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RALEIGH DENTAL ARTS

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RALEIGH DENTAL ARTS
Tarun Agarwal, DDS

8304 Creedmoor Road
Raleigh, NC 27613
Telephone: (919) 870-7645
www.raleighdentalarts.com

Curbing Sleep Apnea Symptoms

The practitioner himself still wears an oral appliance at night. Why? Because he has been diagnosed with obstructive sleep apnea, a sleep-related breathing disorder that causes the body to stop breathing during sleep. The practitioner is Dr. Tarun Agarwal, DDS, of Raleigh Dental Arts. Here is his sleep apnea story.

We are all led to believe that it’s normal to snore. What most don’t realize is that snoring can be a sign of a more deadly condition. About 12 years ago, while still in my late 20s, I was starting to feel more tired during the day, even taking naps. My snoring was getting louder at night, to the point where my wife wouldn’t sleep in the same room with me. That’s usually what causes someone to move forward with treatment, but I typically think it’s more about how it affects our bodies.

Dr. Agarwal and his son, who is wearing the at-home sleep apnea testing equipment. Genetic factors play a role in sleep disorders, so testing family members in the case of a parent with severe sleep apnea is important.

His Wife’s Influence

My wife, a medical doctor, made me get a sleep study done. Previously I hadn’t known a thing about sleep apnea. I took the sleep test and it turned out that I had severe sleep apnea, a very dangerous condition. A C-PAP—a Continuous Positive Airway Pressure machine—was prescribed. The C-PAP delivers pressurized air to you through a facemask. It’s unbelievably helpful and is the gold standard for sleep apnea treatments. I wore it for about four or five months and felt great. Unfortunately the face mask can be uncomfortable and cumbersome. As a traveler, it became an annoyance and got in the way of my life. You can’t easily go to the bathroom at night. You have to clean it. Eventually, you get out of the habit of using it. Statisti-cally, about 60 percent of patients end up not wearing their C-PAP.

I stopped wearing it and things went right back to the way they were. About four years passed and age, children, stresses of work increased; I was starting to take naps at lunch time, becoming more irritable and moody, and put on weight. That’s when I started researching my role as a dentist with an interest in sleep apnea.

An individually designed oral appliance, worn only while sleeping, keeps the airway open to permit healthy, undisturbed sleep.

Notes Dr. Agarwal, “oral appliances to
treat sleep apnea have been around for a long time. What’s new is the digital technology that allows us to make
acrylic appliances that are smaller, stronger, thinner, and better smelling.
And these newer devices result in better compliance. For example, appliances
five or six years ago had to be ten millimeters thick; today, with modern materials and technology, they can be
just three or four millimeters thick.
When something’s more comfortable,
you’ll use it more.”

Symptoms of sleep apnea are varied: irritability and moodiness due to poor sleep, elevated blood pressure, lowering of your immune system response, weight gain, lower sex drive, and more. An estimated 25 million Americans have sleep apnea, 80 to 90 percent of which are undiagnosed.

The Need to Breathe

Severe sleep apnea patients are candidates for cardiovascular problems because they’re not getting enough oxygen while they sleep. Sleep apnea stops your body from breathing and decreases your blood oxygen and subconsciously you will wake up, thus disrupting your sleep. Sleep cycles are extremely important because they release different hormones and chemicals that regenerate your body at night. If our sleep is disrupted, we’re either not getting to some of those stages, or we’re not spending enough time in those stages for the body to do what it’s designed to do.

The Sleep Study

Sleep apnea is diagnosed by having an in-lab sleep study or with a home sleep test. Dentists do provide home sleep tests and work with a board certified sleep physician who will interpret and score the results for us. As a dentist, I’m not allowed to diagnose sleep apnea. The typical home test is done over two days and requires you to wear a chest belt that tests for effort. There’s also a pulse oximeter, which will go on your finger to measure your pulse and oxygen levels, and a nasal cannula that will check your airflow through your breathing patterns. A lab test differs from a home study test because it is going to be significantly more advanced and comprehensive, measuring EKGs, EMGs of your muscles and legs. All of these tests are approved by the FDA, most insurances, and Medicare.

The Apnea-Hypopnea Index

The Apnea-Hypopnea Index is used to diagnose sleep apnea. Apnea is defined as breathing that stops for ten seconds or more. Hypopnea is defined as a drop in oxygen saturation of 3 percent or greater. The patient will go through a sleep test, whether at home or in a lab, and it will record how many events—whether they are apneas or hypopneas—a patient has over a period of time; this becomes your index. For example, I have an index of 38. That means I have 38 events per hour, or one event every ninety seconds or so. The index numbers go from 0 to infinity:

  • 0 to 5 is considered normal, and it is normal to have a few events through the night;
  • 5 to 15 events per hour is considered mild and that’s where oral appliance therapy is especially effective;
  • 15 to 30 events per hour is considered moderate, and oral appliances are effective but we may start looking at a C-PAP;
  • Then there’s 30 plus, which is considered severe. At this point we send the patient directly to a sleep physician, where they will do much more comprehensive testing.

Specialized Oral Appliance—and More

As a dentist with sleep apnea I wanted to make an oral appliance to treat myself, one that would stop my snoring and be more comfortable to wear than a C-PAP. This led me to using a specialized oral appliance, much like a mouth guard, that reduces the symptoms of sleep apnea and the risks associated with it. The appliance is specially designed to fit only my mouth, positioning my jaw to create an optimal opening of the airway while sleeping.

Once I was sold on my oral appliance, I implemented a screening questionnaire for my patients to access those with sleep apnea. I now have a dedicated person who manages all of our sleep patients, from beginning to end, making sure that they’re taken care of and that our notes are sent over to their physician. If there are medications that need to be adjusted, we work with their physician. That’s part of the overall process. It’s not as simple as just coming in and making an appliance for you. It’s about testing you before and afterwards, trouble shooting, communicating with the physician, and then also communicating with the medical insurance. We want to make it easy and affordable for patients to be able to do this.

Conclusions

I cannot diagnose as a dentist. We work very closely with physicians to help our patients. Also, I do not believe that oral appliances are the right solution for everyone. Some people have to have a C-PAP. A C-PAP worked better for me than an oral appliance. But an oral appliance is better than not using anything at all. If you have severe sleep apnea—a 40 or 50 on the index—I can’t get you to a 5. But I can get you to a 20 or a 15. With a C-PAP, we can turn it up and get you to whatever number we want. But ultimately, the key is that you must do something, whether it’s using an oral appliance or a C-PAP.”