Dentist - San Diego
3222 Governor Drive
San Diego, CA 92122
(858) 453-8520

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The noisy sounds of snoring occur when there is a partial blockage to the flow of air through the air passages. Snoring is a result of the vibration of upper airway structures during sleep. When you sleep, the muscles of the body become relaxed, including the ones inside the throat and mouth. If the airway is partially blocked during sleep, when you breathe, the air cannot freely travel through the airway. The noise of snoring happens when the upper airway structures vibrate as the air from breathing struggles to pass by them. The area of obstruction is where the pharynx and tongue meet the uvula and soft palate.

Approximately 40% of adults snore. The loudness of snoring can vary, ranging from seldom light snoring to a loud habitual snore. The later can result in a disruption of sleep for themselves and their partner. Snoring is disturbing and is a major cause of spousal relationship issues. The incidence of snore increases with age. Also, people that are overweight are more prone to snoring. It is estimated that about 10% of children snore.

There are incidences where snoring is so loud that it disrupts the sleep of the person snoring and their family members. In these incidences, the individual’s upper airway is completely blocked and no air is able to pass through. The pauses in breathing can last 10 seconds or longer. There is gasping for air followed by a brief period of partial arousal where the person’s sleep becomes disturbed. During this pause in breathing, there is a decrease in the oxygen blood level, causing the heart to pump harder, and a dose of blood sugar to help stimulate the body. These apnea episodes can occur hundreds of times a night, causing the individual to wake up feeling un-refreshed and tired. Snoring is the most attention demanding indication of a possible serious sleep disorder. This type of sleep disorder is called Obstructive Sleep Apnea (OSA).

Snoring is the connection to the possibility of having Obstructive Sleep Apnea. Often times, sleep apnea goes undiagnosed because it is mistaken for snoring. Snorers who have sleep apnea will make gasping or choking noises when they try to breath.

Common signs of OSA are:

  • Chronic snoring
  • Waking up in the morning feeling restless
  • Daytime drowsiness or sleepiness
  • Being inappropriately sleepy
  • Low energy level
  • Insomnia
  • Morning headaches

The lack of proper sleep and inadequate blood oxygen level that results from Obstructive Sleep Apnea dramatically increases the risk of:

  • High blood pressure
  • Diabetes type II
  • Stroke
  • Gastric reflux (GERD)
  • Depression/anxiety
  • Memory problems
  • Automobile accidents
  • Erectile dysfunction
  • Impaired concentration

There is also a connection between OSA and ADHD and learning problems in children.

What happens during sleep

During sleep, your body is busy at work to heal damaged tissue cells, boost the immune system, rest from the stress of the day and recharge the cardiovascular system and heart. Also, the body cycles through two different sleep phases, REM (rapid eye movement) and NREM (non rapid eye movement). Each phase is important for different bodily functions. For a patient with obstructive sleep apnea, the body is not getting the rest and sleep that it needs to regenerate, restore, and recharge the cells and organ systems for the next day.

Pathway to treatment of OSA

Health care provider assessments are taken on an individual suspected of having Obstructive Sleep Apnea. Patient’s physician(s) or dentist trained in the field of Dental Sleep Medicine can perform the assessments. A complete medical and dental history is taken. The patient also answers one or more sleep questionnaires such as the Epworth test, Berlin test, and Stop Bang test. These questionnaires take in to account any pertinent medical conditions, and ultimately determine the relative amount of sleepiness. From this information, it is determined whether or not to refer the patient for a sleep analysis test. This test can be performed either at home or at an overnight sleep study center. The sleep physician makes the diagnosis of the type of sleep disorder and recommends the most effective treatment approach.

Once a patient has been diagnoses with Obstructive Sleep Apnea (OSA), treatment options are discussed. There are 3 different options:

  1. Surgical treatment
  2. CPAP (continuous positive airway pressure) device
  3. Oral Appliance Therapy (OAT)

Oral Appliance Therapy

The oral appliance, or mandibular repositioning device (MRD) is made and adjusted by a dentist that has been trained in Dental Sleep Medicine. Oral appliances are effective treatment for both mild and moderate obstructive sleep apnea. They can also be used in cases of severe OSA where the patient refuses CPAP or is unable to tolerate the CPAP. The specially trained dentist can help select the best possible type of oral appliance for their patient’s needs.

Custom made oral appliances reposition the tongue and lower jaw forward during sleep to maintain an open airway. They also help to stabilize the position and increase the muscle tone of the soft tissue in the upper airway. Follow up visits with dentists trained in dental sleep medicine and post delivery sleep studies will ensure the proper treatment for the patient’s sleep apnea.

Get the rest you and your partner deserve:

If you feel that you or someone that you know has obstructive sleep apnea, please call our office. Dr. Andrew Firtel has studied the field of Dental Sleep Medicine and treatment of sleep apnea extensively. After a thorough exam and consultation, Dr. Firtel will be able to direct you through the process of getting a diagnosis and treatment for sleep apnea. If you have received a diagnosis of obstructive sleep apnea or suffer from snoring, Dr. Andrew Firtel will help you determine if oral appliance therapy (OAT) is the right treatment for you. If an oral appliance is the right option, fabrication of the appliance will begin. Once the appliance is being used regularly, the patient will be referred back to the sleep physician to determine the effectiveness of the appliance.

Most medical insurance companies pay for part or all of the oral appliance therapy (mandibular repositioning device). Our office will work with you and your insurance company to insure that you optimize your maximum allowable medical benefits.


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