Sleep Breathing Disorders
You need your sleep! There are various reasons that a person can have a problem getting a proper night's sleep. Activating your brain before bedtime by working on your computer or using a reading device can delay the onset of sleep. The bluer and brighter the light, melatonin release is depressed and causes a delay in your sleep cycle. Looking at your smartphone before sleep delays the normal sleep rhythm! Sleeping in a room not dark or quiet is another problem. Our natural circadian rhythm synchronizes with the sun. Going to bed when the sun sets or not too long after and arising with daylight is ideal. Working a night shift or staying up late all play havoc with our normal biological rhythms. Not getting proper sleep impairs your immune system, is implicated in your being more sensitive to pain (i.e., fibromyalgia), and is often an underlying cause of depression.
One of the hugely overlooked causes of improper sleep is a sleep breathing disorder (SBD). This sleep disorder is a situation where you are not getting enough oxygen which causes conscious or unconscious arousals from sleep that disrupt your natural sleep cycles. SBD affects both children and adults. Numerous studies link SBD to ADD/ADHD, chronic fatigue, bedwetting, aggression, depression, restless sleep and more.
How do you know if you have a Sleep Breathing Disorder?
In addition to the above symptoms, a few vital signs are: You do not wake up refreshed; while sleeping your breathing is not quiet; you grind or clench your teeth; you wake up with a headache. I find a significant association between temporomandibular joint problems and SBD. This association is due to the fact is the usual cause of SBD is that the tongue is too far back in the throat, thereby narrowing the air passage. One of the possible treatments is to use a sleep appliance that pulls the tongue forward. The usual reason that the tongue is back in the throat is that the mouth is too small for the tongue. This restriction of space is due to jaws that are underdeveloped and thus too small both in width and in a front to back direction. Also, the bite is usually over closed (the chin is too close to the nose). The lack of proper growth starts as a child often due to extended bottle feeding, pacifier use, and poor nutrition. Some other factors are heredity, finger sucking, and tongue tie. Tongue tie refers to the band of tissue that tethers the tongue to the floor of the mouth. When the band is so tight that you cannot touch the roof of your mouth when your mouth is wide open, you are tongue-tied. The tongue is a unique orthodontic instrument and helps develop the roof of your mouth and the width of your jaws. When you are tongue-tied proper jaw development doesn’t occur, and the problems start.
What to look for in your child's mouth.
Anything that indicated lack of space for the tongue is a warning sign that there may be a problem especially if the symptoms listed above are present. For more symptoms see (Sleep Disordered Breathing uncovering health issues in your child).
Things to look for: crowding of the baby or permanent teeth; the lower jaw is too far back compared to the upper jaw; when closed the upper front teeth cover all or most of the lower front teeth. Breathing while sleeping should be very quiet; if it isn't this may indicate a problem. Grinding of the teeth in a child will almost always be due to worms or to an SDB problem. If your child has enlarged tonsils, it impinges on the airway and also retards midfacial development. Dry lips due to chronic mouth breathing are another warning sign.
In our office, we take a 3-D CAT Scan of the head which is helpful in analyzing the airway three-dimensionally.
If there is a problem, depending on the severity, various treatments are available. However, ultimately the underlying lack of jaw space will need to be addressed by expanding the jaws to allow the tongue to come forward out of the airway. With this goal in mind, we offer orthopedic/orthodontic treatment to correct the problem. It is best to begin treatment as early as possible.
If the abnormal jaw development remains uncorrected in childhood, problems will persist and may even become worse as an adult. The SDB may become critical enough that diseases associated with sleep apnea may manifest. These include hypertension; diabetes; Alzheimer's disease; heart disease; acid reflux. In the mouth look for gum recession, abfraction (ditching of the tooth at the gum line), tongue tie, teeth fracturing, and tooth imprints on the sides of the tongue. When you close your mouth, do your upper front teeth close over your bottom front teeth so that you cannot see all or most of your lower front teeth? Are your teeth crowded? Do you grind or clench your teeth? Do you notice a popping, clicking or noises in the jaw joint in front of your ears? All of these are potential signs of trouble. Again, the 3D CAT Scan, which gives a three-dimensional view of the airway is helpful. Besides seeing the circumference of the airway, we can measure the volume of the airway and the volumetric value in the most restricted area. If based on the scan and symptoms and oral manifestations, there is a likelihood of a problem; a sleep study may be recommended. This sleep study can be done in a sleep center or by taking a scientifically proven home sleep study.
In Our Office
As part of our new patient exam in both children and adults, we evaluate for sleep breathing disorders. The adult new patient exam includes a 3D CAT Scan. In addition to evaluating the air, the 3D Scan is helpful in finding hidden infections, sinus problems, and more. If it seems that there is an SDB problem, we have a Home Sleep Test available, and a medical sleep specialist evaluates the data. Depending on the findings, we offer different options including referral to a medical sleep specialist for a C-pap machine, fabricating a sleep appliance, or correcting the problem orthopedically or orthodontically. Naturally, all treatment in our office is done from a whole-body perspective.
Please call our Fairfield, Connecticut office at 203-371-0300 to schedule an appointment to evaluate the dental connection to your good-nights sleep. We are conveniently located near the Metro North rail road to service our patients from Manhattan as well as adjacent to I-95 for our patients traveling the northeast corridor.