Why is a dentist talking about your airway and how you breathe? It’s because we are in a position to observe and visualise many signs in the mouth that can indicate you have a problem breathing properly or have difficulty breathing during your sleep. I can’t diagnose an airway problem simply by looking at your teeth and mouth but there are some telltale signs that can alert me to a problem. To do this I need to be able to understand and view the structures of your body that are working with and against one another.
What Causes Airway Issues?
Airway and breathing disorders occur due to obstructions in the airway, this could be due to a deviated septum (your nose is bent), narrow nasal passages, chronic allergies, mouth breathing, misaligned bites, narrow jaws or a narrow throat or several of these in combination. Anything that limits or restricts the flow of air is an airway disorder.
One of the common causes of airway issues is there not being enough room in your mouth for your tongue to fit properly. I know that seems odd and that you would think that your tongue would naturally have all the room that it needs. It’s like having a single car garage (your mouth) and the car (the tongue) should have been made to measure. But think about it most garages are a tight fit and then we want to store stuff in there so we pile things up against the sides and squeeze the car in. Eventually, there is too much stuff in the garage you can’t drive your car all the way in so you have to leave the door open.
Ok, now I’ll relate it back to you and your ability to breathe.
We all collect stuff in our bodies, as we age this stuff can cause inflammation and swelling of the soft tissues in your mouth – the tongue, throat and soft palate. You also lose muscle tone with age, which allows the muscles in the throat to collapse. Bone growths can also occur in the mouth that restricts space for the tongue just like trying to park your car in the overstuffed garage.
So just as we wouldn’t leave our garage door open we don’t walk around with our tongue hanging out, no we have to force our tongue back into our mouth to tuck it away and look normal. So now your car is jammed up against your stuff and you are blocked up. That’s what’s happening in your mouth and you can live without noticing this until it gets so bad you have to take action.
If you already had an issue with there not being enough tongue space or limited airway due to poor facial and jaw growth then these processes of muscle collapse and inflammation quickly become a serious and potentially life-threatening issue.
What does this mean – it means your airway gets blocked or obstructed when you lie down and this interferes with your sleep. Proper sleep and sleep quality is a major key for your body being able to rest, regenerate and repair itself from the stressors of the day. Lack of sleep is a killer. Lack of sleep or proper deep sleep leads to inflammation.
If your airway blocks during your sleep at best you will snore and at worst it will fully obstruct, which is like being strangled or suffocated over and overnight after night 100’s or 1000’s of times for up to a minute or more each time. As you can imagine that’s not going to be doing you any good as you gasp and choke for breath.
Obstructive Sleep Apnoea
Obstructive sleep apnoea (OSA), snoring and related sleep breathing conditions all cause lack of deep, quality sleep. However, it's not like insomnia where you lie there awake knowing you can’t sleep, these conditions stop you getting quality sleep and falling into the deep levels of sleep you need to feel rested and refreshed. So whilst you may not remember waking or be fully woken up your body is being aroused from sleep so you only stay in light sleep, the sort you are in as you are falling asleep or getting ready to wake up. This means that the majority of people are totally oblivious to the fact that they have a sleep breathing issue because they think they have been sleeping. And not only that they think they sleep well.
Sleep deprivation leads to poor performance at work, daytime sleepiness and increased risk of you falling asleep while driving.
Without proper sleep you can’t take care of you it is the most essential part and often most neglected aspect of our health and wellbeing, as it is critical to every aspect of our lives.
Sleep breathing issues can mean you wake frequently or need to get up to go to the toilet a lot at night. Your sleep partner may tell you that you snore or even witness you stop breathing or struggle for breath during your sleep. These are all warning signs for sleep apnoea.
This is a serious airway problem. Obstructive sleep apnoea has to be diagnosed by a sleep physician – a doctor with a special interest in sleep disorders – via a sleep study. But as a dentist I am well positioned to be able to examine your mouth, teeth, jaws and airways visually and via x-rays, which along with your health history can help me spot the warning signs and risk factors for an airway issue. If I suspect you have sleep breathing issues I will request that you order a sleep study via your GP.
In OSA your brain is signalling you to breathe but because you have a blockage or obstruction in your airway your breathing stops for 10, 20, 30 seconds or even more sometimes a minute or longer. These episodes of being breathless are called apnoeas and happen many times during the night. You are suffocating and being starved of oxygen throughout the night. As you can imagine this can’t be a good thing.
Sleep apnoea is commonly accompanied by snoring. If you snore it's 70% indicative that you will have OSA. Yet not everyone with OSA snores.
Snoring is caused by narrowing of your upper airway, which causes vibration of your throat tissues. This is considered to be a partial obstruction of your airway, whereas with sleep apnoea it is a full obstruction or total blockage of the airway.
Whilst we often think snoring is humorous it is actually no laughing matter.
Sleep apnoea is a very serious problem.
What Does Sleep Apnoea Do To Your Body?
If you have sleep apnoea or are not getting enough air during your sleep you have an increased risk of heart disease, stroke, diabetes, high blood pressure, depression, anxiety, pulmonary hypertension, congestive heart failure and coronary artery disease. In other words, it is a serious life-threatening condition and should not be ignored or taken lightly.
Along with these conditions people with sleep breathing disorders will often have excessive daytime sleepiness, memory issues, frequent headaches, lethargy and low energy, suffer irritability and moodiness, weight gain or inability to lose weight, wake with dry mouth or sore throat and more often than not grind the living daylights out of their teeth.
The massive issue here is the number of people with OSA who are undiagnosed because we are not picking up the underlying reason for the health issues and symptoms that I have mentioned.
One of the biggest giveaways for me is that I see massive war and destruction in teeth and thickened deposits of bone around the roots of the teeth and along the jawbones. This is because when your airway obstructs your brain signals your jaws and teeth to clench together as this helps to pull the tongue and throat muscles up off the back of your throat in an attempt to increase or restore airflow.
When you have sleep apnoea there are two things that are happening or going wrong in your body. You don’t get enough sleep because you keep having to wake up to breathe and you are not getting enough oxygen for your system because you stop breathing.
The common treatment for sleep apnoea is to use a device called a CPAP machine (continuous positive airway pressure) that delivers a steady flow of air via a nosepiece or mask, which supports to keep your airway open. The problem with these is many people don’t like or can’t get used to wearing them so they simply don’t and hence their condition is untreated and will get worse.
OSA is graded as mild, moderate and severe the higher up you are on the scale the greater the damage there is being done to your body and hence your health.
The issue here is that if your readings during testing fall just below the range that say yes you have OSA, you are told you don’t have it, even though you do actually have episodes where you stop breathing!
Dental Issues and Sleep Breathing Problems
However, dental issues surface way before you hit the magic number to be classified as having OSA. These dental issues include fractured teeth, failed dentistry, gum disease with the bone loss caused by the physical overload of clenching teeth, pH imbalance that makes you more acidic and so on. But due to the way OSA is classified you are left with an ongoing problem that you have been told does not exist and therefore requires no further intervention or treatment. Hope you’re normal so please get on with your life until your next tooth breaks, you are seen to be gasping for breath at night, or you suffer a stroke or heart attack from low oxygen.
We need sleep for several reasons including repair and restoration; we also need a steady flow of oxygen at all times. At night when we sleep our muscle tone is much lower that makes your throat more prone to collapse. However, the healthier you are the greater the muscle tone is during the night.
Lack of oxygen alters your body pH; in humans, it should be around 7.4. If this starts to drop and become acidic your feedback systems let your body know it needs to buffer the change to bring your blood back to normal range. This involves pulling alkalising minerals form your bones immediately to bring the body pH back to balance. When your pH is constantly shifting from lack of oxygen it stresses your entire body.
Stress and acidity cause inflammation and struggling to breathe and low oxygen levels trigger your flight-fight response.
Like TMJ disorder, sleep apnoea takes its toll on your body every day and this accumulative stress adds up.
Studies have found that sleep apnoea causes so much damage to your body that it can shorten your life by years and severely reduce your quality of life as well.
The Importance of Airway Size
It doesn’t take much of change in the size of your airway to really affect your ability to breathe. If you suffer a loss of half the circumference of your windpipe you will require a 16-fold increase of pressure to deliver the same amount of oxygen. The narrower the tube the greater the resistance to airflow becomes. So little changes in your airway will give big results – this means a small obstruction can cause great difficulties for your breathing but also a small increase in the size of your airway will cause dramatic improvements.
This is where oral devices and appliances can be very useful as by positioning the lower jaw more forward and open it is possible to increase the airway size and reduce muscle collapse and the improve airflow and breathing.
In my next blog, I will go more into the diagnosis and treatment of snoring and sleep apnoea.
The team at Evolve Dental Healing is highly trained in dental sleep medicine and the treatment of sleep apnoea and sleep breathing disorders. If you think you or your partner has sleep apnoea or snoring issues call us today to book an appointment with our highly qualified team.