What is undiagnosed Obstructive Sleep Apnoea and what does it mean?
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The Link between Dental and Sleep Hygiene
Sleep is critical, it provides the body with the opportunity to restore the immune, nervous, skeletal, and muscular systems nightly, which is crucial to maintain mood, memory, and cognitive function.
Most people think that snoring is ‘normal’ and part of getting older, but it can be a sign of poor sleep quality and a sleep disturbance. It can be support and treated and should not be ignored!
Dr Charlotte Leigh graduated from the University of Leeds 2012 and works in general practice at Montagu Dental (Central London). After completing a MSc in restorative dental practice with distinction at the Eastman Dental Institute in 2019, she wrote her dissertation on "What do general dental practitioners know about Snoring and Obstructive Sleep Apnoea?" - The answer is very little, and this inspired her journey. She shares her learnings and her tips with us.
What is obstructive sleep apnoea?
Snoring is part of sleep-related breathing disorders that can be regarded as being on a spectrum with simple snoring at one end and obstructive sleep apnoea (OSA) at the other. This is when there is partial or total obstruction of the upper airways during sleep. OSA is often poorly recognised and under-diagnosed, yet it’s common, affecting an estimated 1.5 million adults in the UK. Up to 85% of this total are undiagnosed and therefore untreated.
OSA occurs when the airway is partially or totally obstructed during sleep. This can result in loud noises, oxygen desaturation, and patients often wake up gasping for breath. Symptoms may include daytime sleepiness, loud snoring, dry mouth and restless sleep. Undiagnosed and untreated OSA can lead to multiple health conditions including cardiovascular disease, hypertension, heart disease, stroke depression and daytime sleepiness.
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Snoring is the hoarse or harsh sound that occurs when air flows past relaxed tissues in your throat, causing the tissues to vibrate as you breathe. Most people snore at some point during their sleep cycle, but for some it can be a chronic problem.
The risks of obstructive sleep apnoea
Snoring can create loud noises, which disturb sleep for the whole family. Some patients have been reported as snoring louder than a jet plane! Poor quality sleep affects productivity, efficiency, decision making, nutrition choices and often leads to more chronic health conditions.
There are certain characteristics that increase the risk of snoring, including anything that increases the risk of upper airway infection or inflammation. Nasal obstruction, smoking or alcohol dependence, being male and individual’s body mass index (BMI) and neck circumference (17+ inches) is strongly correlated to sleep related breathing disorders.
Snoring itself is not thought to pose a risk to the health as such, but as part of the continuum there is a risk of it developing into OSA, and this alone merits early treatment.
Diagnosing and treating obstructive sleep apnoea
Screening is often conducted easily in surgery with questionnaires and a dental examination.We use two questionnaires
A Stop Bang Score >3 and an ESS score >10 needs further investigation with a sleep physician. Home sleep tests can be used to assess sleep disturbances occurring during a patient's sleep.
Treatment for snoring and OSA depends on the cause. Simple lifestyle measures include weight loss (if necessary), reduction in alcohol, ceasing smoking, optimal nutrition and good sleep hygiene are often first line measures. Other recommendations can include myofunctional exercises, mandibular advancement devices, continuous positive airway pressure (CPAP) and surgery.
As a dentist I provide bespoke mandibular advancement devices which advances the lower jaw (usually a few mm) to open up the airway. These devices worn at night reduce snoring sounds and allow better oxygen flow, a better rested and more refreshed patient!
Dr Charlotte’s Top Tips for Sleep Disturbance
I have 5 top tips that I recommend to all my patients (regardless or not if they have come to see me about sleep disturbances):
1) Reducing screen time before bed . Electronic devices often emit blue light and studies have shown that these devices can suppress the melatonin, which helps us feel tired and therefore ready for bed. The hour before bed should consist of relaxing activities that don’t involve devices with screens.
2) Reducing alcohol intake . Alcohol intake is linked to a reduction of REM sleep and can cause an imbalance, this decreases overall sleep quality, which can result in shorter sleep duration and more sleep disruptions. It can also worsen snoring and obstructive sleep apnoea.
3) Consider Magnesium Glycinate and or Montmorency cherry extract. Magnesium glycinate is considered to be the most effective type of magnesium for bettering sleep, as it may help relax both the nervous system and your (leg) muscles. Tart cherry juice contains tryptophan and melatonin, which can help regulate sleep. Please consult your doctor before taking any new supplements.
4) Trial sound sleep app (to see if any snoring disturbances). This app is not as accurate as full sleep study but used over a few nights may give an indication if you snore or suffer from any sleep disturbances.
5) Reducing caffeine intake particularly in the afternoon. Caffeine can still be effective up to 12 hours after consumption which for some people may cause them to fall asleep later and reduce sleep quality.
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This article is for informational purposes only, even if and regardless of whether it features the advice of physicians and medical practitioners. This article is not, nor is it intended to be, a substitute for professional medical advice, diagnosis, or treatment and should never be relied upon for specific medical advice. The views expressed in this article are the views of the expert and do not necessarily represent the views of healf
