Obstructive Sleep Apnea services

Sleep apnea is a condition in which a person experiences one or more pauses in breath while sleeping. These pauses can last anywhere from seconds to minutes, and can occur as often as 30 times or more during just one hour of sleep. Obstructive sleep apnea (OSA) is caused by a collapse in the airway that may either constrict or close the airway completely. When the airway is blocked, the body’s oxygen supply is decreased or eliminated altogether and overall blood oxygen levels will begin to drop. This signals the brain to disrupt sleep in order to re-open the airway, often experienced as a gasp or choke.

If the airway is constricted, but not completely closed, this will often manifest as snoring. Certainly very loud snoring can disrupt the sleep of spouses and partners, but even very mild snoring can decrease the amount of oxygen flow into the body and should not be considered benign until tested. Many people who snore are actually experiencing episodes of apnea throughout the night and are simply unaware of it. And for those who snore loudly, and yet do not test positively for sleep apnea, there are dental appliances that can help quiet snoring and allow spouses and partners a better night’s rest.

Over the past two decades, great strides have been made in the diagnosis and treatment of obstructive sleep apnea. Once thought to be a condition restricted mostly to overweight men aged 50 and older, we now know that OSA can effect anyone of any age, gender, or weight, including children. In fact, several recent studies have shown up to a 30% increased incidence of OSA in children with ADHD, as well as improvements in behavior and attention after the apnea has been treated.

know the risks

The risks for people with obstructive sleep apnea can be quite serious. Left untreated, sleep apnea can increase the risk of:

  • High blood pressure
  • Irregular heartbeats
  • Heart attack
  • Stroke
  • Obesity
  • Diabetes
  • And in the worst cases, heart failure

People suffering from sleep apnea also do not rest well due to repeated interruptions of the deeper levels of sleep. This lack of rest can increase a person’s overall risk of work-related and driving accidents due to daytime sleepiness.

For more information please visit the National Heart Lung and Blood Institute.

Dental sleep medicine has grown significantly in the last 20 years as well, and Dr. Rich has been partnering with sleep specialists, primary care physicians, physical therapists, pediatric and adult ENT’s, as well as other health-care practitioners in treating patients with obstructive sleep apnea since the mid-1990’s. Using custom- fabricated oral appliances, Dr. Rich aids in treating the apnea by gently repositioning the lower jaw into a more forward position during sleep, which in turn holds the airway open. In mild to moderate cases, this repositioning alone is enough to treat the apnea. And in severe cases, these appliances are often used in conjunction with a CPAP (Continuous Positive Airway Pressure) machine in order to make the machine more effective at a lower, more comfortable setting.

A CPAP is still considered the standard of care for adult sleep apnea treatment in all but the mildest cases. However, many people are not able to wear them at all, or gradually stop wearing them over time. This can be very dangerous to the overall health of the affected individual. For those people who are unable or refuse to wear a prescribed CPAP machine during sleep for any reason, an oral appliance is often the next best alternative in improving the airway opening during sleep. And for those people who love their CPAPs, wearing a nighttime dental appliance may still be necessary to help protect the teeth from grinding during sleep.

For children diagnosed with OSA, there can be several contributing factors. Allergies and enlarged tonsils or adenoids may often be involved, but the teeth and bite can also play a role in the opening of the airway. If the teeth are positioned so that the lower jaw is held back too far behind the upper front teeth, the airway may be constricted. Functional orthodontic treatment at this early stage can not only help with proper airway development, but it may also help decrease the probability of apnea development as an adult.

In order to determine if you or your child has OSA, a sleep screening or study should be performed. Dr. Rich begins this process by noting initial blood-oxygen level readings while awake, and performing a thorough examination of your throat, bite, and mouth before prescribing an at-home sleep screening to determine if apnea is present. Children may be referred to a physician or pediatric ENT to further evaluate the airway. Moderate to severe cases may be referred directly to a sleep lab for overnight evaluation.

Using the results of the at-home screening or the overnight sleep study, Dr. Rich utilizes computerized diagnostic equipment to determine the ideal position of the lower jaw for improved breathing. The final appliance will then be made to this custom position. Following a period of adjustment to the appliance, another sleep screening or overnight study will be performed to verify that the appliance is working correctly.

to schedule an obstructive sleep apnea evaluation,
or to inquire further about Dr. Rich’s treatment philosophy, please call 503-228-6870.

Obstructive sleep apnea cases are not always complex, but records may need to be obtained before an evaluation can take place. A brief email exchange may begin this process, but ultimately a telephone conversation will be necessary to adequately address all the information needed to schedule the appropriate appointments.