Yldenfonso Vasquez Jr. knew he snored. His wife told him—often. And when he had to travel for work, sometimes sharing a room, his coworkers would tell him they were afraid he was choking in the middle of the night.
“He was snoring really loud,” said his wife, Catalina Vasquez. “I was worried something was going to happen to him.”
Sleep apnea’s common symptoms—loud snoring and daytime sleepiness—may seem minor. But left untreated, sleep apnea can lead to high blood pressure, heart attacks, congestive heart failure, stroke and increased risk of developing or worsening diabetes. Researchers have also discovered that obstructive sleep apnea patients have an increased risk of death from any disease, such as cancer.
An estimated 18 million people in the U.S. have sleep apnea, though many go undiagnosed, according to the National Institute of Neurological Disorders and Stroke.
“There is such a health care crisis involved with this problem that we are trying to get people educated and treated,” said Ann Larsen, D.D.S., clinical director of the Sleep Disorders Center at UT Dentistry, the patient practice of the School of Dentistry.
So many cases are undiagnosed, Dr. Larsen said, because of the public’s lack of knowledge of the risks. And symptoms, like snoring, are thought to be a common nuisance rather than a legitimate health risk. Compounding the problem, she added, is that a patient’s quality of sleep is often not discussed during routine primary care appointments.
“There is a common misconception that it is normal to be tired or snore,” Dr. Larsen said. “It is not normal.”
UT Dentistry opened the Sleep Disorders Center to become part of the solution, using a dental approach to offer another treatment option—a customized oral device that fits inside the patient’s mouth.
When a patient is diagnosed with sleep apnea, physicians can prescribe a continuous positive airway pressure device, also known as a CPAP. The machine uses mild air pressure to keep the breathing airways open. A mask or other device covers the nose, or nose and mouth, and straps around the head. Air is pumped through a tube that links the mask to the machine’s motor.
The inconvenience of the size and fit, as well as the idea of wearing a mask to sleep, may deter people from seeking treatment, Dr. Larsen said.
Prescribed a CPAP by his physician, Vasquez struggled with anxiety and discomfort from the machine. He moved a lot in his sleep, and would sometimes knock the machine off the nightstand.
It also caused minor injuries.
“It would bruise his nose,” his wife said. “It was just uncomfortable.”
Vasquez tried surgical treatment options. His tonsils were removed and his uvula was reduced. He had surgery to realign his jaw. Still, he snored.
Then he was fitted for the oral device. About the size of a retainer, it moves the jaw forward, increasing the size of the upper airway and reducing the air resistance that leads to snoring and sleep apnea.
“Dentists are highly trained in the anatomy of the teeth and mouth,” Dr. Larsen said. “We play an important role in helping to treat sleep apnea with oral appliances.”
At the Sleep Disorders Center, patients like Vasquez are carefully screened through a physical exam and questionnaire to gather information about sleep habits. If there are signs of sleep apnea, the patient is given a small monitoring device to wear during sleep that straps around the chest and measures the patient’s heart rate. A small plastic tube placed just outside the nose measures oxygen flow and exertion rate, and records the number of times the patient stops breathing. Results are then electronically sent to a sleep physician for diagnosis and, if warranted, recommendations for the oral appliance are sent to the dentist.
The dentist then takes digital or physical impressions and models of the teeth to ensure a customized fit. At the center, the appliance is tailored specifically for each patient’s needs. If a patient frequently drinks water at night, a two-piece device is recommended that allows the mouth to easily open and close. If a patient is a teeth grinder, there is a device covered with a thick layering that prevents damage to the teeth and appliance. Appliances can also be fitted for certain facial features and characteristics.
Follow-up visits with the dentist are scheduled to adjust the appliance, if needed, to maximize comfort and effectiveness.
The device is compact, portable and requires no electricity. And for Vasquez, it was what he needed to finally get a good night’s sleep. He feels more energetic and alert.
“I just have to put it in at night, then I am done,” he said.
His wife notices the difference, too.
“It is a lot quieter,” she said with a light laugh. “I can get a better night’s sleep too, and I am happier. There was a big concern when they said he could have a stroke or heart attack. I don’t worry as much anymore.”