Dr Gatti's Blog a Lawrence Dentist Reflections

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.

All through the house not a creature was stirring-except for someone snoring.

So many people snore that everyone thinks it is normal even if it is extremely disruptive. A good night of sleep is not only very important to your overall health, but to the health of all the people in your home. A poor night of sleep affects your ability to function effectively throughout the day. It is estimated that 30% of adults snore on a regular basis and up to 50% snore occasionally. Living with a snorer can strain even the best relationship.

If you are kept awake night after night by a bed-partner’s snoring, you are not getting the sleep you need. The effect of the noise on a sleeping partner of a snorer can raise blood pressure in direct relation to the intensity of the noise. High blood pressure is a known risk factor for stroke, heart disease, kidney disease and dementia. What seems to be simple snoring could also be related to the more serious condition of Obstructive Sleep Apnea. Snoring and/or obstructive sleep apnea are serious medical problems. Improperly treated obstructive sleep apnea can be a serious threat to you health. Many couples are resorting to separate bedrooms or even a second master suite, which is not only expensive, but extreme when there is qualified, affordable and effective help available.

Dr. Gatti is a qualified dentist in the area of sleep-disordered breathing and will work with your physician to optimize your health or the health of a loved one. The dentist you choose to treat your problem with sleep disordered breathing must be properly educated and have adequate experience. Did you know that legally, any dentist can fabricate an appliance for the treatment of snoring and/or sleep apnea? However, that does not mean that every dentist has the necessary experience and training to provide proper therapy. Because no special qualifications are required it is your responsibility to choose your dentist wisely.

A qualified sleep-disorders dentist should have:

• Appropriate knowledge of sleep medicine
• Adequate training in oral appliance therapy
• Years of experience with many different appliance types
• Solid relationships with local sleep labs and sleep physicians
• Current knowledge of emerging trends
• Ability to derive maximum insurance benefits for you
• A team approach with other professionals
• A proven follow-up system in insure healthy results long-term
• In-depth knowledge of oral appliance research

If you have any concerns about our qualifications, please ask. We will be happy to discuss them with you.