Understanding Sleep: A Guide from Smile Innovations Hawaii

“It is time for us to reclaim our right to a full night’s sleep.  We can then be reunited with that most powerful elixir of wellness and vitality.  Then we may remember what it feels like to be truly awake during the day, infused with the very deepest plenitude of being.” – Matthew Walker, Ph.D, from his book, “Why We Sleep”

Normal sleep involves air passing through the nose and sinus and going directly down to the lungs.  This requires a wide open airway and nasal passages, in a mouth with upper and lower jaws and tongue in its proper position to allow this exchange promoting healthy sleep.  

Sleep apnea is a serious sleep disorder characterized by intermittent cessation of breathing. These periods without breath degrade sleep quality and disrupt the body’s oxygen supply, potentially leading to significant health issues. Sleep apnea is generally presented in three key forms:

Obstructive Sleep Apnea (OSA): As the most prevalent category of sleep apnea, OSA results from excessive relaxation of the throat muscles during sleep. This relaxation obstructs the airway, impeding normal breathing.

Central Sleep Apnea: The central form of sleep apnea, which is less common, arises when the brain doesn’t instruct the respiratory muscles to breathe, causing short-term breathlessness.

Complex Sleep Apnea Syndrome: Also described as treatment-emergent central sleep apnea, this disorder manifests when an individual concurrently suffers from obstructive and central sleep apnea.

Although often recognized by robust, loud snoring, it’s important to note that not everyone who snores has sleep apnea. Risk factors for sleep apnea include obesity, excessive alcohol intake, drug use contributing to airway blockage. Genetics can also play a role – those with a family history of sleep apnea may be more susceptible to the condition. As declared by the Sleep Foundation, sleep apnea is a widespread sleep disorder affecting both genders and all age groups in the United States.

Pediatric Obstructive Sleep Apnea

An estimated 1-4% of children suffer from Obstructive Sleep Apnea (OSA). Signs and symptoms include, but are not limited to:

• Snoring
• Heavy breathing
• Restless sleep or unusual sleeping positions
• Bedwetting
• ADHD
• Large tonsils
• Anxiety

Many of these signs and symptoms are presumed to be normal for children, but they are not. Children who are unable to breathe properly will not thrive. If not addressed, these conditions can lead to improper jaw development, causing crooked teeth, jaw problems, bad breath, and cavities. It is crucial to get treatment as soon as symptoms appear, as early as 2 years old. Dr. Sebastian and her team are passionate about helping children breathe better to grow and thrive.

Treatment for children may consist of one or more of the following options:

Dental Appliances: Depending on the child’s age, removable or fixed appliances can be worn to help them breathe better while sleeping, allowing the tongue to rest on their palate and develop their dental arches properly.
Myofunctional Therapy: This is physical therapy for the mouth, tongue, and facial muscles, which helps strengthen and restore normal function. A myofunctional therapist teaches children the correct muscle use for improvements in talking, eating, and breathing.
Tongue and/or Lip Tie Release: This laser surgical procedure releases the muscle for proper range of motion in tongue or lip function.
Surgery: In children, obstructions may arise from enlarged tonsils and adenoids. A referral to an ENT specialist can be made to help your child breathe better.

Adult Snoring and Sleep Apnea Treatment

Obstructive Sleep Apnea (OSA) affects 39 million US adults, but only 6 million are diagnosed. Breathing disruptions may occur when a patient’s upper airway is blocked during sleep, leading to snoring or gasping for air. Complete pauses in breathing are termed apneas, while shallow breaths are hypopneas. Many health conditions are linked to sleep apnea, including Alzheimer’s Disease, stroke, diabetes, asthma, and COPD. Screening and diagnosis are critical in reducing the number of OSA patients and helping them live healthier lives while lowering their risks for other diseases linked to OSA.

Common signs and symptoms of OSA include, but are not limited to:

• Excessive daytime sleepiness
• Snoring or gasping for breath at night
• Episodes of no breathing or difficulty breathing causing sounds
• Mouth breathing while asleep or during the day
• Severe teeth grinding or unexplained fractured back teeth
• Lack of concentration or memory loss

Home sleep testing is now available through our office using the FDA-cleared SleepImage Ring. It is easy to use, comfortable to wear on a finger, and suitable for children over age 2 and adults. The extensive data from the Ring is reviewed by a board-certified Sleep Physician, interpreted, and manually scored for the diagnosis of OSA and/or CSA (Central Sleep Apnea). We then collaborate with your physician to create a proper treatment plan.

Treatment Options:

Dental Oral Appliance: A custom-made oral appliance is designed to posture the lower jaw forward and downward, opening up the airway at night.
Orthopedic Expansion: Utilizes removable oral appliances that exert forces to expand dental arches and enlarge the space for the tongue and teeth, thereby improving the airway for better breathing.
Myofunctional Therapy: Similar to the children’s therapy, it strengthens and restores normal function in the mouth, tongue, and facial muscles. A myofunctional therapist trains patients to use these muscles properly for improvements in talking, eating, and breathing.
Clear Aligner Therapy: Involves wearing clear plastic aligners to move teeth into better positions, creating more room for the tongue and thus increasing airway space.
CPAP: This is the gold standard for OSA treatment and is prescribed by a physician. For those who cannot tolerate a CPAP machine, oral appliance therapy has been an effective alternative.
There are other surgical options for OSA treatment that may be considered if all other treatments are unsuccessful.

If you’re grappling with sleep apnea or suspect you might be, reach out to our compassionate team at Smile Innovations Hawaii. We’re committed to providing personalized care and professional advice tailored to your specific needs. Contact us via phone or email or fill out our online appointment request form. We look forward to helping you reclaim your restful nights and healthful days.