front) aspects of the upper and lower jaws in both children and adults. By changing the size of the jaws, the size of the airway space is directly increased. A wider airway reduces the incidence of snoring and sleep apnea and increases your ability to get oxygen into your body tissues, especially during sleep. The result is a dramatic improvement in your ability to breathe.
Biomimetic Oral Appliance Therapy (BOAT) aims to achieve midfacial redevelopment in combination with mandibular repositioning. Combined maxillo-mandibular correction may be a useful method of managing mild to moderate cases of OSA in adults, and represents an alternative to Mandibular Advancement Devices and Continuous Positive Airway Pressure (CPAP) therapy. BOAT aims to remodel the upper airway through midfacial redevelopment followed by mandibular correction, which may resolve OSA in adults, and possibly avoid long-term CPAP therapy.
If Sleep Disordered Breathing in a child is due to a malformation of the teeth and jaw then we will be able to evaluate the child for oral appliance therapy. With oral appliance therapy we can correct structural problems such as recessed jaw, narrow arches that may be leading to airway narrowing or collapsing. BOAT induced craniofacial and airway changes produce a more favorable result, resulting in an optimally reshaped upper airway, which results in a reduction in the severity of sleep disordered breathing, which may effectively resolve the disorder of sleep apnea.
By starting early in a child’s development, we can use functional appliances and other orthopedic stimulation to maximize the full genetic potential of facial growth.
By eliminating snoring and mouth breathing by developing the child’s airway, we promote restful sleep and all the developmental benefits that affords a growing child.
The full forward developed jaws also create competent airways and proper body posture which are key factors in avoiding sleep apnea as an adult.
Mandibular Advancing Sleep Appliance
Sleep apnea treatment may depend on the severity of the condition. If you suffer from mild to moderate obstructive sleep apnea, we may recommend an oral appliance. It can work by preventing the tongue from blocking the air passage or by holding your jaw in a position that prevents airway blockages during sleep. The American Sleep Disorders Association is recommending dental appliance treatment for patients with severe OSA who are intolerant of, or refuse treatment with, CPAP.
Collaboration with ENT
If an obstruction is suspected at any point along the upper airway (including the nasal passages, adenoids and/or tonsils) a referral will be given to an otolaryngologist (ENT). An ENT will be able to determine the degree of obstruction (if any) and necessity for intervention.
Collaboration with Sleep Physician
Typically, most treatments for sleep disorders at Revive will depend on the medical diagnosis of the sleep disorder. Obstructive Sleep Apnea is one of the possible diagnoses that come from the result of a sleep study. The sleep study will be interpreted by a Sleep Physician he/she will give a diagnosis and treatment recommendations.
The most common diagnosis is Obstructive Sleep Apnea (OSA) and this comes in varying degrees of severities. The norm that is being used is the amount of breathing interruptions per hour: AHI which stands for Apnea Hypopnea Index.
According to the American Academy of Sleep Medicine:
The first line of treatment for mild to moderate sleep apnea is oral appliance therapy.
The first line of defense for severe sleep apnea is CPAP.
If the patient cannot tolerate CPAP then oral appliance therapy is the next line of treatment.
The following are standards for adults:
AHI 0-5: normal
AHI 5-15: mild OSA; Treatment recommendations: Oral Appliances
AHI 15-30: moderate OSA; Treatment recommendations: Oral Appliances, CPAP
AHI over 30: severe OSA; CPAP and oral appliances when patient cannot tolerate CPAP
Vitamin D, Iron, Vitamin B Complex Levels
Vitamin deficiencies can play a role in sleep quality and quantity. At Revive, we may recommend assessment and monitoring of your levels of Vitamin D, Iron, and Vitamin B complex.
Fatigue is one of the most common signs of iron deficiency. This is due to less oxygen reaching body tissues, depriving them of energy. Iron deficiency has also been linked to restless leg syndrome which is a strong urge to move your legs at rest. It can also cause unpleasant and strange crawling or itchy sensations in the feet and legs. It is usually worse at night, meaning that sufferers may struggle to get much sleep.
Proper levels of vitamins B3, B5, B6, B9 and B12 may help achieve good sleep, as they help regulate the body's level tryptophan, which helps the body produce sleep-inducing melatonin. Vitamin B3 (niacin) often promotes sleep in people who have insomnia caused by depression and is an important nutrient to help people who fall asleep rapidly but keep waking up during the night. A deficiency of B5 (pantothenic acid) can cause sleep disturbances and fatigue. Vitamin B9 (folic acid) deficiency has been linked to insomnia. Vitamin B12 (cobalamin) may help insomniacs who have problems falling asleep, as well as promoting normal sleep-awake cycles.
Being deficient in vitamin D can lead to a host of sleep issues, including sleep disruption, insomnia, and overall poor sleep quality. Vitamin D affects both how much sleep we get and how well we sleep. Several recent studies have shown a connection between Vitamin D deficiency and risk of sleep apnea. A lack of Vitamin D may also affect the severity of sleep apnea, with lower D levels linked to more severe cases of OSA.
If you're taking too long to fall asleep, you should consider evaluating your sleep routine and revising your bedtime habits. Just a few simple changes can make the difference between a good night’s sleep and a night spent tossing and turning. We can help!
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