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                                                        DR. DAN PETERSON

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Snoring and Dental Treatment

Do you keep those you sleep with up at night?

     It is estimated that more than 80 million people in North America snore while sleeping. National Institutes of Health (NIH) found that 30% of the population under 40 years of age snores, while 50% over the age of 60 does. Spouses and children are often repeatedly disturbed during their sleep cycles by a snoring family member, which can lead to tensions and animosity.

     Sleep apnea and snoring can be frustrating for patients and their loved ones. Lack of sleep and the associated physical affects can be life altering or life ending. Recent studies have linked a high percent of patients with sleep apnea and snoring with an increase in arteriosclerosis of the carotid arteries of the neck. This can lead to an increased risk of cardiovascular problems such as heart attack or stroke. Snoring can kill you, according to a UCLA School of Dentistry study: the struggle for breath can result in soaring blood pressure which can damage the walls of the carotid arteries and increase the risk of stroke.

Snoring and sleep apnea can also worsen serious health problems including hypertension, leading to stroke, heart attacks, heart failure and puts the patient at an increased risk for sudden death. The National Council on Sleep Disorders attributes 38,000 cardiovascular deaths per year to consequences of sleep apnea.

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 What causes snoring?

During sleep, the muscles and soft tissue in the throat and mouth relax making the breathing airway smaller. This decrease in the airway space increases the velocity of air flowing through the airway during breathing. As the velocity of required air increased in the constricted space, soft tissue like the soft palate and uvula vibrate. These vibrations of the soft tissues in the mouth and throat result in what is called "noisy breathing" or generally referred to as snoring. It has also been shown in sleep studies that excess body weight especially in the throat area, heavy alcohol consumption and other sedatives increase the severity of snoring.

Relaxed and collapsed airway produces soft tissue vibrations during breathing which result in snoring.

With a SILENT NITE device the airway remains open allowing easier breathing and preventing snoring.

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Surgical techniques to remove respiration impairing structures such as uvula, enlarged tonsils and adenoids have been among the many attempted snoring remedies. These soft tissue surgical procedures have shown only moderate success rates (e.g. 20 - 40%). At certain levels of severity, complete blockage of the airway space by soft tissues and the tongue can occur. If this period of asphyxiation lasts longer than 10 seconds, this is called Obstructive Sleep Apnea

The majority of snorers can be treated with dentist prescribed oral snoring appliances such as the Silent Nite. This also serves as a wonderful adjunct in those patients who do require surgery to treat their OSA and snoring, increasing success to 85 - 90% in those patients.

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What are the symptoms Snoring and Sleep Apnea?

bulletWaking up after a full night in bed and feeling tired
bulletWhile you sleep, do you jump or jerk
bulletWaking with a headache
bulletFeeling sleepy during the day
bulletFalling asleep during the day
bulletWaking during the night with a feeling of gasping for air
bulletUnable to concentrate during the day
bulletDecrease in psychomotor behavior such as sexual activity
bulletSnore loudly or erractically

 Self Test For Sleep Apnea

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How can I prevent snoring?

Snoring is involuntary but changes in your lifestyle an alleviate occasional snoring.

bulletAvoiding sedatives and antihistamines
bulletLose weight to increase the airway space.
bulletDaily exercise to improve muscle tone 
bulletQuit smoking
bulletGet treatment for allergies is you have them
bulletSleep on your side instead of your back ( when you sleep on your back, your tongue falls backwards into your throat, which can narrow your airway and partially block airflow)
bulletAvoiding alcohol and heavy meals 3-4 hours before bedtime
bulletSleeping with a pillow that supports the neck and does not cause the head to    be held at a sharp angle
bulletKeeping the air moist in your bedroom, as dry air causes the membranes to more readily collapse.
bulletNasal sprays for snorer whose nasal passages are blocked due to swelling or increased mucous 
bulletOral appliances with a cost range from $50 to $2,000.
bulletRead about sleep disorders :"Sleep Disorders for Dummies". 
bulletAvoid caffeine it is one of the main culprits in sleep disorders.

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How can snoring and sleep apnea be treated?

Snoring and sleep apnea both are sleep disordered breathing.  Simply snoring represents a mild disorder where breathing becomes very loud but the upper airway is only partially obstructed during sleep. 

Snoring is a common symptom of obstructive sleep apnea.  However, sleep apnea is a serious medical disorder that occurs because the airway is totally obstructed during sleep and breathing completely stops for 10 seconds or more.  In one night 20 to 30 involuntary breathing pauses can occur.  If your partner hears loud snoring punctuated by silences and then a snort or choking sound as you resume breathing, this pattern could signal sleep apnea. 

18 million Americans suffer from undiagnosed and untreated sleep apnea.  This disorder may:

bulletRaise your blood pressure
bulletDecrease the flow of oxygen to your brain
bulletDecreased work performance
bulletImpaired daytime functioning
bulletHart failure 
bulletPossibly for stroke

Depending on the severity of your snoring and sleep apnea several approaches can be used. Often they are used in combination to eliminate the problem.

Oral appliances such as the Silent Nite, can be used either alone or following surgery to help increase the airway space.

Continuous positive airway pressure (C-pap) involves the use of a mask worn over the nose during sleep that blows air into your throat to maintain an open airway decreasing airway collapse.

Surgical approaches include; trimming of the soft palate and uvula with a laser called laser assisted uvuloplasty (LAUP). Radio-frequency devices have been used to shrink tissues in the throat and nose. Correction of deviated septum and trimming of the bony turbinates of the nose has been used to increase nasal airflow.

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How does the Silent Nite prevent snoring?

Snoring research has shown that custom fabricated dental appliances worn at night that move the lower jaw into a forward position, increase the three dimensional space in the airway tube which reduces air velocity and soft tissue vibration. By increasing the volumetric capacity of the airway and preventing soft tissue vibrations, snoring is eliminated. In clinical research studies, these dentist fabricated oral appliances have exhibited initial snoring prevention success rates of between 70 to 100%.

The Silent Nite~ appliance positions the lower jaw into a forward position by means of special connectors that are attached to the upper and lower forms. These forms are custom laminated with heat and pressure to the dentistís model of your mouths providing an excellent and comfortable fit with minimal size to the appliance.

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Breathing is EASIER with the Silent Nite appliance

The Silent Nite does not interfere with breathing through the mouth. Even when nasal passages are congested the device prevents snoring and allows uninhibited oral breathing. The connectors allow the patient to move the jaw side to side and open and close the mouth minimizing potential stiffness in the joints of the jaw in the morning. Silent Nite appliances help promote deeper, more restful sleep by preventing snoring. You wake feeling better rested and more energetic.

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How can I determine if the Silent Nite appliance will benefit me?

A simple test is to put your teeth together, close your lips and inhale through your nose. You should then open your mouth and move your lower teeth slightly in front of your upper teeth (a bull dog like bite) and close your lips. When inhaling through your nose you should notice improved airflow and less snoring noise. If the result to this test is positive (less noise and better breathing) then the SilentNite appliance will benefit you. This therapy has been shown in studies to help 85% of patients that snore or have sleep apnea. The remaining 15% require other therapeutic approaches (i.e. surgical) to correct the problem.

Snoring may indicate sleep apnea. Sleep apnea is a serious disease - and is said to reduce lifespan by about 10 years, be associated with heart problems, memory problems, impotence. It's not about snoring - it's about life and death. Present it correctly to your patients and not many refuse diagnosis.

According to a recent study, untreated sleep apnea may increase a person's risk of motor vehicle accidents. That's because sleep apnea, a snoring condition characterized by intermittent airway obstruction, can deprive you of sleep, making driving a danger. But accident risk is reduced when sleep apnea is treated.

Your dentist can help diagnose this condition or refer you to a specialist.  If your dentist thinks your have sleep apnea he may refer you to a physician or sleep specialist.  For a proper diagnosis you may have to undergo an overnight sleep study.  With a proper diagnosis your dentist and doctor can work closely together to implement a therapy to help you.

Source: RealAge Benefit: Getting 6 to 8 hours of sleep per night can make your RealAge as much as 3 years younger

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New Research:

Curing The Snore  

With the news this week that snoring and chronic daily headache are linked, here are simple exercises that help in reducing snoring frequency and volume, for those who don't want to take drugs daily 

 Tongue and throat exercises, if practiced diligently over a period of time, may be of great benefit in reducing snoring. Repeat each of the following exercises 5 times each, twice daily

1) Slowly open and close your mouth to its full extent, making sure the lips meet when closing.
2) Pucker your lips (as if about to kiss). Hold for a count of 10. Relax.
3) Spread your lips into a big, exaggerated smile. Hold. Relax.
4) Mix Exercises 2 & 3: Pucker-Hold-Smile-Hold. 
5) Try to pucker with your mouth wide open, without closing your jaws together. Hold & relax.
6) Close your lips and press them tightly together. 
7)Close your lips firmly, then make a 'slurping' noise, as if sipping a drink.
8) Open your mouth and stick out your tongue. Be sure your tongue comes straight out of your mouth and doesn't go off the side. Hold, relax and repeat several times. Work toward sticking your tongue out farther each day, but still pointing straight ahead.
 9) Stick out your tongue and move it slowly from corner to corner of your lips. Hold in each corner, relax and repeat several times. Be sure your tongue actually touches each corner each time. 
10) Stick out your tongue and try to reach your chin with the tongue tip. Hold at the farthest extension.
11) Stick out your tongue and try to touch your nose with the tongue tip. Hold at farthest extension.
12) Stick out your tongue. Hold a spoon upright against the tip of your extended tongue and try to push it away while your hand holds the spoon in place.
13) Repeatedly stick your tongue in and out as fast as you can.
14) Flick your tongue from corner to corner as quickly as you can. 
15) Move tongue all around your lips in a circle as quickly as you can, making sure you stay in constant contact.
16) Open and close mouth as quickly as you can, making sure your lips close each time. 17) Say 'Ma-Ma-Ma-Ma' as quickly as possible, ensuring there's an 'em' and an 'ah' sound each time. 
18) Repeat with 'La-La-La-La.'
19) Repeat with 'Ka-Ka-Ka-Ka' as quickly and accurately as you can. 
20) Repeat with 'Kala-Kala-Kala-Kala.'
21) Gargle loudly with warm water. 
22) Sing through the vowel sounds (A-E-I-O-U) as loudly as you can (or dare). Songs like 'Old McDonald Had a Farm' are also good.
Further information Further advice for patients can be found in Scott E. Dr. The Natural Way to Stop Snoring

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Snoring associated with head shapeCWRU researchers find snoring associated with head shape.   Approximately 75 percent of the time, the
investigator was able to predict whether the individual was a snorer.
In addition to reducing the cardiovascular problems and accidents
snorers suffer, one of the benefits of the study is that head shape can now be used to find new ways to lower the fortissimo of the nightly music to a soft lullaby.
Wed, 09 Jan 2002 17:31:33 -0000

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Exercises to Help Cure Snoring

Exercises to cure snoring are found at this site: Exercises to reduce snoring frequency and volume.

To learn about sleep apnea see: Sleep apnea and dental treatment.

Academy of General Dentistry Fact Sheet, Impact pg 20  May 2003.

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