Sleep apnea and sleep breathing disorders

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"I am a terrible sleeper."

"My child is so grouchy when he wakes up and is hyperactive during the day."

"My wife says I snore."

"My daughter grinds her teeth."

"I am fatigued and stressed out"

What do these statements have to do with dentistry?  These statements point to poor quality breathing.   Your breathing isn't only causing problems when you are asleep, but 24 hours per day.  Chronic stress and inflammation, anatomical changes, and diseases are things that your body experiences because it is not breathing well.  A part of your routine dental exam at Life Smiles Family Dentistry includes questions and thoughts into breathing.  I have focused my continuing education to be accessing what is going on with your airway, and not just your teeth.  While you come in for just a routine check-up and cleaning,  you may leave with some answers to your health concerns that no one has figured out yet.  Dr. Geisler has a passion for helping babies, children, adolescents and adults with their overall health.  The first step in detective work is asking questions about your health, listening and asking more in depth questions.  We take photos, measurements, films to document what we see.  Is it possible that what a general dentist visulaizes could be related to how you breathe?  For instance, we may find that your teeth are worn and flat.  Or maybe you know you clench or grind your teeth during the day or night.  While that is easy for any dentist to see, not everyone knows why it is happening.  I used to like to show people their intra-oral photos and show the flat spots to prove they were clenching and grinding.  While I still love to show photos and discuss what I see, I am taking a step back from recommending a night guard immediately.   For most people, worn and cracked teeth are a sign that we need to delve into the etiology (the cause).  A night guard may be the best approach, but a diagnosis must proceed the cure.

Everyday I see areas by the gum-line that looked "scooped out."  They are often sensitive to touch and cold, sometimes are not aesthetically pleasing and accompanied with gingival recession . Recession and these concave spots are not a natural progression of teeth and gums as we age.  Worn teeth, recession, concave spots near the gum-line, and broken teeth are all signs that something is amiss.  Open wide and say "Aaahhhh."  As a part of your oral cancer screening, I see huge and inflamed tonsils red throats, post nasal drip and tonsilloliths everyday.  You may have missed a lot of work this year due to colds and sinus infections, ear aches.   Why do some people get Strep throat or colds often and others don't?  Why do you get sinus infection after sinus infection?   Is this the new "normal?"

In addition, I find other signs such as frequent new cavities and gum bleeding that doesn't respond to good therapy and home care.  While it's true that Mountain Dew may be a factor for some people getting cavities, what about those who haven't had a cavity in a really long time and eat really healthy foods?  Contrary to popular opinion, I find most people are honest about their brushing and flossing.   Why is it that some people never have bleeding gums, brush only one time per day and visit a dentist once per decade?  And others have periodontal disease that is more aggressive.  While a great number of disease processes are multi-factorial, I believe that healthy teeth and gums begins with the next breath you take.  Every 10 seconds you have an opportunity to take in air in a way to promote health or disease. 

 I am a doctor who knows and considers your airway, not just a tooth doctor.  I know what proper anatomy should look like for good airflow.  Everyday I see air passages that are very challenging.   When you close your mouth and take a large breath through your nose, do your nostrils collapse?  The tissue that hangs down off your palate can be part of a soft tissue problem, along with enlarged tonsils and adenoids that often create an obstruction.  Often physicians will report that a patient has a large tongue.  Dentists agree that most of these tongues are really normal sized, but just living inside a small space.   When I look at your profile, I will be able to see if your upper jaw or lower jaw are set back.   When your jaw isn't out as forward as it should be, your airway become compromised.  Did you have four premolars removed due to crowding when you had orthodontics?  Often teeth are retracted back, which makes the volume in your mouth smaller.  A smaller volume of your nasal or oral space will limit your breathing.  Through continued education after dental school, I know the signs and questions to ask about health, breathing, sleeping, stress, fatigue and habits.

It is rare that a child will admit that they cannot breathe well.  We adapt to survive and kids really adapt well.  They will find a way to breathe even if that means leaning their heads way forward in their awake posture, or sleeping with their heads cranked far back.  While, I have had some kids know that they are tired a lot or snore, many do not.  Parents are advised to video their kids sleeping for 5 + minutes so we can see what they are doing while sleeping.  I also recommend filling out some paperwork over the period of a few weeks to observe awake and sleeping behaviors.  I know that kids don't just "grow out of it" when they grind their teeth.  Kids actually grow into their grinding problems (they worsen).  I know that 95% of bad bites (malocclusion) is not caused by genes, but by how you grew when you were really young due to eating and breathing patterns.  I know better than to tell the parents of a six year old with a bad bite to "just start saving for braces now."  We can address the problems now.  We can improve health and change your child's anatomy of their airway now.  Grinding teeth can stop, growth delays and headaches can stop.  Sleep can improve and many times ADHD meds can be stopped.  When breathing is an issue, sleep is a problem.  When breathing is an issue, the shape of your face changes.  When breathing is an issue, your whole health is affected.  And the detective work starts when we review your health questionnaire and continues through a thorough exam. 

I am educated in and have a special interest in preventing childhood breathing disorders.  Why do so many kids now have ADHD, wet the bed, and are not able to sleep soundly through the night?  Did you know that 50% of children diagnosed with ADHD have sleep disordered breathing?   Improve their sleep, and many of the questions you checked "yes" to on the questionnaire about ADHD is now a "no."  My interest really peaked since seeing so many newborns with tongue ties.  I release the tongue and lip ties with a laser for correct functioning during swallowing, speaking, breathing.  While it effects feeding tremendously, it is just the tip of the ice berg.  Consequences of unreleased tongues actually affect the anatomy, or shape, of your face.  A long narrow face equals tight nasal airways.   A tongue tie leads to needing a lot of braces.   A tongue tie leads to mouth breathing which is the prime culprit causing asthma, frequent sinus infections, inflamed tonsils and adenoids.   You don't have to have a tongue tie to be a mouth breather.  It can be a life-long habit learned after having a really bad cold with a stuffy nose.   Did you break your nose playing football?  A deviated septum forces people to breathe through their mouth,  negatively impacting every aspect of health.

I also have a special interest in Upper Airway Respiratory Syndrome (UARS).  When you know you aren't sleeping well, but you don't snore, does that mean you are imagining it?  Is your job and busy life style to blame for your stressed-out feelings?  What if your sleep study doesn't show you stop breathing much?  Does that mean you are O.K.?   Why do you feel so stressed out when you wake up and why do you have extreme fatigue day after day?  It is very possible that little changes in your upper pharygeal anatomy caused some small restrictions to air flow.  You don't stop breathing, but your body may be working really hard, making little adjustments to let the air flow.  You were clenching and grinding and moving a lot.  This chronic managing of your airway prevented you from getting a good nights rest (for your body, brain, and emotions).   Lack of deep sleep leads to body aches and pains.  Lack of REM sleep leads to stressed emotions.  Night after night of poor sleep leads to chronic fatigue and can be given a diagnosis of insomnia ADHD, fibromyalgia, anxiety and depression.  Let's say you are a pre-menopausal woman, who really doesn't sleep well.  You likely are fatigued day after day, and may take anti-depressants or anxiety medications.   You have a hard time falling asleep and are a light sleeper, often waking at 3 am and cannot get back to sleep. When you go through menopause, your progesterone drops and you may gain ten pounds.  When your muscles aren't as toned with age,   sleep problems at night symptoms change from clenching at night to snoring.  The unhealthy yet eventual progression of UARS leads to obstructive sleep apnea (OSA).  You didn't just get OSA overnight, it happened progressively over many years.  You didn't just get high blood pressure overnight either.  The video below gives a general view of sleep apnea, which is very different than UARS when a sleep study is done.  A sleep physician may say that your REM is altered with UARS but don't have any moments where your oxygen dips greater that 4% for greater than ten seconds.   This sleep problem is often not known or diagnosed.  If physicians have to offer only medication, CPAP, weight-loss or sleep hygiene recommendations only as tools, often their investigation doesn't go any further to reach a diagnosis.  Obstructive sleep apnea gets all the press, but is not a sudden condition. Stopping breathing and then arousing to take a deep breath happens when your body has discontinued doing little "fixes" like it did when you were younger.  Your body has, in a sort, given up on fixing the problem independent of the brain.  In sleep apnea, your brain takes over and arouses you out of sleep to gasp for air, which leads to more deep gasping for air and high blood pressure all night.  For years before obstructive sleep apnea is diagnosed, you were breathing poorly.   Wouldn't you like to know that now, and prevent yourself from having the morbidities associated with sleep apnea?  OSA increases the risk for dealthly motor vehicle accidents, high blood pressure, pulmonary vascular disease, cerebral vascular disease, ischemic heart disease , congestive heart disease and arryhthmias.  Let's rewind and prevent these horrible health problems.  Perhaps all the breathing problems started when you were a baby.   My current career passion is to prevent babies and kids from turning into the poor breathers that the adults of this day and age are.  When I look at my team, my family, my friends and even myself, I recognize the health problems that already exist and will lead to a diagnosis of UARS and OSA.   Let's pay attention, and fix breathing to improve health.  So here I am, a general dentist who never would have predicted this the day I graduated from dental school.  My job is bigger than just treating the teeth, it's helping the person.  Let's start breathing through our noses and feeling better.