1. What is Sleep Disorders Dentistry John Viviano BSc DDS D ABDSM

2. Sleep Disorders Dentistry the treatment of Sleep Disordered Breathing Eg. Snoring, Sleep Apnea, UARS Sleep Disordered Breathing is... STILL often ignored by Primary Medical Care Associated with Major Health Consequences Dentists are... ideally positioned to screen / refer / treat these disorders 3. Yearly Cost to Society (USA): Approaching $200 Billion Sleep Disorders Dentistry 4. Sleep Disorders Dentistry 5. Sleep Apnea found inSleep Apnea found in 4% of men and 2% of Women (Age 40) Increases with each decade of life Higher in certain high risk groups 78% of Long Distance Truck Drivers Highest on-the-job mortality of all professions Snoring found inSnoring found in 40% of men and 20% of women Increases with each decade Sleep Disorders Dentistry 6. With Sleep Disordered Breathing The airway narrows or collapses Interfering with breathing during sleep Occurs at various levels of the airway Net Result Snoring Soft Tissue Vibration Soft Palate, Uvula, Tongue, Airway Walls etc Sleep Apnea Airway Narrows or Collapses may have Blood O2 Desaturation UARS Airway Narrows: extra effort required to breathe causing arousals from sleep . Sleep Disorders Dentistry 7. Why me Narrowing of the upper air-passages Reduced airway muscle tone Nasal obstruction Obesity Drugs Alcohol Fatigue Smoking Heredity Sleep Disorders Dentistry 8. Important Terminology Apnea: Breathing stops for 10 seconds or longer Hypopnea: 50% in airflow and 4% in blood O 2 RERA: Respiratory Effort Related Arousal Apnea Index (AI) Number of Apneas / hour of sleep Apnea Hypopnea Index (AHI) Number of Apneas + Hypopneas / hour of sleep Respiratory Disturbance Index (RDI) Number of Apnea + Hypopneas + RERAs / hour of sleep Sleep Disorders Dentistry 9. Spectrum of Disease & Recommended Therapy as per American Academy of Sleep Medicine Sleep 2006 Snoring UARS (Sleepy Snorer) Mild Sleep Apnea (5-15 Events/hour) Moderate Sleep Apnea (15-30 Events/hour) Severe Sleep Apnea (Over 30 Events/hour) Sleep Disorders Dentistry 10. Typical Screening Questions How Restful or Restless is your Sleep? How often do you Awaken during your Sleep Period? Witnessed Apneas? Witnessed Snoring? Do you Awaken Tired? Daytime Fatigue? Do you have Morning Headaches . Sleep Disorders Dentistry 11. Epworth Sleepiness Scale Score over 10 suggests a Sleep Disorder Sleep Disorders Dentistry 12. Only a Physician can Diagnose these disorders Usually after having a Sleep Study Provides Objective Measurement of Apnea Snoring Blood Oxygen Arousals from sleep Breathing Patterns and much more . Sleep Disorders Dentistry 13. Literature Validated Therapies AASM Sleep 2006 Lifestyle Choices Positional Therapy Surgery nCpap Airway Orthotics . Sleep Disorders Dentistry 14. Lifestyle Choices Reduce Weight Increase Physical Fitness Avoid Alcohol & CNS Depressant Medications Avoid Smoking . Sleep Disorders Dentistry 15. Positional Therapy For some, Apnea is worse when sleeping on back; gravity makes it more likely for the tongue to fall back into airway and tissues to collapse and block the airway. Sew Tennis Ball into the back of your PJs. So every time you try to sleep on your back, your reduced comfort level will encourage you to role to your side . Sleep Disorders Dentistry 16. Surgery: most common are Palatal Surgeries or variations there of Sleep Disorders Dentistry 17. Uvulopalatopharyngoplasty (UPPP or UP3) UPPP involves the removal of the tonsils, followed by removal of the anterior surface of the soft palate and uvula, folding of the uvula toward the soft palate and suturing it together as demonstrated in the figures. In the US, UPPP is the most commonly performed procedure for obstructive sleep apnea, with approximately 33,000 procedures per year. The surgery is more successful in patients who are not obese, and there is a limited role in morbidly obese (>40 kg/m2). Success; 25-50% for OSA, 75% for Snoring Sleep Disorders Dentistry 18. Laser Assisted Uvulopalatoplasty (LAUP) Success; Not for Apnea, 50% for Snoring Relapse a problem, Apnea may Worsen Sleep Disorders Dentistry 19. nCPAP: Pumps air into nose under pressure to expand collapsed airway Overall, 65% compliance after 6 months Average 3-4 nights a week, 3-4 hours a night Compliance lower if