Sleep Apnoea Treatment

The different types of sleep apnoea

What Is Sleep Apnoea? Do You Suffer From It?

The origin of the word ‘apnoea’ is Greek and means ‘without breath’. There are three kinds of sleep apnoea, the most common one being Obstructive Sleep Apnoea (OSA). This is when air is unable to flow in and out of a person’s nose or mouth at times whilst asleep.

Central Sleep Apnoea (CSA) (Eckert et al., 2007) is a neurological condition, where the brain fails to send signals to the respiratory muscles. Complex Sleep Apnoea Syndrome (CompSAS) (Wang et al, 2013) is a rare combination of both.

Obstructive sleep apnoea happens when the upper airway is obstructed, whilst central sleep apnoea is from a lack of respiratory effort, due to a malfunction in the part of the brain that controls respiration.

Central sleep apnoea tends to happen in patients with heart failure, brain cancer, or a nervous system disorder. It can also occur in people who have too much carbon dioxide in their blood. Whilst snoring can also be a symptom, this isn’t always the case for central sleep apnoea.

*Disclaimer: Any reference to the terms ‘Orofacial Pain, ‘Oral Medicine’ and ‘Fellowship(s)’ are made within the context of the USA and not Singapore. The designation of ‘qualified sleep dentist’ is only used in the sole context of the European Academy of Dental Sleep Medicine, an organisation founded and governed by university and hospital-based practitioners which sets the standards of competency in the practice of Dental Sleep Medicine across Europe; dental sleep medicine is not an established dental specialty in Singapore. Please refer to our Disclaimers and FAQ pages for more information.

What Is Sleep Apnoea? Do You Suffer From It?

The dangers of sleep apnoea

Why Is Sleep Apnoea A Problem?

The scary thing about sleep apnoea is that the pauses in breathing can last for 10 seconds or longer. In severe cases, this can happen 30 times or more within an hour. The body is starving for oxygen on an unconscious level, so patients are often unaware of the problem. They usually learn about it through their loved ones, who are usually disturbed by their chronic snoring, or gasps for air in the middle of the night.

Sleep apnoea can impact a patient’s quality of life negatively in many ways (Halfeld and Sonnesen, 2022). The effects of a poor night’s sleep spills over to the day, and can lead to serious impaired mental function, heart attack, hypertension, stroke, diabetes, or even sudden death.

It is important to watch out for the signs and symptoms, and see a doctor if you suspect that you or a loved one might be suffering from sleep apnoea.

Signs & symptoms

What Are The Symptoms Of Sleep Apnoea?

What Are The Symptoms Of Sleep Apnoea & Do You Have It?

Sleep Apnoea is a Public Health Hazard Risk

Many people who snore may in fact, be suffering from sleep apnoea. This affects the over all quality of your life, as a poor night’s sleep can spill over to affect your entire day. This can turn into a vicious cycle, and further affect your activities and people around you.

In fact, sleep apnoea is considered a public health risk, and has caused many accidents on the road (Faria et al., 2021).

Complex sleep apnoea is usually only discovered after treatment for obstructive sleep apnoea shows little to no improvement.

Symptoms For Obstructive Sleep Apnoea (During The Day):

  • Fatigue and drowsiness
  • Poor concentration
  • Morning headaches
  • Waking with a dry mouth
  • Poor memory
  • Irritability
  • Depression or mood changes
  • Sexual dysfunction or decreased sex drive
  • Shortness of breath, problems with swallowing, weakness or numbness in the body or voice changes (all of which are more common for individuals with central sleep apnoea)

Symptoms For Obstructive Sleep Apnoea (During The Night):

  • Choking sensation
  • Gasping for air
  • Frequent waking from sleep
  • Nocturia (frequent urination at night)
  • Loud snoring
Always Sleepy but Still Lacking Sound Sleep? Learn More About Sleep Apnoea in This Infographic by Nourish Dental Care.

(Infographic: Always sleepy, but lacking sound sleep? It may be a precursor to Obstructive Sleep Apnoea, affecting your overall health.)

Who sleep apnoea affects & the process of diagnosis

Sleep Apnoea Diagnosis

Who It Affects: Sleep Apnoea in Singapore & Worldwide

Findings in The Lancet, Respiratory Medicine estimate that almost a billion people are affected by sleep apnoea worldwide (Benjafield et al., 2019). About 15% of Singaporeans suffer from sleep apnoea as well (How et al., 2015). In Singapore, 1 in 3 people have moderate to severe symptoms, and 1 in 10 have severe sleep apnoea.

It can also occur in children, and some of the symptoms include snoring and irritability in the day. Such children are often diagnosed with ADHD when the problem is in fact, sleep apnoea.

Common Risk Factors

Some of the common risk factors for sleep apnoea include:

  • Males
  • Adults over 40 years of age
  • Obesity
  • Structural problems in the mouth, such as an enlarged tongue or tonsils, a smaller or misaligned lower jaw
  • Heart or kidney failure
  • A larger neck size (17” or more in men and 16” or more in women)
  • Genetics, affecting Chinese and Malays more than Indians
  • Family history of sleep apnoea
  • GERD (gastroesophageal reflux)
  • Nasal obstruction due to allergies, sinus problems, or a deviated septum
  • Type 2 Diabetes
  • Smoking
  • Mixing alcohol with certain medication
  • Brain tumours or infections, strokes, or any other condition which affects the brain stem
  • Neuromuscular conditions
  • Endocrine disorders
  • Premature birth (usually improves as the brain matures)

How is Sleep Apnoea Diagnosed?​

Your doctor will first conduct a physical examination, after learning more about your medical history. They may recommend a sleep study (polysomnography) if needed. Whilst you may need to stay over at a sleep disorder clinic, many of these studies can be done at home these days. Recordings of your blood oxygen levels, heart rate, air flow and pauses in breathing are taken whilst you sleep.

Additional tests may be necessary for those with other medical conditions to rule out certain issues. For example, your doctor may order an echocardiogram to exclude signs of heart failure. An electrocardiography checks for irregular heart beats. Arterial blood gases measure levels of oxygen and carbon dioxide in your blood.

Blood tests to check on your hormone levels may be necessary to rule out endocrine disorders, which can affect sleep apnoea as well. Pelvic ultrasounds examine the ovaries or detect cysts, to rule out conditions such as PCOS (Polycystic Ovary Syndrome). Your doctor will then conclude and form a diagnosis based on the medical evidence.

How a sleep apnoea dentist can help & how to manage it

Sleep Apnoea Treatment Options & How to Manage it

Sleep Apnoea Treatment Options

What Can You Do To Manage Sleep Apnoea?​

In some cases, you can manage sleep apnoea with healthy lifestyle changes. Here are some things that might help:

  • Maintaining a healthy weight through good eating and exercise habits. Eat more heart healthy foods. such as vegetables, fruits and whole grains.
  • Avoid smoking.
  • Avoid taking certain medications together with alcohol. These include sedatives, benzodiazepines and opioids.
  • Avoid drinking right before bed.
  • Avoid sleeping on your back.

In many cases however, intervention and treatment are necessary.

Sleep Apnoea​ Treatment Options

The gold standard treatment for sleep apnoea is a CPAP (Continuous Positive Airway Pressure) machine. You will need to wear a mask when you go to sleep at home, and this device puffs pressurised air into it. Whilst it is an effective treatment that is proven to work, many find it uncomfortable.

A sleep apnoea dentist may suggest using an oral device (a.k.a. a Mandibular Advancement Device) if CPAP machines aren’t working for you, or before you try one at all. These are mouthpieces custom-fit by your dentist, and are usually for mild to moderate cases of sleep apnoea. They can be particularly helpful for obstructive sleep apnoea, and can be used in combination with CPAP in certain cases.

Surgery is sometimes done if none of these treatments work. Removal of tonsils, adenoids or tissue creates more space within your throat. Surgery may be necessary to remove blockages caused by polyps or a deviated septum.

In rare and life-threatening cases, a breathing tube is inserted into the trachea itself. Surgery to advance the jaw forward is particularly useful in opening up the upper airways. In many cases it also serves as a definitive cure for obstructive sleep apnoea. However, not everybody may be suitable, or want to undergo surgery.

One of the most promising developments are implants that are embedded beneath the skin of the neck and chest. It is a pacemaker-like device that monitors your breathing patterns as you sleep. It automatically stimulates muscles in the respiratory tract to keep the airway open.

Common questions & answers

Sleep Apnoea Treatment FAQs

Sleep apnoea affects your oral health, and your dentist may be able to detect it through the resulting signs and symptoms.

People with sleep apnoea breathe through their mouths due to obstructed airflow, which can result in dry mouth, scalloped tongues, and redness in the throat.

Bruxism (tooth grinding) is another sign of sleep apnoea, which wears your teeth out over time. The damage done can lead to other problems as well, such as cavities and inflamed gums. The jaw may also start to shrink and look smaller in size due to excessive clenching.

Dentists can conduct physical examinations and take x-rays of your neck and mouth, to see if there are abnormalities that may indicate sleep apnoea. A sleep apnoea dentist who is trained in pain and sleep dentistry can help to diagnose, manage and treat the condition properly.

Dental sleep medicine, which includes sleep apnoea, is a highly multidisciplinary field that includes medical practitioners such as your primary care physician, ENT (ear, nose & throat) specialists, oral and maxillofacial surgeons, and orofacial pain specialists (Lobbezoo, 2020). You may also be referred to a cardiologist or neurologist if central sleep apnoea is suspected.

A sleep specialist can further evaluate your condition to confirm the diagnosis, and also help manage your sleep apnoea.

Read more about how a dentist trained in sleep dentistry can help with sleep apnoea on our blog.

When you suffer from sleep apnoea (“no breathing”) or hypopnea (“under breathing”), the blood oxygen level in your brain drops. As a result, your brain wakes you up by reflex so that you can breathe again.

This interruption can occur in any of the four stages of sleep, depending on the type, severity and individual. Repeated interruptions result in a poor night’s sleep, which further leads to poorer cognition and tiredness in the day.

Yes, in fact the connection between sleep apnoea, TMD / TMJ disorders and orofacial pain is quite common. Whilst these conditions can exist independently, they can also be interrelated.

Read more in our post: Is There A Connection Between Sleep Apnoea, TMD & Orofacial Pain?

According to the American Academy of Dental Sleep Medicine (AADSM) (Lobbezoo et al., 2018):

“Dental Sleep Medicine is the discipline concerned with the study of the oral and maxillofacial causes and consequences of sleep-related problems.”

It includes orofacial pain, oral moistening disorders, GERD, mandibular movement disorders and also sleep-related breathing disorders such as snoring and obstructive sleep apnoea.

The follow-up care matters a great deal in sleep apnoea, as it is a chronic condition that needs to be monitored and managed closely (Heatley et al., 2013).

Read more about how a dentist trained in sleep dentistry can help with sleep apnoea on our blog.

A dentist or health practitioner needs to undergo extra training to earn their accreditation in Dental Sleep Medicine.

The extra knowledge grants the sleep specialist insight into sleep-disordered breathing, and also on oral appliance therapy for treatment.

Dr. Eric Chionh of Nourish Dental Sleep & TMJ Care, Singapore, has an Accreditation in Dental Sleep Medicine from the European Academy of Dental Sleep Medicine (EADSM), and has over 20 years of experience in pain and sleep dentistry.

Read more about how a dentist trained in Dental Sleep Medicine can help with sleep apnoea on our blog.

CPAP machines are the gold standard treatment for treating obstructive sleep apnoea, but the compliance rate is low as many patients find it uncomfortable.

Mandibular Advancement Devices (MAD) are another common treatment for sleep apnoea. These should be custom-made by your sleep specialist, as a generic and poor-fitted device will not improve your situation much.

Medications are typically used for central sleep apnoea only; treating the underlying cause usually helps with this type of sleep apnoea.

There are different kinds of surgeries that may help with sleep apnoea as well, depending on the individual and the root cause. However, surgery should only be considered for severe cases where no other treatments work.

It is best to consult a sleep specialist to first evaluate the extent of the problem, and to see which treatment approach would work best for you.

Read more about how a  sleep apnoea dentist can help on our blog.

The primary purpose of a Mandibular Advancement Device (MAD) is to move the jaw forward in order to widen the airway, which helps to prevent closure during sleep (Jayesh and Bhat, 2015).

There are a few different types, such as tongue stabilising devices and oral appliances. Such devices can be made with different materials which vary in softness or hardness.

It is best to get them custom-made, as the shape of your mouth and position of your jaw and teeth varies from another person’s. Using an oral appliance that does not conform to your mouth is not only uncomfortable, but can compound problems at worst.

Click here for more information on oral appliances, and how a sleep apnoea dentist can help.

Our focus at Nourish Dental Sleep & TMJ Care, Singapore

How Nourish Dental Sleep & TMJ Care, Singapore, Can Help With Sleep Apnoea​ Treatment

Nourish Dental Sleep & TMJ Care is based in Singapore, and uses the necessary technology to diagnose, treat and manage each patient’s condition. Dr. Eric Chionh Chye Kiat who runs the practice has over 20 years of hands-on experience. He focuses on pain and sleep dentistry (which includes sleep apnoea)orofacial painTMDmyofascial pain, and other head, neck, mouth and jaw conditions.

Dr. Chionh is formally trained in Oral Medicine and Orofacial Pain, and holds a Singapore Dental Council approved qualification in these areas. He is also a *qualified sleep dentist under the European Academy of Dental Sleep Medicine. You can learn more about Dr. Eric Chionh’s qualifications and our dental practice here. Visit Our Services page to view all dental and pain management services we provide.

*Disclaimer: The designation of ‘qualified sleep dentist’ is only used in the sole context of the European Academy of Dental Sleep Medicine, an organisation founded and governed by university and hospital-based practitioners which sets the standards of competency in the practice of Dental Sleep Medicine across Europe; dental sleep medicine is not an established dental specialty in Singapore. Please refer to our Disclaimers and FAQ pages for more information.

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