Sleep Apnea

Sleep is a biological necessity, and when it is repeatedly disrupted, the consequences extend well beyond tiredness. Obstructive sleep apnea (OSA) is the most prevalent form of sleep-disordered breathing in Canada, and many cases go undiagnosed.

As a general dentist with a focused practice in TMJ and sleep-disordered breathing, Dr. Cruz can evaluate patients for signs of sleep-disordered breathing, provide oral appliance therapy where indicated, and work collaboratively with sleep physicians to support appropriate diagnosis and care.

Important: Sleep apnea is a medical condition and diagnosis must be made by a physician.

What Is Sleep Apnea?

Sleep apnea is characterized by repeated interruptions to breathing during sleep. There are three recognized types:

Obstructive Sleep Apnea (OSA)

The most common form. OSA occurs when the muscles and soft tissues of the upper airway relax during sleep to the point that the airway partially or completely collapses. Breathing stops, blood oxygen levels drop, and the body briefly arouses, often without the person’s awareness. This cycle can repeat many times per night. Contributing factors include jaw position, tongue posture, airway anatomy, weight, and hormonal status.

Central Sleep Apnea

A neurological form in which the brain does not send appropriate signals to the breathing muscles. The airway itself is not blocked, but the drive to breathe is absent. This type does not respond to oral appliance therapy and requires medical management.

Mixed / Complex Sleep Apnea

A combination of obstructive and central events. Oral appliances may be considered in select cases, under the guidance of a sleep physician.

Key Terms

• Apnea: A complete cessation of airflow lasting 10 seconds or more
• Hypopnea: A partial reduction in airflow accompanied by a measurable drop in blood oxygen levels
• AHI (Apnea-Hypopnea Index): The total number of apnea and hypopnea events per hour of sleep used to classify severity

OSA Severity Classification

According to the American Academy of Sleep Medicine:

OSA in Children

Children should not snore regularly. In the pediatric population, enlarged tonsils and adenoids are the most common cause of sleep-disordered breathing. Untreated childhood OSA has been associated with behavioural difficulties, impaired growth and development, altered craniofacial growth, and bedwetting.

If your child snores regularly beyond the duration of a cold, early assessment is recommended.

Snoring vs. Obstructive Sleep Apnea

Snoring occurs when the soft tissues of the throat, including the soft palate, the uvula, and surrounding structures, vibrate as air passes through a narrowed airway during sleep.

Snoring and sleep apnea are not the same condition. Not everyone who snores has sleep apnea. However, many people with OSA do snore, and some individuals with what appears to be simple snoring are experiencing significant airway obstruction without being aware of it.

Signs that snoring may warrant further evaluation:

• Gasping, choking, or snorting sounds during sleep
• Witnessed pauses in breathing reported by a bed partner
• Waking unrefreshed despite a full night’s sleep
• Significant daytime sleepiness
• Morning headaches or jaw pain
• Frequent nighttime urination
• Mood changes or difficulty concentrating

In children, snoring should always be assessed promptly, as it is not considered a normal finding.

If you or a family member snores, an evaluation can help determine whether further investigation is appropriate.

Health Risks Associated with Untreated Sleep Apnea

Untreated obstructive sleep apnea is associated with a number of serious health conditions. The information below reflects findings from published medical research.

Cardiovascular

Repeated drops in blood oxygen place strain on the cardiovascular system. Untreated OSA is associated with hypertension, increased risk of heart attack, stroke, and cardiac arrhythmia.

Metabolic

OSA has been linked to insulin resistance, type 2 diabetes, and weight gain. Disrupted sleep also affects hormones that regulate appetite.

Cognitive and Psychological

Chronic sleep fragmentation can impair memory, concentration, and executive function. Depression and anxiety occur more frequently in people with untreated OSA.

Safety

Research indicates that people with untreated OSA are at significantly elevated risk of motor vehicle accidents due to daytime sleepiness. Workplace accident risk is also increased.

Relationships

The disruption that snoring and restless sleep cause to household members is a real and frequently reported consequence of untreated sleep-disordered breathing.