Do You Have Sleep Apnea?

Sleep apnea is a disorder which affects 18 million Americans.  It results in loud snoring and excessive daytime sleepiness and fatigue.

There are three types of sleep apnea:

• obstructive--the most common--occurs when soft tissue in the back of the throat collapses and obstructs the airway, causing breathing to stop
• central--when the brain doesn't signal the muscles to breathe
• mixed--a combination of the two

During normal sleep, muscles that stiffen the airway behind the tongue and soft palate relax..With a normal size airway, there is no problem.  However, if the airway is small (anatomically or because of excess weight) it can close.  Breathing continues against the closed airway and becomes increasingly strong (in response to diminished oxygen levels and increased carbon dioxide levels) until the greater effort causes awakening, which activates the muscles to reopen the airway.  The arousals are brief (and mostly unnoticed) but if they occur frequently enough during the night, sleep becomes fragmented and non-restorative, and daytime fatigue and sleepiness results.

With proper diagnosis of sleep apnea, some dentists make appliances for patients to wear that are designed to keep the airway open.  www.prevention.com has a listing of research studies regarding the health effects of untreated sleep apnea.

Robert G. Tupac, DDS, FACP, Inc.,
Diplomate, American Board of Prosthodontics
(661) 325-1275 | www.drtupac.com
5060 California Ave., #170, Bakersfield, CA 93309

Do You Have Sleep Apnea?

Sleep apnea is a disorder which affects 18 million Americans.  It results in loud snoring and excessive daytime sleepiness and fatigue.

Types of Sleep Apnea

• obstructive--the most common--occurs when soft tissue in the back of the throat collapses and obstructs the airway, causing breathing to stop
• central--when the brain doesn't signal the muscles to breathe
• mixed--a combination of the two

How Does Sleep Apnea Affect Rest?

During normal sleep, muscles that stiffen the airway behind the tongue and soft palate relax.  With a normal size airway, there is no problem.  However, if the airway is small (anatomically or because of excess weight), it can close.  Breathing continues against the closed airway and becomes increasingly strong (in response to diminished oxygen levels and increased carbon dioxide levels) until the greater effort causes awakening, which activates the muscles to reopen the airway.  The arousals are brief (and mostly unnoticed) but if they occur frequently enough during the night, sleep becomes fragmented and non-restorative, and daytime sleepiness and fatigue results.

With a proper diagnosis of sleep apnea, some dentists make appliances for patients to wear that are designed to keep the airway open.  Prevention.com has a listing of research studies regarding the health effects of untreated sleep apnea.

Robert G. Tupac, DDS, FACP, Inc., Diplomate, American Board of Prosthodontics (661) 325-1275 | www.drtupac.com 5060 California Ave., #170, Bakersfield, CA 93309

Lose Weight to Lessen Sleep Apnea

The current issue of The Journal of the American Dental Association contains a study from Finland that was published in Sleep Medicine.  A five year observational study with a one year randomized controlled trial of adult participants who were moderately obese and had mild obstructive sleep apnea.  The investigators reported a significant change in the apnea-hyhpopnea index in the participant group that had lost weight.  Those who lost at least 5% of their weight had an 80% reduction in the incidence of OSA progression compared to those who had lost less than 5%.

Source: JADA, (4/1/14) 145, 329-330


Robert G. Tupac, DDS, FACP, Inc., Diplomate, American Board of Prosthodontics (661) 325-1275 | www.drtupac.com 5060 California Ave., #170, Bakersfield, CA 93309

Prosthodontic Treatment of Sleep Apnea

Sleep apnea symptoms

Diagnosis for sleep apnea can be made on the basis of signs and symptoms or an evaluation may be made by a sleep specialist.  A "sleep study" (nocturnal polysomnography) at a sleep disorder center involves monitoring of your heart, lung and brain activity, breathing patterns, arm and leg movements, and blood oxygen levels while you sleep.  Sometimes simplified tests may be used at home with portable devices to measure heart rate, blood oxygen level, airflow and breathing patterns, to show drops in oxygen level during apneas and subsequent rises with awakenings.  

Mild cases of obstructive sleep apnea are typically addressed with lifestyle changes:  weight loss to relieve throat constriction, avoiding alcohol or CNS depressants, quitting smoking, sleeping on your side or stomach rather than your back, or using a saline nasal spray to help keep nasal passages open.  If obstructive sleep apnea does not respond to lifestyle changes, or is moderate to severe, additional therapies or surgery are employed. 

Sleep apnea treatment

Therapies include:  CPAC--continuous positive airway pressure--a machine that delivers air pressure through a mask placed over your nose while you sleep.  The pressure is greater than that of the surrounding air and is just enough to keep upper airway passages open and prevent apnea and snoring.  It is the preferred method of treating apnea and a comfortable and secure fit may require some adjustment.  BPAP--bilevel positive airway pressure--devices adjust pressures for both inhaling and exhaling.  Oral appliances--these devices are designed to keep the throat open by bringing the lower jaw forward.  We provide these types of appliances in our prosthodontic practice.  

Surgery:  UPPP--uvulopalatopharyngoplasty--removal of tonsils, adenoids and the part of the soft palate that hangs down.  This type of surgery helps to stop throat structures from vibrating and causing snoring.  Maxillomandibular advancement--a procedure to move the jaw forward from the facial bones to enlarge the space behind the tongue and soft palate.  This may require further oral surgery and orthodontic treatment.  Surgical procedures to treat snoring--laser removal of the uvula, for example, aren't usually recommended as sole treatments for obstructive sleep apnea.  

Source:  Mayo Clinic 

Robert G. Tupac, DDS, FACP, Inc., Diplomate, American Board of Prosthodontics (661) 325-1275 | www.drtupac.com 5060 California Ave., #170, Bakersfield, CA 93309

Do You Have Sleep Apnea

Sleep apnea is a disorder which affects 18 million Americans.  It results in loud snoring and excessive daytime sleepiness and fatigue.

Types of Sleep Apnea

• obstructive--the most common--occurs when soft tissue in the back of the throat collapses and obstructs the airway, causing breathing to stop
• central--when the brain doesn't signal the muscles to breathe
• mixed--a combination of the two

How Does Sleep Apnea Affect Rest?

During normal sleep, muscles that stiffen the airway behind the tongue and soft palate relax.  With a normal size airway, there is no problem.  However, if the airway is small (anatomically or because of excess weight), it can close.  Breathing continues against the closed airway and becomes increasingly strong (in response to diminished oxygen levels and increased carbon dioxide levels) until the greater effort causes awakening, which activates the muscles to reopen the airway.  The arousals are brief (and mostly unnoticed) but if they occur frequently enough during the night, sleep becomes fragmented and non-restorative, and daytime sleepiness and fatigue results.

With a proper diagnosis of sleep apnea, some dentists make appliances for patients to wear that are designed to keep the airway open.  Prevention.com has a listing of research studies regarding the health effects of untreated sleep apnea.

Robert G. Tupac, DDS, FACP, Inc., Diplomate, American Board of Prosthodontics (661) 325-1275 | www.drtupac.com 5060 California Ave., #170, Bakersfield, CA 93309

Do You Have Sleep Apnea?

Sleep apnea is a disorder which affects 18 million Americans.  It results in loud snoring and excessive daytime sleepiness and fatigue.

Types of Sleep Apnea

• obstructive--the most common--occurs when soft tissue in the back of the throat collapses and obstructs the airway, causing breathing to stop
• central--when the brain doesn't signal the muscles to breathe
• mixed--a combination of the two

Normal Sleep 

During normal sleep, muscles that stiffen the airway behind the tongue and soft palate relax.  With a normal size airway, there is no problem.  However, if the airway is small (anatomically or because of excess weight), it can close.  Breathing continues against the closed airway and becomes increasingly strong (in response to diminished oxygen levels and increased carbon dioxide levels) until the greater effort causes awakening, which activates the muscles to reopen the airway.  The arousals are brief (and mostly unnoticed) but if they occur frequently enough during the night, sleep becomes fragmented and non-restorative, and daytime sleepiness and fatigue results.

Diagnosis of Sleep Apnea

With a proper diagnosis of sleep apnea, some dentists make appliances for patients to wear that are designed to keep the airway open.  Prevention.com has a listing of research studies regarding the health effects of untreated sleep apnea.


Robert G. Tupac, DDS, FACP, Inc., Diplomate, American Board of Prosthodontics (661) 325-1275 | www.drtupac.com 5060 California Ave., #170, Bakersfield, CA 93309

Do You Have Sleep Apneas?

Type of Sleep Apneas

Sleep apnea is a disorder which affects 18 million Americans.  It results in loud snoring and excessive daytime sleepiness and fatigue.

• obstructive--the most common--occurs when soft tissue in the back of the throat collapses and obstructs the airway, causing breathing to stop
• central--when the brain doesn't signal the muscles to breathe
• mixed--a combination of the two

How Does Sleep Apnea Affect Rest?

During normal sleep, muscles that stiffen the airway behind the tongue and soft palate relax.  With a normal size airway, there is no problem.  However, if the airway is small (anatomically or because of excess weight), it can close.  Breathing continues against the closed airway and becomes increasingly strong (in response to diminished oxygen levels and increased carbon dioxide levels) until the greater effort causes awakening, which activates the muscles to reopen the airway.  The arousals are brief (and mostly unnoticed) but if they occur frequently enough during the night, sleep becomes fragmented and non-restorative, and daytime sleepiness and fatigue results.

With a proper diagnosis of sleep apnea, some dentists make appliances for patients to wear that are designed to keep the airway open.  Prevention.com has a listing of research studies regarding the health effects of untreated sleep apnea.

Robert G. Tupac, DDS, FACP, Inc., Diplomate, American Board of Prosthodontics (661) 325-1275 | www.drtupac.com 5060 California Ave., #170, Bakersfield, CA 93309

Sleep Apnea Can Be Diagnosed And Treated

What is sleep apnea?

Sleep apnea is a sleep disorder in which breathing repeatedly stops and starts.  It occurs in two main types: obstructive--when throat muscles relax, and central--when the brain doesn't send proper signals to the muscles that control breathing.  

Signs and symptoms for sleep apnea

The most common signs and symptoms are:  excessive daytime sleepiness, loud snoring, observed episodes of breathing cessation curing sleep, abrupt awakening accompanied by shortness of breath, awakening with a dry mouth or sore throat, morning headache or insomnia.  In obstructive sleep apnea, the muscles in the back of the throat--supporting the soft palate, uvula, tonsils and tongue--relax and the airway narrows or closes when breathing in and breathing momentarily stops.  This may lower blood oxygen levels.  The brain senses the inability to breathe and briefly rouses you from sleep so you can reopen your airway.  The awakening is usually so brief that you don't remember it.  You can awaken with transient shortness of breath that corrects itself quickly within one or two deep breaths.  You may make a snorting, choking or gasping sound.  This pattern can repeat itself 5 to 30 times or more each hour, all night long.  These disruptions impair your ability to reach the desired deep, restful phases of sleep, but many people still think they have slept well.  In central sleep apnea, which is much less common, the brain fails to transmit signals to our breathing muscles.  This is often the result of heart disease and sometimes stroke.  

Risk factors for sleep apnea

Certain factors put you at risk:  excess weight, neck circumference greater than 17 inches, high blood pressure, a narrowed airway, being male or over the age of 65, having a family history of the disorder, use of alcohol or other CNS depressants, or smoking.  

Sleep apnea is considered a serious medical condition, with the following complications:  Cardiovascular--sudden drops in blood oxygen strain the system and increase the risk of high blood pressure two to three times, stroke, atrial fibrillation, congestive heart failure or sudden death.  Daytime fatigue--drowsiness, irritability, depression and poor performance.  Post-surgery complications due to breathing problems may result from undiagnosed sleep apnea.  Bed partners of people who snore are sleep deprived as well.  People with sleep apnea may also complain of memory problems, morning headaches, mood swings, frequent urination at night and impotence.  

Source:  Mayo Clinic

Robert G. Tupac, DDS, FACP, Inc., Diplomate, American Board of Prosthodontics (661) 325-1275 | www.drtupac.com 5060 California Ave., #170, Bakersfield, CA 93309

Prosthodontic Treatment of Sleep Apnea

Sleep apnea symptoms

Diagnosis for sleep apnea can be made on the basis of signs and symptoms or an evaluation may be made by a sleep specialist.  A "sleep study" (nocturnal polysomnography) at a sleep disorder center involves monitoring of your heart, lung and brain activity, breathing patterns, arm and leg movements, and blood oxygen levels while you sleep.  Sometimes simplified tests may be used at home with portable devices to measure heart rate, blood oxygen level, airflow and breathing patterns, to show drops in oxygen level during apneas and subsequent rises with awakenings.  

Mild cases of obstructive sleep apnea are typically addressed with lifestyle changes:  weight loss to relieve throat constriction, avoiding alcohol or CNS depressants, quitting smoking, sleeping on your side or stomach rather than your back, or using a saline nasal spray to help keep nasal passages open.  If obstructive sleep apnea does not respond to lifestyle changes, or is moderate to severe, additional therapies or surgery are employed.  

Sleep apnea treatment 

Therapies include:  CPAC--continuous positive airway pressure--a machine that delivers air pressure through a mask placed over your nose while you sleep.  The pressure is greater than that of the surrounding air and is just enough to keep upper airway passages open and prevent apnea and snoring.  It is the preferred method of treating apnea and a comfortable and secure fit may require some adjustment.  BPAP--bilevel positive airway pressure--devices adjust pressures for both inhaling and exhaling.  Oral appliances--these devices are designed to keep the throat open by bringing the lower jaw forward.  We provide these types of appliances in our prosthodontic practice.  

Surgery:  UPPP--uvulopalatopharyngoplasty--removal of tonsils, adenoids and the part of the soft palate that hangs down.  This type of surgery helps to stop throat structures from vibrating and causing snoring.  Maxillomandibular advancement--a procedure to move the jaw forward from the facial bones to enlarge the space behind the tongue and soft palate.  This may require further oral surgery and orthodontic treatment.  Surgical procedures to treat snoring--laser removal of the uvula, for example, aren't usually recommended as sole treatments for obstructive sleep apnea.  

Source:  Mayo Clinic 

Robert G. Tupac, DDS, FACP, Inc., Diplomate, American Board of Prosthodontics (661) 325-1275 | www.drtupac.com 5060 California Ave., #170, Bakersfield, CA 93309

Sports Dentistry

The Academy for Sports Dentistry will hold its annual meeting on August 1-3, 2013.  The group's mission is to effectively serve the combination of the fields of dentistry and athletics.  The "team dentist" has a variety of roles:

• preparation and readiness of the athlete
• sleep apnea considerations
• evaluation and management of concussions
• recognition and treatment of dental trauma
• restoration of teeth after trauma
• custom mouthguard fabrication
• intraoral suturing 

The group is affiliated with the Special Olympics Special Smiles program and the United States Olympic Committee.

Robert G. Tupac, DDS, FACP, Inc., Diplomate, American Board of Prosthodontics (661) 325-1275 | www.drtupac.com 5060 California Ave., #170, Bakersfield, CA 93309

Do You Have Sleep Apnea?

What is Sleep Apnea?

Sleep apnea is a disorder which affects 18 million Americans.  It results in loud snoring and excessive daytime sleepiness and fatigue.

Types of Sleep Apnea

• obstructive--the most common--occurs when soft tissue in the back of the throat collapses and obstructs the airway, causing breathing to stop
• central--when the brain doesn't signal the muscles to breathe
• mixed--a combination of the two

How Does Sleep Apnea Affect Rest?

During normal sleep, muscles that stiffen the airway behind the tongue and soft palate relax.  With a normal size airway, there is no problem.  However, if the airway is small (anatomically or because of excess weight), it can close.  Breathing continues against the closed airway and becomes increasingly strong (in response to diminished oxygen levels and increased carbon dioxide levels) until the greater effort causes awakening, which activates the muscles to reopen the airway.  The arousals are brief (and mostly unnoticed) but if they occur frequently enough during the night, sleep becomes fragmented and non-restorative, and daytime sleepiness and fatigue results.

With a proper diagnosis of sleep apnea, some dentists make appliances for patients to wear that are designed to keep the airway open.  Prevention.com has a listing of research studies regarding the health effects of untreated sleep apnea.

Robert G. Tupac, DDS, FACP, Inc., Diplomate, American Board of Prosthodontics (661) 325-1275 | www.drtupac.com 5060 California Ave., #170, Bakersfield, CA 93309