Snoring or sleep apnea?
Snoring is the sound of air moving past relaxed tissue at the back of the throat. On its own it is common, and mostly a problem for whoever is trying to sleep beside you.
Obstructive sleep apnea is different. The airway narrows or closes during sleep, again and again, so breathing stops or becomes very shallow until the brain rouses you enough to take a breath. Most people do not remember waking. They just feel tired. Untreated, it is linked with high blood pressure and other health problems, which is why it deserves a proper diagnosis rather than a shrug.
Signs worth mentioning to your physician
Any of these is worth raising, and more so when they come together:
- Loud snoring, most nights.
- Gasping, choking or pauses in breathing that a partner notices.
- Daytime sleepiness, even after a full night in bed.
- Morning headaches.
Who diagnoses sleep apnea?
A physician does, after a sleep study. The study records your breathing and oxygen level overnight, in a sleep lab or with equipment you take home, and your physician uses it to decide whether you have sleep apnea, how severe it is, and which treatment suits you.
A dentist does not diagnose sleep apnea, and neither does a snoring app. What we can do is notice the signs and point you toward the right person.
What we look for at a check-up
Some signs show up in the mouth or come up in conversation at a check-up: large tonsils, a crowded airway at the back of the throat, or a partner's complaint about your snoring. When we notice them, we ask a few questions about your sleep. If the answers point toward sleep apnea, we will suggest you talk to your physician about a sleep study.
When a physician recommends an oral appliance
An oral appliance fits over your upper and lower teeth, a little like two joined mouthguards, and holds the lower jaw slightly forward while you sleep. That helps keep the tongue and soft tissue from falling back into the airway.
CPAP, a machine that keeps the airway open with air pressure through a mask, is prescribed and managed by your physician. Many people use an appliance instead when their physician agrees it suits them, including some who have tried CPAP and could not get on with it. Whether it suits you is your physician's call.
Our part is to check that your teeth, gums and jaw joints can support one, then make it, fit it and adjust it in small steps until it does its job and you can sleep in it. Your physician may want a follow-up sleep study with the appliance in place.
Side effects and follow-up visits
Most people get used to an appliance, but it has trade-offs worth knowing. Jaw soreness or tender teeth in the morning are common at first and usually ease. Over time, holding the jaw forward can shift the bite, so the teeth do not meet quite the way they did.
That is why follow-up matters. We keep an eye on your teeth, your bite and your jaw joints for as long as you wear it, and adjust the appliance when needed. If your jaw hurts or your bite feels different, tell us, and talk to your physician before you stop wearing it.
Working alongside your physician
Sleep apnea is a medical condition, and your physician stays in charge of it. We make and look after the appliance; they decide whether it is the right treatment and whether it is working. The fee depends on the appliance, so you get a written estimate before anything is made, and it is worth asking your insurer what they cover. If you are new to the office, your first visit is the place to start.
Questions patients ask
Can a dentist diagnose sleep apnea?
No. A physician diagnoses sleep apnea after a sleep study. A dentist can notice signs, ask about your sleep and suggest you see your physician, and can make an oral appliance when a physician recommends one.
Does snoring mean I have sleep apnea?
Not necessarily. Plenty of people snore without it. Snoring with gasping or pauses in breathing, or with heavy daytime sleepiness, is more telling and worth raising with your physician.
What does an oral appliance feel like?
Like wearing a snug mouthguard to bed. It takes most people a little while to get used to, and the jaw or teeth can feel sore in the morning at first. That usually eases, and if it does not, the appliance can be adjusted.
Can an oral appliance change my bite?
It can. Holding the jaw forward night after night can gradually change how the teeth meet, which is why we keep checking your teeth and bite for as long as you wear one.