What is Sleep Apnea / Sleep Disordered Breathing?

  • Do you feel tired, even after a full night’s rest?
  • Do you have morning headaches?
  • Have you been told that you snore loudly?
  • Do you have difficulty concentrating?
  • Do you wake up during the night choking or gasping for air?

Every night, millions of people go to sleep hoping to wake in the morning feeling rested and relaxed. However, for people with sleep-disordered breathing problems, this is just not possible.

If you suffer from non-restful sleep, you’re not alone! More than 40 million Americans suffer from some variety of sleep disorder – many of which go undiagnosed. However, due to ongoing research and advances in dental sleep medicine, there is much that can be done today to provide you with treatment options that will help you find relief!

Why is sleep so important?

Sleep is more than a time out from daily activities. It is an active state, essential for physical and mental restoration. Seventy million Americans suffer from sleep disorders according to Carl E. Hunt, Director, National Center on Sleep Disorders Research. The result is a huge sleep debt that if left untreated can put you at increased risk of diabetes, hypertension, stroke, heart attack, auto accidents and workplace injuries. In addition, the National Highway Traffic Safety Administration (NHTSA) conservatively estimates that 100,000 police-reported crashes are the direct result of driver fatigue each year. This results in an estimated 1,500 deaths, 71,000 injuries and $12.5 billion in monetary losses. The good news is that much can be done, through technology and advances in dental sleep medicine, to enable patients who suffer from sleep disorders find relief.

Who is at risk of developing a sleep disorder?

Men suffer most often from non-restful sleep. In addition, according to both the National Institutes of Health and the American Academy of Family Practice, the rates of obstructive sleep apnea (OSA) and other airway-related sleep disorders are 2-4x higher after the age of 50.

Since the health of women and children may also be affected by sleep-disordered breathing problems, we urge anyone who does not wake in the morning feeling rested and relaxed after a full night’s sleep to discuss their sleep concerns with their family physician, a dentist with expertise in dental sleep medicine or another trusted health provider.

Getting a good night’s sleep is essential to good health! If you or your partner’s sleep is being disrupted by a sleep-disordered breathing (SDB) problem, such as snoring or sleep apnea, you could be at risk of developing a host of health problems – some quite serious!

The primary reason behind many SDB problems is the way the tongue, jaw and other tissues in the mouth and throat are positioned. For this reason, dentists with the right training are uniquely qualified to provide safe, non-surgical, and highly effective treatment options.

If you or someone you love suffers from non-restful sleep, consult your primary healthcare provider or make an appointment with us for a dental sleep exam. Proper diagnosis and treatment, if warranted, can improve your quality of life and increase your life expectancy!

Do you suffer from any of these?
  • Fatigue
  • Headaches upon Awakening
  • Excessive Daytime sleepiness
  • Falling Asleep While Driving
  • Difficulty Concentrating
  • Difficulty Breathing through your Nose
  • Hoarseness in the Morning
  • Memory Problems
  • Depression
  • Frequent Illnesses
  • Irritability
  • Night Sweats
  • Weight Gain
  • Loud Snoring
Causes of Sleep Disorder

Sleep is as important to your health as diet and exercise. Without enough sleep, it's impossible to live your life to its fullest.

By the most basic definition, anyone who doesn't get enough quality sleep has a "sleep disorder? -- a broad term that is used to identify a range of problems.

Sleep is as important to your health as diet and exercise. Without enough sleep, it's impossible to live your life to its fullest.

Sleep problems have many causes:
  • It could be a problem with your airway and/or your breathing, such as snoring and obstructive sleep apnea.
  • It could be a problem with the way signals travel to and from your brain, such as narcolepsy.
  • It could be a condition that causes uncontrollable leg movements at night--that is, restless legs syndrome.
  • Or it could be one of the many problems that lead to insomnia, such as stress.

Sleep disorders are common among patients who suffer from allergies, ulcers, arthritis, heart disease, asthma, hyperthyroidism, kidney disease, Parkinson's disease, and Alzheimer's disease. If you or someone you love is suffering from a lack of restful sleep, a smart first step is to discuss your concerns with a sleep physucian or with Dr. Demerjian.

Commonly Known Sleep Disorders
"Laugh and the world laughs with you. Snore and you sleep alone."

Snoring is partially obstructed breathing Some 76 million people in North America (U.S. and Canada) suffer from snoring. Snoring is frequently a person's most socially disruptive and annoying personal trait. Recent research reveals that continuing throughout life as a snorer or a sleep apneic no longer is unavoidable, but rather is a personal choice - a decision by a specific person not to do anything about it.

  • 60% of males and 40% of females over the age of 60 snore (female snoring increases after menopause).
  • The loudness of snoring may reach as high as 90 db(worker’s compensation requires ear protection in the workplace at 90 db).
  • 98.5% of snorers exhibit some apneic tendencies.

Snoring can lead to sleep apnea because it can change tissue structure. In recent clinical studies, dentists and physicians have found that, in the majority of patients, a well-made, well-fitted dental appliance will effectively reduce or eliminate snoring.

Most sleep researchers agree that the position of the tongue during sleep is a substantial causative factor in both snoring and sleep apnea. As a person goes to sleep, especially while lying on his or her back, the muscles of the tongue and jaw relax and these structures move backward against the posterior wall of the throat. As the airway becomes partially blocked, snoring occurs . If it progresses to complete airway blockage, sleep apnea (multiple stoppages of breathing for 10 seconds or longer) occurs . The tongue is attached to the lower jaw. By moving the lower jaw forward with a nighttime dental appliance, the tongue is moved forward, the airway is opened up and stays opened, and snoring stops. The snoring stays stopped as long as the appliance is worn. Most severe snorers wear their appliances for the rest of their lives. The downside of the dental approach is that there is a two to three night adjustment period (as with any other item such as contact lenses) and possible sore teeth for a few nights if the snorer is a nighttime tooth grinder. Upon awakening, your bite may be different for approximately thirty minutes.

Upper Airway Resistance Syndrome (UARS)

The term “Upper Airway Resistance Syndrome” (UARS) is used to describe chronic daytime sleepiness that is often accompanied by snoring, brief yet frequent arousals, and only slightly abnormal breathing. Unlike snoring and obstructive sleep apnea, UARS is often more prevalent among women than men.

Symptoms may include:
  • Sleep-onset insomnia
  • Headaches
  • Gastroesophageal reflux
  • Depression
  • Bruxism (grinding of teeth),
  • Rhinitis
  • Hypothyroidism
  • Asthma

People who suffer from UARS lack the typical findings of apnea, hypopnea and nighttime oxygen desaturation on polysomnography (diagnostic sleep studies). As a result, UARS is often not diagnosed by physicians. However, the arousals and sleep fragmentation related to an increased effort to breathe can be diagnosed by measurement of pressure changes in the esophagus. Source: Quiet Sleep

Obstructive Sleep Apnea (OSA)

Virtually all people that have sleep apnea snore, but not all snorers have sleep apnea. Because sleep is repeatedly interrupted during the night you never get a full night's sleep, and day-time sleepiness is a second major indication. Other indications include falling asleep during the day, automobile accidents or accidents on the job due to tiredness or exhaustion, changes in personality, mental fatigue resulting in difficulty in thinking and concentrating, frequent nocturnal urination, and high blood pressure with the attendant increased risks of heart attack and stroke. Suspect you have sleep apnea if your spouse reports that your stoppage of breathing, gasps, choking, and your attempts to start breathing again "scare her to death."

Obstructive sleep apnea (OSA) is far more common than central sleep apnea . OSA occurs when air cannot flow into or out of the person’s nose or mouth, although efforts to breathe continue. In a given night, the number of involuntary breathing pauses – or “apneic events” – may be as high as 20 to 60 or more per hour. Snoring and choking between apneic events is common, although not everyone who snores has OSA. The frequent interruptions of deep, restorative sleep often lead to excessive daytime sleepiness and may be associated with early morning headache.

OSA occurs in all age groups and both sexes but is more common in men (it may be underdiagnosed in women). Early recognition and treatment is important because OSA may be associated with irregular heartbeat, high blood pressure, heart attack, and stroke.

Once diagnosed, OSA is often managed through the use of a Continuous Positive Airway Pressure (CPAP) machine or dental appliances that reposition the lower jaw and the tongue.

  • Rates of OSA are 2x-4x higher after age of 50.
  • Mild to moderate sleep apnea patients are the most likely not to be screened.
  • Untreated sleep apnea can put you at increased risk of developing:
    • Hypertension
    • Heart disease
    • Stroke
    • Diabetes
Source: National Sleep Foundation
Central Sleep Apnea

There are two main types of sleep apnea. “Central Sleep Apnea” appears to be related to a malfunction of the brain’s normal signal to breathe, therefore cannot be treated by dental sleep appliances. It is less common than “Obstructive sleep apnea” which may represent cessation of breathing due to mechanical blockage of the airway.

Prompt and proper diagnosis is an important first step to treating any and all forms of sleep apnea. Problems associated with untreated sleep apnea include hypertension, coronary artery disease, myocardial infarction, stroke, psychiatric problems, impotence, cognitive dysfunction, memory loss, and death.

Source: National Institutes of Health

Sleep Bruxism

Sleep Bruxism (SB) is the gnashing, clenching or grinding of the teeth during sleep. It is the third most prevalent sleep disorder, after sleep talking and primary snoring. Tooth grinding or tooth-clenching during sleep may cause:

  • Abnormal wear of the teeth.
  • Sounds associated with bruxism (It's about as pleasant as fingernails on a chalkboard!).
  • Jaw muscle discomfort.

Some people have episodes of SB that occur less than nightly with no evidence of dental injury or impairment of psychosocial functioning. Others experience nightly episodes with evidence of mild impairment of psychosocial functioning. Yet others have nightly episodes with evidence of dental injury, temporomandibular joint (jaw) disorders , or moderate or severe impairment of psychosocial functioning.

Source: The Sleep Well, Stanford University

Excessive Daytime Sleepiness

Excessive Daytime Sleepiness (EDS) is a condition in which an individual feels very drowsy during the day and has an overwhelming urge to fall asleep, even after getting enough nighttime sleep. People with EDS frequently doze, nap, or fall asleep in situations where they need or want to be fully awake and alert. This can be particularly dangerous at times, such as when driving a car or operating other hazardous machinery.

EDS can interfere significantly with a person's ability to concentrate and perform daily tasks and routines. People with EDS often report feelings of low self-esteem, frustration, and anger about being misunderstood and regarded as unintelligent, lazy or uninterested in learning. They also report having difficulty with relationships -- in social situations, in the workplace, and within the family.

EDS is a sign of an underlying medical condition, typically a sleep disorder.


After a thorough examination of the airway and nasal passages, if the problem is found to be in the nasal passages or adenoids and tonsils a referral will be given to an otolaryngologist (ENT) with the testing results for the ENT to be able to determine the degree of obstruction and necessity for surgery.

If a patient has been diagnosed with obstructive sleep apnea (OSA) by a sleep physician, then a qualified dentist like Dr. Demerjian can make a Dental Sleep Appliance to keep the airway open in the back of the throat, treating the obstruction and any snoring.

CPAP is an extremely effective therapy; however, nationally only 45% of patients using CPAP machines continue to use them.

The American Sleep Disorders Association is recommending dental appliance treatment for patients with severe OSA who are intolerant of, or refuse treatment with, CPAP.

What is a CPAP?

A CPAP (continuous positive airway pressure) is a machine that delivers lightly pressurized air through a hose to a small nose mask. The flow of the air acts like an "air splint" to keep the upper airway open and prevent apnea (i.e., shortness of breath). CPAP machines have 99% efficiency in restoring normal breathing during sleep. They have also undergone many improvements since an Australian invented the first one from a vacuum cleaner and a length of hose. However, the rate of patient compliance with CPAP is less than 50%.

Are There Alternatives to CPAP?

Yes! Thanks to advances in dental sleep medicine, qualified dentists can effectively treat many patients who suffer from snoring, obstructive sleep apnea, upper airway resistance syndrome and other sleep-disordered breathing problems using oral appliance therapy.

An oral sleep appliance is similar in appearance to an athletic mouthguard, and it is worn during sleep to maintain airway patency. Oral sleep appliances are safe, less expensive vs. CPAP or surgery, and easy to use. There are also few, if any, side effects. However, one size does not fit all.

There are currently six (6) different FDA-approved oral appliances we can use to treat sleep-disordered breathing. Regardless of the appliance selected, to be effective, it must be properly customized and precision fit for each patient.

For some patients, an oral sleep appliance can eliminate the need for CPAP or surgery. For patients with more severe sleep problems, an oral appliance can be an effective and convenient adjunct therapy.

At the present time, obstructive sleep apnea is defined as a medical problem and the diagnosis must be made by a medical doctor or sleep physician (pulmonologist) who is specially trained in the area of sleep medicine.

The dental profession has an important role to play in the treatment of patients with snoring and sleep apnea. If 60% of men and 40% of women between forty and sixty years of age snore, this is a huge problem. Snoring is a serious social problem for the spouse, but obstructive sleep apnea can be a life threatening situation for the patient in that it can lead to irregular heartbeat, high blood pressure and strokes.

At the present time, obstructive sleep apnea is a medical condition that is being controlled and treated mainly by the medical profession. Despite the fact that in September 1995, the American Sleep Disorder Association finally endorsed oral appliance therapy as the third currently acceptable treatment method for snoring and sleep apnea, the vast majority of the medical doctors are not aware of the value of oral appliances

As time goes on, the public is going to become more aware of the health risks associated with snoring and sleep apnea. It is the dental profession ' s responsibility to educate their members, the public and the medical profession about the important role that dentists and oral appliances play in the treatment of snoring and obstructive sleep apnea.

Q: Why should I consult a dentist about my sleep concerns?

Mild to moderate sleep apnea patients are among largest groups of patients that are not screened. However, dentists with advanced training in dental sleep medicine can be patients' first-line of defense against the potentially devastating cardiovascular, neurologic and interpersonal consequences of undiagnosed and untreated sleep-disordered breathing problems.

In our office, we use a state-of-the-art pharyngometer/rhinometer to measure your airway volume, determine whether or not your airway collapses, and evaluate your nasal turbinates (small, bony structures covered by mucous membranes that protrude into the nasal airway and help to warm, humidify and cleanse air as it is inhaled and before it reaches the lungs). Enlarged turbinates and nasal congestion can contribute to headaches and sleep disorders such as snoring and obstructive sleep apnea, as the nasal airway is the normal breathing route during sleep.

In addition to screening for sleep disorders, qualified dentists can provide dental sleep medicine therapies to patients that suffer from snoring, sleep apnea and other sleep-disordered breathing problems. These therapies can often enable sleep patients to find effective alternative or adjunct therapies to traditional treatments for sleep disorders, including CPAP or surgery.

Q: If I snore, does that mean I have obstructive sleep apnea?

Snoring is no laughing matter. Although often depicted comically, snoring should be taken seriously. It can disrupt your sleep as well as your partner's sleep. Snoring can also lead to sleep apnea by changing the structure of tissues. However, not everyone who snores has sleep apnea.

If you've been told that you snore, or you suffer from excessive daytime sleepiness or shortness of breath upon awakening, consult your doctor. Today, patients with mild to moderate sleep apnea are among the largest groups of patients not screened. That said, the only way to determine with certainty if you have sleep apnea is by referral to an overnight sleep lab for a diagnostic polysomnographic (sleep) study. We are happy to you with names of sleep physicians and sleep labs that we work with upon request.

Q: Can a dental appliance stop snoring?

For simple snoring and mild to moderate obstructive sleep apnea (OSA), oral appliance therapy is an excellent alternative to CPAP and/or surgery. Both the American Academy of Sleep Medicine and the Academy of Dental Sleep Medicine endorse it.

When they are well made and used as directed by a qualified health professional, dental sleep appliances can put an end to snoring in the majority of patients. However, the success of these splint-like devices for any given patient cannot be determined without a complete dental sleep examination.

In our practice, we use six (6) different FDA-approved oral appliances to successfully treat snoring as well as other types of sleep-disordered breathing problems. To achieve maximum results, each of these splint-like devices must be customized and precision-fit to each patient. One size does not fit all, which is why you should be evaluated and treated for snoring by a dentist with advanced training and expertise in dental sleep medicine.


National Sleep Foundation
American Sleep Apnea Association
Narcolepsy Network
Academy of Dental Sleep Medicine
Restless Legs Syndrome Foundation
Academy of Clinical Sleep Disorders Dentistry
Sleep Research Society
American Academy of Sleep Medicine

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