Dr Gatti's Blog a Lawrence Dentist Reflections

I have just returned from the 19th Annual meeting of the American Academy of Dental Sleep Medicine and it was fantastic! This was my fifth time in attendance and it still amazes me how much new information I gain as well as reconfirming much of what we are already doing. Again, a number of references were made tying in the prevalence of nocturnal bruxism and obstructive sleep apnea. This is something we have paid particular attention to over the last year and it has changed our protocol on night time appliances. A new area that I found very compelling is the possible link between snoring and plaque build up in the carotid arteries. The link between heavy snoring, obstructive sleep apnea and stroke is something that is at the forefront of my concern when I am dealing with our clients. Over the next weeks and months I will share more of the information I gained at this meeting, however I wanted to at least touch base with all of you about some of the highlights. I look forward to seeing you soon.

Today more than ever, the idea of a good night’s sleep is a fleeting one. Scrimping on sleep causes more than midday drowsiness and saggy eyelids – it may raise your blood glucose levels and cause other medical complications that I have written about in previous blogs. We don’t really know why the body needs sleep, however we do know that sleep is a dynamic, complex activity. The hypothalamus tells the body when to sleep, wake up, change blood pressure, help the immune system and regulate hormones for digestion. Every organ of the body, including the hypothalamus depends on sleep to function properly. Lack of sleep interferes with your ability to produce insulin, increases your risk of diabetes, high blood pressure, depression, heart attack and stroke. Also, sleepless nights increase the level of stress hormones in your body, causing the body to store fat and make it more difficult to loose weight.

In the past I have talked about obstructive sleep apnea (OSA) and snoring causing sleep disruption for you and your bed partner. We have also discussed how these can be addressed with oral appliances. Now I would like to review some simple general rules to improve the overall quality of your sleep. I am talking about sleep hygiene. Bottom line is that your bed should not be an extension of your office or family room. The bed is meant for sleep and sex. I can give you some sound advice for sleep; as for sex, well…

Here are some sleep hygiene recommendations:

• Wind down for about 30 minutes prior to bedtime.
• Try to go to bed and wake up at the same time every day.
• Avoid exercising or eating within 2 hours of bedtime.
• Avoid caffeine after lunch.
• Limit alcohol intake.
• Don’t eat or watch TV in bed.
• Try relaxing breathing exercises when you get into bed.
• After an estimated 20-30 min. of not falling asleep, get out of bed. Then, do something relaxing, like listening to music or light reading until you are sleepy enough to return to bed. Do not get on the computer.
• Don’t set up camp on the couch or you will begin to associate sleep with the couch and not your bed.

These are fairly straight forward and simple; however, developing good sleep hygiene and a consistent routine is very important to sleep and that is not a laughing matter.

Occasionally I will have a patient ask me why they should spend the additional money for us to make them an anti-snore mouthpiece rather than just buy one from a TV advertisement or off the internet. I know that if a couple of people ask me, then many more are wondering the same thing.

I have several concerns about utilizing these devises without proper medical supervision and fitting. Realize that simple snoring, although it can be very annoying to your bed partner, is not a real medical problem. The concern is that without a proper study, it is impossible to really know if you are dealing with simple snoring or if you are dealing with Obstructive Sleep Apnea (OSA) which is a serious medical problem. My fear is that you can resolve the snoring, yet the sleep apnea remains. In essence the life threatening disease has been masked.

A second very real concern is that studies have shown after wearing an oral appliance for two years, 70% of the patients have changes in their bite that they are unaware occurred. These changes are permanent. With patients who have had orthodontics as an adult the percentage is near 100%. Stability and predictability are critical to long term oral health. Some of the ways to prevent changes occurring have to due with fit and design of the appliance.

The other concerns I have are not nearly as important, such as the comfort of the “boil and bite” type of appliances. Also, they tend to breakdown rather quickly. If my concerns were just limited to these last two I would recommend trying the inexpensive over the counter, unsupervised appliance. However, given the medical issues and the stability issues, I am very concerned about just guessing about how far to move your lower jaw forward and the forgiveness of the materials used in the “over the counter” appliances.

If you would like to talk about what may be a better way to address snoring and sleep apnea, I would be happy to do so, just give us a call to set up an appointment.