Airway & Sleep Apnea in Calgary
As babies, we all start off as being required to breath through our noses, which allows for proper growth and development of our faces via natural feeding and breathing patterns. The airway is the keystone to facial development. The most important and immediate physiologic function at birth is the maintenance of breathing, which remains the number one priority for our brains throughout life, to facilitate our living. Sleep-disordered breathing, tempro-mandibular dysfunction (TMD), dental crowding, bruxism/clenching, craniofacial distortions, ADHD (ARCD: Airway Related Craniofacial Dysfunction) and many other medical sequelae are considered signs and symptoms (compensations) of the deficient airway in the vast majority of cases. The airway focused dentistry approach does not obviate traditional dental intervention, but rather enhances its delivery by taking a global approach to the many problems we manage on a daily basis. It is our goal to provide a foundation for a wellness approach to dental health and development versus disease management of just the signs and symptoms.
In recent years, awareness has increased greatly about one airway issue in particular: sleep disordered breathing (SDB). Sleep-disordered breathing (SDB) is a general term for breathing difficulties occurring during sleep. SDB can range from frequent loud snoring to Obstructive Sleep Apnea (OSA), which is a condition involving repeated episodes of partial or complete blockage of the airway during sleep. When an individual’s breathing is disrupted during sleep, the body perceives this as a choking phenomenon and this sets off our “fight or flight” response, otherwise known as the sympathetic nervous system. The heart rate increases, blood pressure rises, the brain is aroused, and sleep is disrupted. Oxygen levels in the blood can also drop. Imagine having your body go through this repeatedly all night long; the effects are significant. In one estimate, OSA has been suggested to take 7-10 years off an individual’s lifespan. Consider all the effects on the body cycling through stress responses and not undergoing restorative sleep and the healing and regular hormonal regulation that normally occurs during it. This also affects our mental and physical abilities to function on a day to day basis.
However, not everyone may be on the OSA side of the spectrum. Greater awareness is now growing on the upper airway resistance (UARS) patient. In a normal sleep study, UARS patients are often not diagnosed as having any significant sleep diagnosis as they often do not meet the rigid criteria for an official medical diagnosis. As such, even though they are having those stress responses, and do exhibit signs and symptoms of fragmented sleep and overall body consequences, they leave with being told that they are fine. Yet, it is a large proportion of the population that is the UARS patient, and research is showing they are NOT fine. This is why a move away from home sleep studies alone and more thorough clinical screenings via both thorough questionnaires, assessments, high resolution pulse oximetry, and multidisciplinary teams are being employed. It is also in this sense that we are moving away from considering the above as sleep issues, and much more about an overall approach as a breathing or airway issue. Afterall, dental oral appliances (used to position the jaw forward) and CPAPs (used to open up the nasal and oral airways with air pressure) that are for OSA are moreso breathing appliances opening up the airway, rather than sleep appliances per say.
When an airway issue is suggested, it is often an interaction between form, function, and behaviour. As such, addressing issues such as tonsils/adenoids or allergies or nasal architecture or tongue ties or dental arches with orthodontic intervention(form); oral tongue and other facial muscle posture and usage (function); and dysfunctional breathing habits and sleep hygiene (behaviour) can result in treating the actual cause as opposed to a band-aid solution.
Given all of this, we screen patients regularly for any potential airway concerns. When a concern exists, we perform a joint airway and oral myology assessment (please see oral myology section) with a two visit approach: initial data collection visit and then a discussion of results visit. In this process, numerous photos, videos, measurements, and screening forms will be used to discuss any potential concerns, along with a discussion of potential treatment modalities or referrals that may be appropriate. The key to remember is this is a process, not a shotgun magic bullet to a problem. Yet, a dedicated move to improving your dental and overall health can be life-changing.