Why do so many patients with snoring issues also grind their teeth? And why do elderly patients who sleep without dentures often wake up gasping for air? Why do so many people keep a glass of water next to their bed yet still wake up with a dry mouth? Their dentists might hold answers to some of these questions.
Francisco, a patient from my dental practice, stands out in my memory. A charming 30-year-old, he was a regular visitor due to frequent dental emergencies. His teeth were ground down to stubs and constantly breaking. He complained of low energy, persistent morning headaches, and feeling worse upon waking than when he went to bed. Suspecting sleep apnea, I referred him for a sleep study, hoping to break the cycle of sleepless nights and recurring dental problems.
From Francisco and countless other patients, I've learned that dentists can play a critical role in helping people achieve better sleep.
Dentists are uniquely positioned to detect early signs of sleep-disordered breathing, including sleep apnea. With regular checkups every three to six months, we form trusted relationships with our patients, giving us insight into their overall health.
Take Francisco, for example. He kept coming in with persistent jaw pain, morning headaches and complaints of a dry mouth, unaware they might be tied to his dental health. His family constantly mentioned his loud snoring, but he didn't connect it to a deeper issue. During his visits, tight jaw muscles, clenching and enamel erosion consistently show up -- key indicators of acid reflux, a condition frequently linked to obstructive sleep apnea.
Studies reveal a strong connection between teeth grinding (bruxism) and obstructive sleep apnea. Nearly three-quarters of people who grind their teeth also have obstructive sleep apnea, while half of those with sleep apnea are also affected by bruxism. This demonstrates a two-way relationship between the conditions, emphasizing the need to address both when treating patients.
Dr. Steven Lamberg, author of Treat the Cause, Treat the Airway, emphasizes that "dentists are often the first to notice these signs, even before patients realize there's a problem."
While dentists cannot diagnose sleep apnea, we can collaborate with medical practitioners to identify and treat the condition. We can use questionnaires, apps or wearable gadgets to screen for sleep apnea and refer patients to sleep specialists. Dentists certified by the American Academy of Dental Sleep Medicine can create custom oral appliances as an alternative to CPAP therapy for patients diagnosed with sleep apnea. These appliances reposition the jaw to keep the airway open during sleep.
"All my patients who come to the office for dental care fill out a sleep questionnaire," mentioned Dr. David Federici, diplomat of the American Academy of Dental Sleep Medicine.
Sleep apnea isn't just an adult issue. Around 1-5% of children have sleep apnea, often due to enlarged tonsils or adenoids.
Dentists may notice several signs in children indicating potential sleep or airway issues. These include a vaulted roof of the mouth, which can lead to a narrower dental arch and result in crowded teeth. Symptoms like snoring, mouth breathing and a constant open-lip position are common signs. Additionally, excessive energy, sometimes misdiagnosed as attention deficit hyperactivity disorder, and poor growth could point to underlying sleep-related problems.
Dr. Joseph Gaudio, author of Your Child and Sleep-Disordered Breathing, notes that "dentists play a vital role in recognizing these signs early, helping children avoid life-long consequences."
1. Focus on promoting nasal breathing. Breathing through the nose is essential for restful sleep, while mouth breathing can lead to fatigue and interrupted sleep. To encourage nasal breathing, clear your nasal passages before bed using saline irrigations, apply moisturizing nasal creams and consider putting tape over your mouth during sleep, starting with daytime use. Nasal breathing engages the parasympathetic nervous system, helping your body relax and recharge.
2. Improve your sleep hygiene by investing in a supportive pillow that properly aligns your neck and head, ensuring better posture during sleep.
3. Keep your room temperature below 65 degrees Fahrenheit to help your body cool down overnight.
4. Limit blue light exposure at least 30 minutes before bed. Blue light from screens disrupts melatonin production, which is vital for sleep. Instead, opt for red or orange light to promote relaxation.
5. Light exposure in the morning for 10 minutes can also help align with your circadian rhythm. This helps reset your internal clock and prepares your body for the day ahead. Molly Eastman, sleep coach with the Sleep is a Skill program, emphasizes the importance of living in sync with sunlight cycles: "Bright blue light in the morning energizes us, while the warm red hues of sunset prepare us for sleep."
By detecting sleep-disordered breathing, collaborating with medical specialists and guiding patients toward better habits, dentists do much more than fix teeth -- they empower patients to lead healthier, more energized lives.
Francisco's story had a happy ending. Once his sleep apnea was treated, we restored his damaged teeth, and he woke up feeling refreshed, regaining the energy for his morning walks. His story is just one of many that highlight the vital role dentists play in solving the mystery of poor sleep.