How does the doctor determine if I have OSA?
First, a sleep test called polysomnogram is usually done to diagnose sleep apnea. There are two kinds of polysomnograms. An overnight polysomnography involves spending one night at a sleep laboratory to obtain a full report of movement, respiration, oxygen levels, etc. during sleep, which the doctor will review. This is the best form of sleep study there is. The second kind of polysomnogram is a home monitoring test. Dr. Lawson can provide a small device to take home with you, which will record your sleep with a computerized polysomnogram; these are painless tests.
Very mild snoring is usually treated by some behavioral changes. Weight loss and sleeping on your side are often recommended. There are oral appliances that keep the airway open that may help to reduce snoring in three different ways. Some devices (1) bring the jaw forward or (2) elevate the soft palate or (3) retain the tongue (from falling back in the airway and blocking breathing).
Severe sleep apnea is usually treated with a C-PAP (Continuous Positive Airway Pressure). C-PAP is a machine that blows air into your nose via a nose/face mask, keeping the airway open and unobstructed. Some people have facial deformities that may cause sleep apnea: a jaw too small for their airway or a smaller opening at the back of the throat. Some people have enlarged tonsils, and sometimes a large tongue or some other tissues partially blocking the airway. Correcting a deviated septum may help to open the nasal passages. Removing the tonsils and adenoids or polyps may help as well.
Children are much more likely to have their tonsils and adenoids removed, combined with palatal expansion to increase the size of their airway. Children with OSA must be treated as soon as possible as the apnea can greatly retard their ability to grow properly or fully.
Screening tests that Dr. Lawson performs may include:
1. Performing an oral examination and evaluation on the head, neck and facial area, teeth and supporting structures.
2. Upper and lower dental impressions may be taken.
3. Lateral Cephalogram and Tomographic x-rays of the jaws will be used to evaluate the jaw position and airway potential.
4. Using a non-invasive instrument called an Eccovision® Pharyngometer/Rhinometer.
The Pharyngometer/Rhinometer, used with a computer, assesses both the oral and nasal airway passages. The pharyngometer is the first accurate, non-invasive, yet cost-effective screening technique to identify patients at risk for OSA.
During the test, the patient is asked to breathe into a tube. Sound waves travel through the mouth into the throat area and are then reflected back and measured. The equipment records the information in the form of a graph that is then interpreted by the dentist.
The patient is awake and alert at all times. This initial screening can be accomplished in as little as five minutes and is easy and quick.
Pharyngometry/Rhinometry offers to the dentist and the patient the first non-invasive, three- dimensional view of the pharyngeal (throat) and nasal airways using sound waves much like sonar on a submarine.
With this unique equipment Dr. Lawson can:
1. See if a patient has a narrow airway and/or collapsible airway (these are indications of possible sleep apnea).
2. Determine if the patient’s airway responds positively to vertical and/or anterior (forward) positioning of the mandible (lower jaw), which shows if an oral appliance will have a positive effect on the airway. If not, the appliance would not be appropriate at this time.
3. Evaluate whether the nasal airway is blocked by mucous and/or structural damage since this can be part of the snoring noise.
4. Determine the proper positioning for an oral appliance. With the use of this state-of-the-art equipment, the sleep professional does not guess at oral appliance positioning. He can actually prescribe the correct appliance to treat the snoring and/or apneic condition.
Both Pharyngometry and Rhinometry measurements have been verified by endoscopy, CT and MRI scanning with less time and money involved. A printout of the test result is made for medical specialists. The dentist may recommend a sleep study be performed by a physician or sleep clinic either before or after screening, or as a follow-up to delivery of the sleep appliance.
These screening tests are extremely effective when used before surgery and in evaluating relief of nasal obstruction after surgery. Along with the pulmonologist or sleep doctor, sleep dentistry brings effective “team management” to the patient to minimize or correct the problem.