Sleep & Airway Dentistry Q & A
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Melanie L. Throne, DDS, PA - General Family Dentist located in Fort Worth, Texas
Over 50 million Americans have a sleep disorder, and over 70% of children diagnosed with attention-deficit/hyperactivity disorder (ADHD) have an underlying and undiagnosed breathing and airway issue instead of ADHD. Sleep dentistry from Melanie L. Throne, DDS, PA, helps patients of all ages in the North Texas area get a good night's sleep. If you or your child is having trouble sleeping, call the practice or book an appointment online for a sleep dentistry evaluation. 817-735-4700
What is sleep dentistry?
Parents Magazine on Sleep ADHD & Orthodontics by Katherine Reynolds Lewis
Sleep dentistry is an area of dental medicine that treats sleep disorders such as Upper Airway Resistance Syndrome (UARS), Obstructive Sleep Apnea (OSA), Sleep Disordered Breathing (SDB), and snoring. Breathing issues that effect the quantity and quality of sleep have been implicated in medical conditions like ADHD, Stroke, Hypertension, Anxiety, Reflux, Depression, Erectile Dysfunction, Asthma, Enuresis or Nocturia (nighttime bed-wetting or urgency), Allergy, Eczema, Thyroid, and various Autoimmune Diseases. Colon, prostate, and breast cancer have been linked to disordered breathing and poor sleep quality. Proper identification and diagnosis of the full list of problems on every unique patient is critical because almost everything works, but not everything works on everyone.
The body does critical things during the deeper stages of sleep. Once we move out of infant sleep patterns, our brains move through the stages of sleep at about the same rate. It takes the brain about 120 minutes to complete each cycle working through the individual stages within each cycle. If we are able to breathe effectively and stay asleep, further into the night our brains spend more time in the N3 and REM stages which are so critical to so many body functions. As the brain moves into these stages, the body paralyzes and begins to flush itself of toxic byproducts and repair and rebuild damaged and aberrant cells, like cancer cells. The brain categorizes and organizes our experiences and memories of the day eliminating fog, and our critical body hormones are synthesized and growth occurs in children. If the airway is obstructed at the time of relaxation and paralysis, the brain is distracted and wakes up and none of these processes occur. This is why a sleep test is similar to a road map of your brain's sleep journey and gives us a lot of information about the bumps and traffic bottlenecks helping us to identify targeted therapies and later be able to measure and assess success.
Dr. Throne has assembled a team of over 50 professionals located across North Texas to assist patients with comprehensive sleep dentistry, including the assessment and treatment of the various causes of disordered breathing. The team consists of doctors, sleep specialists and coaches, myofunctional therapists, speech pathologists, lactation specialists, chiropractors, medical massage therapists, craniosacral therapists, osteopathic manipulative medicine physicians, physical therapists, ENTs, nutritionists, and mental health personnel who work together to identify the best treatment for each patient.
What is obstructive sleep apnea (OSA)?
The most common form of sleep apnea, obstructive sleep apnea, is the result of collapsed tissues in the back of the throat that block your airway and reduce the amount of oxygen your body receives. There are multiple areas where soft tissues can collapse and block an airway. In one study, multiple areas of collapse were shown to be present in 68.2% of patients. A study in 2016 by the Cincinnati Children's Hospital of over 500 children below the age of 18 showed that 43% of children have 4 sites of airway collapse, while only 28% of them had obesity as a contributing factor. Studies show that 63% of all tonsil and adenoid surgeries and most all turbinate reduction surgeries result in relapse to disordered breathing within 2 years. In addition, a child's face who is struggling to breathe and grow will continue to show lagging growth and signs of craniofacial dystrophy with inadequate forward and downward growth of the jaws resulting in aberrant profiles, crowded teeth, and insufficient airways.
People of any age can have obstructive sleep apnea or snore, but your risk increases with age and obesity. Studies show that 95% of OSA patients are completely undiagnosed and untreated OSA results in a 20% reduction in life expectancy! It has been shown that snoring in children with growing brains allowed to continue for 6 months will result in the brain beginning to show signs of permanent damage at the level of the nerve cell and have PERMANENT cognitive decline. In addition to lagging growth and it's effects on skeletal structures of the face and body, children will show signs of ADHD, aggressive behaviors, and a decrease in executive function. It is 8 times more likely for these children to require special education interventions and provisions at school by the age of 8.
How is mouth breathing related to disordered breathing and body health?
When a person mouth breathes out of habit or necessity due to blockage, it is very detrimental to the body in many ways. It has been shown that 65-80% of stroke patients have OSA. Mouth breathing bypasses the critical filtering and germ killing processes in the nose recruiting the tonsils and adenoids to act as filters. Breathing through the mouth has been shown to be 60% less efficient than nasal breathing at the cellular level where oxygen and carbon dioxide are exchanged at the red blood cells. This causes the body and the heart to work harder to compensate for less available oxygen resulting in increased resting heart rates and higher blood pressures. As the heart experiences this stress and works harder to compensate, and as a result of negative pressures in the chest due to airway obstruction during sleep, the heart releases a distress hormone into the body called Atrial Natriuretic Peptide (ANP) that causes the bladder to relax resulting in bed-wetting (Enuresis) or frequent visits to the bathroom during the night (Nocturia). It is important that a person exhibiting either of these symptoms not ignore them as the heart is crying out for help.
We are designed to be obligate nasal breathers from birth. Breathing through the nose produces nitric oxide in the sinuses (only place it is made in the body) which is a critical substance for many body processes including oxygen exchange at the level of the red blood cell as well as dilation of the alveoli in the lungs. Nitric oxide in the nose kills harmful bacteria, viruses, and fungi that might otherwise take hold in the nose and sinuses making us ill and enter our lower respiratory tract making us more prone to severe respiratory illness. When we mouth breathe, nitric oxide is not formed at all.
How is obstructive sleep apnea treated?
You can try treating obstructive sleep apnea on your own by losing weight, decreasing alcohol consumption, and sleeping on your side instead of your back. If these methods aren't successful, visit Dr. Throne for an in-depth sleep dentistry evaluation. Her approach strives to find the underlying cause of the problem before deciding on a path to resolution together with a patient. While CPAP therapy remains the first line of recommended management for breathing issues during sleep, this modality treats only a symptom and does nothing to address the underlying cause of why a person isn't breathing well. Compliance with CPAP use is very poor, especially long term, and it can compromise the daytime breathing and airway over time and can also become less effective resulting in the need for higher pressures. Many times the underlying problem stems from inadequate skeletal growth of the face and jaws from early in life, often even before birth. A thorough discussion and history taken with each patient often reveals difficulties and signs of breathing issues all the way back into infancy.
Possible treatments may include:
- Vitamin and Mineral Assessments
- Sleep Hygiene Protocols
- Stress Reduction, Exercise & Counseling
- Nutritional Support
- Functional Growth Appliances/Epigenetic Orthodontics
- Oro-Myofunctional Therapy (OMT)
- Habit Correctors
- Tonsil/Adenoid reduction or removal
- Oral appliance therapy
- Hypoglossal Nerve Stimulation (Inspire)
What is oral appliance therapy?
Oral appliance therapy is a common treatment for snoring and obstructive sleep apnea. The appliance is custom-fit by Dr. Throne, and there are many varieties that are designed differently based on what the identified problem is that each of them is designed to treat. That is why a proper diagnosis is important for each individual regardless of age. Some devices are worn when sleeping to support the jaw in a forward position and prevent the airway from collapsing, and other devices work mainly to increase the vertical distance between the teeth giving more height to the airway and protecting the teeth from the harmful effects of grinding.
The providers at Melanie L. Throne, DDS, PA, go above and beyond the common oral appliance therapy in combination with their team of specialists to ensure appropriate treatment is selected for each patient.
What is the connection between ADHD and sleep disorders?
Over 70% of children diagnosed with ADHD could actually have undiagnosed breathing and airway issues. Because of this, they receive medication for ADHD and experience sleep disorders and medication side effects, and, oh, THEY STILL CAN'T BREATHE. There has been a significant increase in the past 20 years in suicide rates in ages 9-16, and these numbers are alarmingly high in minority males. During sleep, a child's brain cannot tell the difference between someone sneaking in to your child's bedroom choking them cutting off their airway and your child's airway simply collapsing on itself. The brain experiences extreme stress and wakes up the child's sympathetic fight-or-flight nervous system and body responses to try and save the child's life all night resulting in poor quality sleep. This is why many children actually experience fear of sleep, thrashing about, sweating, and will awaken feeling scared and seeking out parents during the night. This overstimulation mixed with exhaustion carries over into the daytime hours and is know as SYMPATHETIC DYSTROPHY, and therefore it is not surprising that these poor kids become moody and emotional and sometimes aggressive.
In the medical community, it is often recommended that tonsils and adenoids be taken out to assist with immediately opening the airway. While this alone helps initially, studies that actually follow these cases long term have shown that breathing difficulties actually return in 63% of cases within 3-5 years, and any orthodontics done will relapse when function is not addressed and corrected. A study done by the Stanford University sleep clinic physicians has shown that functional therapies alone (no surgical intervention at all) result in a 63% improvement of the AHI (apnea hypopnea index) in children and 52% improvement in adults. A child with apnea simply cannot wait 8 or more years to breathe properly. Studies have shown that a child with sleep fragmentation is 60% more likely to need special education intervention by the age of 8 and will have a 20% decline in cognitive ability. This equates to permanent brain damage from oxygen restriction and deprivation to the brain. These children often lag behind in growth milestones as well from lack of growth hormone synthesis during certain stages of sleep. Similar to the childhood model, adults are increasingly being diagnosed with ADHD and are experiencing the same effects on their bodies and brain and lives. Adults who are feeling tired and overwhelmed and anxious will have a very hard time helping to find solutions for their child struggling with the same issues.
Cancer Breathing & Sleep Quality
Many patients as well as physicians are unaware of the links between sleep quality, breathing, and cancer occurrence. Our brains and bodies are incredibly active at night during sleep. Our immune cells actively identify, attack, and remove cancer cells during the deeper stages of sleep flushing them from our system. If our brain does not reach these deeper stages of sleep because of breathing or airway difficulties awakening it, this cleansing and renewal process never occurs and those cells are allowed to proliferate and grow. Cancers of the colon, breast and prostate have all been directly linked to poor quality sleep and sleep apnea.
Pregnancy Breathing & Sleep Quality
Breathing efficiently and sleeping well is critical for a pregnant mom as well as for her developing child. If mom is mouth breathing which results in 60% less oxygen to her tissues as well as to the baby, it stands to reason that significant issues can develop for both she and the baby due to this oxygen depletion at the cellular and tissue levels. Studies are beginning to correlate sleep fragmentation/disordered breathing and daytime mouth breathing with preeclampsia, low birth weight, premature birth, and hormonal difficulties making breast feeding more difficult, just to name a few issues. It is therefore becoming recommended that breathing and sleep be evaluated and corrected with mom prior to conception to ensure optimal growth and development of a healthy child.
Dr. Throne is committed to helping bring awareness and treatment of sleep disorders to ADHD patients and their parents. If you or your child were diagnosed with ADHD and experience daytime sleepiness, snoring, or are waking repeatedly during the night, call Melanie L. Throne, DDS, PA, or use the online booking tool to schedule an appointment for a sleep dentistry evaluation. 817-735-4700