Dr. Barry Chase graduated Georgetown University School in 1976. He is a Board Certified Diplomate to the American Board of Dental Sleep Medicine and the Academy of Sleep Disorders Disciplines. At Stony Brook University in he is an Adjunct Professor on Oral Appliance Therapy in the Respiratory Care and Polysomnography Programs in the Health and Sciences Department.Dr. Chase has been a practicing dentist for 40 years, dedicating the last 10 years of his private practice to oral appliance therapy to treat Obstructive Sleep Apnea and snoring.
In this episode we discuss:
– What is Sleep Apnea?
– What is the point of a sleep study?
– The challenge of treating patients with oral appliance therapy
What is sleep apnea?
The word apnea means without breath. Sleep apnea is sleeping with out breathing. When I tell a patient that they have sleep apnea, that means there are periods during the night when they stop breathing. You can hold your breath and stop breathing with no consequence. The difference between that and sleep apnea is that these events can last 20 seconds, 30 seconds, a minute to a minute and a half or longer. If you are not taking oxygen in that time, the oxygen in your blood will go down. When we loose this oxygen, the body becomes physically stressed. Most events happen during our deepest stages of sleep and as we get into those deep sleeps, the tongue and jaw fall back and the airway becomes blocked. The sleep study to determine your level of sleep apnea depends on multiple different aspects but we focus heavily on two: How many times per hour is the patient stopping their breathing, and oxygen saturation. If you are taking oxygen away from the body, you have an increased risk of heart attack, a stroke, high blood pressure, cardiovascular disease, anxiety, depression, and decision making. Its far reaching, and the therapy is just to restore an open airway all night long and prevent the collapse of the airway.
Can you discuss the differences between the different types of sleep apnea?
When we say someone has obstructive sleep apnea, thats a function of the airway being blocked, as you said, there can be different sites of obstruction. The main site is the base of the tongue which will fall back and pinches off the airway at the soft palette. You can have nasal obstructions as well. There is also something during the sleep study called the apneic index indicating how many apneic events that will happen during each night. The oral appliance is really intended for obstructive sleep apnea. With central sleep apnea you will see decreased air flow and no respiratory effort meaning the muscles are not even trying to push air through. An oral appliance will not treat central sleep apnea. Whats really interesting is that no one will have a 100% central or a 100% obstructive, they will normally have a blend. The third type of sleep apnea stems from this and it is a mix of the previous two, where it will start as a central sleep apnea and then move toward obstructive. We need to establish these things before we provide treatment and thats why we have patients do a sleep study.
What do our listeners need to know about the future of sleep apnea? What is changing in the way that we treat and diagnose sleep disorders?
I dont think appliance design is changing much, some of the materials are being improved so that the appliances can be made smaller. I think what dentist really need to keep in mind is to no stereotype the patient. A lot of us have this idea that people with sleep apnea are these overweight middle aged guys, but I treat very thin people, very healthy individuals, lots of women and even children. A common idea to help these children is to take out the tonsils and adenoids, but it has been proven that only 50% of the children with removed tonsils and adenoids saw any improvement in their disorder. These become potential dental treated patients. I think that we need to put these kids on our radar and rethink the way that we look at orthodontics. Whats changing is the way that we look at people and just how many different types of people this disorder can affect and how we can treat them as dentists.
How can we get into sleep disorders and helping our patients?
Its really why we should. We are dentist and we have this oral cavity right in front of us and we see this patient more often than a physician does and we really develop relationships with our patients. With the service that we can is fabulous and sleep medicine is here to stay and we can help out a lot of people live better lives.