What obstructive sleep apnea is

Muscle tone falls when you sleep. The soft palate, tongue and throat walls relax, and every breath pulls them inward. A narrowed airway makes the tissue flutter, which is snoring. An airway that closes for ten seconds or longer is an apnea, and a partial collapse with a drop in oxygen is a hypopnea. Either way oxygen falls, adrenaline surges, the airway stiffens and you surface briefly without waking. The night gets broken in a way that never registers as insomnia, which is why people with apnea insist they sleep fine.

Anatomy does most of the deciding: a large tongue, a set-back lower jaw, a long soft palate, big tonsils, a blocked nose, weight around the neck. Alcohol, sedatives and sleeping flat on your back make it worse. Central sleep apnea, where the brain does not signal the body to breathe, is a different problem that an oral appliance does not treat.

Symptoms, including the ones you sleep through

The person with apnea is usually the last to know. The useful history comes from whoever sleeps in the room.

  • What a partner notices. Loud snoring most nights, pauses that end in a gasp or a snort, thrashing, repeated trips to the bathroom. Some moved to another bedroom years ago.
  • How you wake up. Dry mouth or a raw throat, a dull headache in the first hour, and the sense of having slept badly whatever the clock says.
  • How the day goes. Dozing in front of the television, heavy eyelids on the drive down Highway 41, caffeine to stay level, a short temper, losing the thread mid-sentence.
  • What your physician may already be watching. Blood pressure that needs more than one medication, an irregular heartbeat, blood sugar that will not settle, reflux at night.

None of it proves anything alone. Together it is a reason to get tested.

What we see in your mouth that raises the question

A dental exam is not a screening test for apnea. Some findings turn up often enough in people later diagnosed that we mention them and, with your permission, write to your physician. That is a referral, not a diagnosis.

A scalloped tongue
Wavy indentations along the sides where the tongue presses against the teeth, often a large tongue in a mouth without room for it.
Worn and cracked teeth
Grinding travels with disordered breathing more often than chance explains. Flattened cusps, cracked fillings and morning jaw soreness are worth connecting. See TMJ and jaw pain.
A crowded throat
A long soft palate, a low-hanging uvula, large tonsils, or little space visible behind the tongue when you open wide.
Dry mouth and gumline decay
Mouth breathing all night dries the tissues, and saliva is what protects teeth overnight. New gumline decay in an adult who cleans well gets followed up at exams and cleanings.

How testing works

Testing is easier to arrange than it used to be. Your physician orders the study, and most people we refer are tested at home in their own bed.

  1. A home test or a night in a lab

    A home test records airflow, breathing effort, oxygen and pulse. An in-lab study adds brain activity, sleep stages and leg movements, and is used for complicated cases.

  2. The result comes back as an AHI

    The apnea-hypopnea index is the average number of breathing events per hour of sleep, and the higher the number the more severe. Your physician places it in a mild, moderate or severe band and reads it alongside your oxygen levels.

  3. The physician chooses the therapy

    CPAP is first-line treatment for moderate to severe apnea and works at any severity. An oral appliance is generally considered for mild to moderate disease, or for genuine CPAP intolerance.

  4. If an appliance is part of the plan, we build it

    Records, fitting and gradual adjustment happen here, then a repeat sleep test so your physician can confirm it is working. See oral appliances.

CPAP and an oral appliance side by side

People looking for a sleep apnea dentist in Oakhurst usually want a CPAP alternative. The two are not equivalent, and which suits you depends on the severity of your apnea.

Consideration CPAP Oral appliance
How it works Pressurized air through a mask splints the airway open from the inside. A custom device holds the lower jaw forward, pulling the tongue clear of the back of the throat.
Where it fits First-line therapy for moderate to severe apnea, and effective at any severity when worn. Usually mild to moderate apnea, CPAP intolerance, or snoring once apnea is ruled out.
How well it works Controls breathing events reliably when it is worn all night, every night. Helps many people and not everyone. A follow-up sleep study tells you which you are.
The drawbacks Mask, pressure, noise and dryness make some people give up, and an unused machine treats nothing. Jaw soreness and tooth tenderness early on, and the bite can shift over years of use.
Day to day Needs power, a hose, filters and cleaning. Packs in a case the size of a glasses box.

Questions we hear about sleep apnea

I snore. Does that mean I have sleep apnea?

Not necessarily. Some people snore without apnea, and some people with apnea barely snore. Snoring means the airway is narrowing, which is a reason to be tested.

Can you look in my mouth and tell me?

No. We can tell you the tongue is scalloped, the palate long and the teeth worn, and that testing is sensible. That is as far as it goes.

I cannot stand my CPAP. Can I switch to an appliance?

Talk to your physician before you stop using it, particularly if your apnea is moderate or severe. CPAP intolerance is a recognized reason to consider an appliance, and that call is your doctor's.

Is a sleep appliance a dental benefit or a medical one?

Usually medical rather than dental, because the condition is medical. What a plan does with the claim varies, and nobody here will tell you it is covered before it is verified. See insurance.

In this area of treatment

Each of these has its own page with the detail that does not fit here.