The Dental Sleep Center is devoted to the multidisciplinary management of sleep disordered breathing. Prior to the visit, all patients have to fill out the health history and sleep questionnaire. The initial visit is approximately 2 hours and it involves comprehensive assessment, review of medical records, diagnostic studies such as radiographs and treatment planning. We believe in the importance cross communication with your other treating clinicians. We interact closely with sleep centers and sleep physicians in the New England region. A report will be mailed to your physician, as well as phone contacts where necessary. When a patient presents with a complex medication history, we also work with the other clinicians in order to provide the best coordination of care.
At the initial visit, patients are expected to bring a copy of their most recent sleep study (if any) and other medical records. Additionally, the health questionnaire and the sleep questionnaires, which can be accessed at the bottom of this page, should be filled out completely. Jaw symptoms and headache commonly co-occur with sleep disorders. We conduct a comprehensive assessment to rule out any of these mediating issues.
Management of sleep disordered breathing such as snoring and obstructive sleep apnea is decided according the specific needs of each patient. Various types of dental appliances are often used for optimum patient care. A review of the psychological and social consequences of sleep disorder is important as psychological factors have been shown to either enhance or inhibit recovery. In many cases, a specialist in behavioral medicine or an intern in training may participate in an interview with a series of brief questions.
What is Obstructive Sleep Apnea?
Obstructive Sleep Apnea (OSA) syndrome is a common disorder that is associated with serious adverse health consequences. During an apnea episode the tongue and soft palate collapse onto the back of the throat; these are associated with drops of oxygen level, arousal and fragmented sleep.
Associated symptoms may include:
- Unrefreshing sleep
- Excessive daytime sleepiness
- Nocturnal snorting, choking or gasping for air
- Morning headaches
- Cognitive impairment
In addition to excessive daytime sleepiness, sleep apnea patients are much more likely to suffer from heart problems (heart attack, congestive heart failure, hypertension), strokes, as well as having a higher incidence of driving related accidents (patients often report falling asleep while driving).
How is sleep apnea diagnosed?
Diagnosis is based on medical history, physical exam and the results of a full night polysomnography (sleep study), which is conducted at a sleep laboratory.
- CPAP TherapyContinuous positive airway pressure is the most effective treatment, it requires the use of a mask interface, sealed tubing, and a device connected to a power source. Many patients are unable to tolerate the use of CPAP due to difficulty on keeping the mask on, feeling claustrophobic, noise from the machine awaking the bed partner, difficulty to bring the CPAP machine every where the patient goes (frequent travelers).
- Oral Appliance TherapyA recent update of the clinical practice parameters of the American Academy of Sleep Medicine (AASM) state that oral appliances are indicated for the treatment of mild-to-moderate Obstructive Sleep Apnea in patients who prefer oral appliances to CPAP, who do not respond to CPAP, who are not suitable for treatment with CPAP, or for whom treatment attempts with CPAP are unsuccessful. CPAP is a more efficacious treatment, it is recommended that CPAP be considered before oral appliances for patients with severe OSA (Practice parameters for the treatment of snoring and obstructive sleep apnea with oral appliances: an update. Sleep 2006).Oral appliances are an alternative option for patients who can’t tolerate CPAP therapy, they are considered by patients to be a more acceptable treatment modality compared to CPAP. Oral appliances are portable and do not requires a power source. The greater acceptance by patients of oral appliances results in better treatment adherence.Oral appliances are removable devices used at nighttime to prevent the collapse of the tongue and the soft palate onto the back of the throat. These are attached to the upper and lower teeth, and then mechanically move the lower jaw forward to keep the airway open during sleep. The objective of these devices is to improve the patency of the upper airway during sleep by increasing its dimensions and reducing its collapsibility.Several anatomic changes occur as a result of the mechanical advancement of the mandible and tongue. The Lateral x ray below shows a patient with a narrow airway (top), the same patient wearing an oral appliance improving the airway patency (bottom).
We offer comprehensive evaluations and treatments for related complaints and symptoms.