pdf of this article

For more information, contact:

Tarun Agarwal, DDS

8304 Creedmoor Road
Raleigh, NC 27613
Telephone: (919) 870-7645

Sleep Apnea: A Body Out of Balance

Perhaps surprisingly, Dr. Tarun Agarwal of Raleigh Dental Arts, reports that one of the most serious health imbalances he encounters in his dental practice is sleep—more specifically, poor quality sleep. “Sleep problems,” he says, “are a classic example of a body out of balance and they have a profound impact on our overall health, including our dental health.”

Dr. Agarwal

Perhaps surprisingly, Dr. Tarun Agarwal of Raleigh Dental Arts, reports that one of the most serious health imbalances he encounters in his dental practice is sleep—more specifically, poor quality sleep. “Sleep problems,” he says, “are a classic example of a body out of balance and they have a profound impact on our overall health, including our dental health.”

In theory, says Dr. Agarwal, “you should be rested and alert after sleeping through the night. But too many of the patients we see aren’t functioning well, even though they claim to be getting enough sleep. They’re tired and foggy, and having a hard time getting through the day.

“The main issue,” he explains, “isn’t whether you’re getting eight hours of sleep, but how much oxygen your body gets at night. Anything that disrupts our sleep cycle is considered a sleep disturbance, and a serious consequence occurs when we stop breathing. A decrease in oxygen saturation signals our body to disrupt the sleep cycle so that we can find a way to get more oxygen into your body—this is the condition called sleep apnea.”

During sleep cycles, he explains, “various body regulatory processes occur and if you don’t spend enough time in each of these sleep cycles, it causes many problems. For example, insufficient sleep will alter levels of corticosteroids, which increases inflammation. Heart rates can go up and down significantly, having long-term cardiovascular effects. And not getting enough oxygen is fatiguing.”

Dental Health and Sleep

“Sleep disturbances affect all parts of our bodies,” says Dr. Agarwal. “But there is often a direct, important connection between sleep apnea and dental health. That’s because many of the symptoms of sleep problems are reflected in our mouths. Among the classic symptoms of sleep apnea, for example, are cracked, broken or missing teeth, excessive grinding or jaw clenching, worn front teeth, and a higher risk of cavities. And because people who have sleep apnea are likelier to breathe through their mouths, they are also likely to have dry mouths and tooth decay.

Treating Sleep Apnea

There are three methods of treating obstructive sleep apnea: with a C-PAP device, that creates continuous air pressure to allow normal breathing; with an oral appliance, that positions the jaw to create an optimal airway open-ing while sleeping; or surgery.

In the past, oral appliances were viewed as a second choice to C-PAP. But now, notes Dr. Agarwal, “we’re finding that we can get great results with appliance therapy—a far more comfortable and far less costly choice.”

One reason, he explains, is the development of a new technology to assess the likely effectiveness of an oral appliance. “The FDA approved test MATRxPlus, which works like a home sleep test, can evaluate the nature of your sleep obstruction and thus determine how to design an appliance that will resolve your problem. You wear a device on your chest while sleeping, and it uses a semi-custom-fitted mouth-piece with a micro motor that attaches to your mouth This mouthpiece moves the appliance backward and forward while you sleep, measuring how well you’re oxygenating in different positions.

“In the past,” says Dr. Agar-wal, “an appliance often wouldn’t be tried because there was no ad-vance way of knowing if it would work; so people were guided towards the C-PAP. An oral appli-ance works accurately when the optimum jaw position is deter-mined and MATRxPlus is able to determine that position.

“These are all signs of concern when evaluating our patients’ dental health,” he says. “And when we see these patterns, we encourage them to get a sleep study. Sleep apnea is a serious health problem.”

Sleep Studies

It’s hard to diagnose sleep apnea without a sleep study test being done, notes the doctor. “During a sleep study, your oxygen levels are monitored throughout the night, which is how we find evidence of oxygen deprivation. The average healthy adult should be at 96-97 percent oxygen saturation much of the time. With sleep apnea, we’ll see patients whose oxygen saturation drops into the 70, 80, and even low 90 percent range. This level of oxygen deprivation isn’t good for our bodies for extended periods.”

And, he points out, “there are significant correlations between obstructive sleep apnea and many serious health problems. For example, it’s unlikely that sleep apnea causes diabetes, but studies show that these conditions are related—70 percent of diabetics have obstructive sleep apnea and a third of patients on blood pressure medications have it, as well.”

Addressing the Problem

“The challenge to any health care provider,” says Dr. Agarwal, “is to make the public aware of these important health concerns, so that people can get appropriate testing and receive treatment if needed. Dentists aren’t licensed to diagnose sleep apnea, but physicians are. What we are able to do in this office—in conjunction with Dr. Gupta’s medical office—is to provide home sleep testing kits. It’s easier now: patients used to have to go to a sleep lab and spend the night, but that’s changed: the vast majority of all sleep tests are now done with a remote device in the comfort of the patient’s home.”

Screening for sleep apnea is a fundamental part of his dental practice, Dr. Agarwal notes. “It starts the moment the patient fills out their health history form, and it is an important part of the dental exam. I’m looking for common associations: blood pressure issues, diabetes, acid reflux, past history of sleep conditions. This information helps us determine the likelihood of someone having sleep apnea. We look in their mouth: how large is their tongue? How open is their airway? We look for bone spurs on the jaws—which are often indicative of someone who’s clenching or grinding.
“Our next step for those exhibiting symptoms is to encourage them to take a sleep test—the only real way to rule out the condition of sleep apnea. That can be done through our medical office, with their primary care physician, or by referral to a sleep physician.

“We have a dental practice, and we don’t treat sleep apnea,” Dr. Agarwal says, “but we often help manage it. The gold standard for treating sleep apnea is the C-PAP (continuous positive airway pressure therapy) device, which is worn while sleeping and—as its name suggests uses continuous pressure to keep the airway open. Unfortunately, statistics suggest that about half of the people getting C-PAP therapy are considered C-PAP failures. To be a C-PAP success, you have to wear the device four nights a week, for at least four hours a night—and the vast majority of C-PAP users aren’t fully compliant.

“And that, in my view, is where dentists come in. We’re able to provide a simple, custom oral appliance that has proven, in many cases, to be very effective in positioning the mouth to keep the airway open. (see box) And—in the case of C-PAP failure—I would argue that some form of therapy is much better than zero therapy.”