Oral cancer, heart disease, stroke, lung diseases like chronic bronchitis and emphysema, osteoporosis, cataracts, and now you can add Obstructive Sleep Apnea to that list. Smoking is the leading cause of many medical conditions that can easily be prevented. There have been various studies now linking smoking to Obstructive Sleep Apnea. Those who smoke are three times more likely of developing OSA. About 35% of smokers have OSA.

Obstructive Sleep Apnea occurs when the muscles of the throat or relax and cause an obstruction of the airway. This can be the result of excessive fatty tissue, an oversized tongue or uvula, a soft palate or a narrow airway.  It can also is caused by anatomical swelling in the airway that happens when you smoke. OSA stops your breathing for periods of time and lowers your blood oxygen saturation because of the lack of oxygen.

These disruptions in breathing and lack of oxygen cause sleep fragmentation.  Sleep fragmentation during OSA “breaks up your sleep”, as you are temporarily woken up to resume breathing in a Flight or Fight response. The person’s mind and body have not restored during the night making them fatigued during the day, creating morning headaches or problems concentrating. Not to mention there are many serious medical consequences that result from a lack of sleep and a lack of oxygen in the body.

A study at Johns Hopkins University found 22.5 percent of smokers said they experienced restless sleep, in comparison to 5% of nonsmokers. Another study proves that smokers spend more time during the night in the lighter sleep stages, never reaching REM stage while non-smokers experienced more restorative, deep sleep.  Heavy smokers with OSA had a higher percentage of light sleep in NREM stages N1 and N2 and a lower percentage of deep sleep found in NREM stage N3, because of sleep fragmentation caused by OSA.

Smoking causes induced upper airway inflammation caused by nicotine irritation of the upper airway muscles. It inflames the nose, uvula, and throat, which obstructs and reduces the space in the airway. Long-term smokers with moderate and severe OSA, have increased uvular mucosa and uvular collapse. An inflamed uvula is also known as “battered uvula.”  This can be attributed to the thickened mucosa caused from smoking and a response to nicotine withdrawal during sleep. During the first hour of sleep, nicotine acts as a stimulant, reducing the number of apneas and hypopneas during sleep.  According to the National Sleep Foundation, the stimulating effects of nicotine can cause smokers to develop insomnia if they smoke frequently and close to bedtime. (As we have mentioned in the past OSA is commonly misdiagnosed as insomnia and its primary symptoms.) As nicotine withdrawal continues throughout the night, your sleep apnea increases due to a rebound effect produced by the withdrawal.

Smoking is a known risk for snoring, and snoring is a symptom of OSA. A study found a higher association between heavy smokers and a higher AHI of greater than 50 events per hour (severe apnea is 30 events per hour). Smokers were also found to have longer durations of hypoxia with significantly lower oxygen levels.

If you have sleep apnea and you smoke, please talk to one of our dental professionals. Help is available to you at Raphaelson Dental Sleep Center. Our professionals are here to help to improve your health and quality of life.

1 Comment
Read More

Did you know that your personalized care at Raphaelson Dental Associates begins the moment you fill out your paperwork? Our dental family cares about you, not just a tooth or your mouth. We find that is it very important to know what is going on systemically with our patients, and sometimes we are given these clues from what we see your mouth. These clues can help us potentially save a person’s life.

Sleep Apnea awareness is becoming more relevant in the media since the terminal crash in Hoboken and the more recent accident in Brooklyn with the LIRR.  We believe Sleep Apnea is not talked about enough, and that is why so many people go undiagnosed. Sleep apnea is very personal to some of our employees and their families. We have seen the negative effects it can have on a person’s health when it is left untreated and that is why we feel it is important to screen our patients for this potentially dangerous sleep disorder.

As mentioned above our personalized care starts with your paperwork- primarily your medical health history. Chronic headaches, high blood pressure, stroke, acid reflux, heart attacks, depression, and stroke have all been linked to Obstructive Sleep Apnea. If you have any of these conditions our team will dig a little deeper into your medical history and look for common physical oral signs of OSA. When the mandible (lower jaw) is pushed back; the tongue, fatty tissue of the neck, and muscles in the upper airway are also displaced backward. This causes an obstruction of the airway when a patient with OSA sleeps on their back (which happens to be the exact position they are in our operatory chairs). As dental professionals, we can see these obstructions and other common physical signs of OSA during a routine check up or dental exam.  These common physical signs include heavy wear on teeth from grinding, a scalloped tongue, a higher Mallampati classification, enlarged tongue or uvula, a soft palate, and a narrow airway. During sleep, a patient with OSA clenches and grinds their teeth in order to wake up and resume breathing, which results in tooth wear. Patients with Class 3 or Class 4 Mallampati (see the picture below) usually have some form of OSA because of the small space in their throat that allows for the passage of air. A patient with a scalloped tongue is trying its best to push forward and open the airway again. When the tongue is in this state, the teeth can easily exert pressure on it to cause scallops or grooves at the edges.

Intraoral Check List for OSA

If our dental professionals observe any of these physical signs of OSA and our patients experience any of its symptoms, we will refer them for a Sleep Study. A Sleep Study or polysomnography is the only way to diagnose OSA. Raphaelson Dental Sleep Center offers a convenient Home Sleep Study that measures the number of times you have stopped or reduced breathing per hour ( known as the Apnea-Hypopnea Index). It also measures the drop in your blood-oxygen levels. Keep in mind that oxygen values under 90 percent are considered low and dangerous. After you have completed your Home Sleep Study, a sleep physician will read the results to determine whether you have sleep apnea. If you have Obstructive Sleep Apnea, the sleep physician will let your know whether your results are mild, moderate or severe.

If you have any of symptoms of Obstructive Sleep Apnea please contact our office for a FREE Consultation.  Common symptoms include: snoring, gasping for air, excessive daytime sleepiness, snoring, gasping during sleep, or insomnia.  At Raphaelson Dental Sleep Center, our patients with Sleep Apnea are treated with an Oral Appliance. Oral appliances are custom and comfortable, they fit like a sports mouth guard or an orthodontic retainer. The oral appliance holds the lower jaw forward keeping the airway open, preventing the tongue and muscles in the upper airway from collapsing and obstructing the airway. Raphaelson Dental Sleep Center works with hundreds of medical insurance companies for Sleep Apnea treatment. Our sleep coordinators will contact your insurance company to verify medical coverage and to obtain any needed authorization prior to your treatment.

No Comment
Read More