Of the 50 to 70 million people with a sleep disorder in the United States, at least 10 million of them remain undiagnosed, and therefore untreated. On top of the disruptions to their daily lives, those with a sleep disorder may also be at higher risk of developing chronic health conditions such as diabetes, heart disease, and hypertension. Lack of sleep can even be dangerous: drowsy driving is responsible for over 1,000 fatalities and 40,000 injuries every year in the US.
Diagnosis and treatment are essential to preventing the development or worsening of these conditions due to sleep deprivation. As a dentist, you play an instrumental role in the screening and treatment of sleep disorders. According to the ADA, dentists should play a more prominent role in treating sleep-related breathing disorders like sleep apnea because they are the only healthcare provider with the expertise needed to provide oral appliance therapy. Dentists like you are the key to addressing sleep and breathing disorders and improving the lives of your patients.
When do your patients’ offhanded comments about being tired suggest something more serious is happening? Here are four signs that your patient may be dealing with a sleep disorder.
They Breathe Through Their Mouth
How we breathe can influence the quality of our sleep in a few ways. For example, nasal breathing is better for rest than oral breathing. When we breathe through the mouth rather than the nose, it triggers the sympathetic nervous system, causing us to become more hyperactive and preventing us from settling into a deeper sleep. Mouth breathing also narrows the size of the airway significantly, as it causes the jaw to move inferiorly and posteriorly. Finally, breathing through the mouth bypasses a reflex called the nasal ventilation reflex, which increases respiratory rate and minute ventilation, leading to deeper sleep.
If you notice that one of your patients breathes through their mouth and has a hard time keeping their mouth open for the entirety of a checkup because of it, ask them about the quality of their sleep. They could have obstructive sleep apnea (OSA) due to disordered breathing.
They Clench Their Teeth
Teeth clenching is another sign of obstructive sleep apnea. Studies have found that many people with OSA grind their teeth at night, although it is unclear whether there is causation or only correlation. There are a few reasons why sleep apnea and teeth grinding/clenching are associated with one another. First, some believe that clenching can help those with a restricted airway open their jaw to breathe better. Others think it may help lubricate the tissue in the back of the throat that becomes dried out from the labored breathing that comes with OSA.
If you notice that your patient has teeth that are flattened, fractured, loose, or chipped, or that they have worn tooth enamel, they most likely grind their teeth at night. In this case, consider screening them for a sleep disorder like OSA. Addressing the sleep disorder first may help them stop grinding and clenching, therefore improving the strength of their teeth.
They Have Poor Sleep Hygiene
Nobody gets closer to your patients’ mouths than you during a checkup, which means you probably get a pretty good idea of their bedtime habits, at least when it comes to their oral hygiene. If it seems as though they are not regularly brushing and flossing, it’s possible they also do not have a consistent bedtime routine. Setting a schedule when it comes to sleep can improve the quality of one’s sleep—alternatively, failing to do so can result in the opposite and lead to insomnia.
For example, poor sleep hygiene practices can include the following behaviors:
- Regular consumption of alcohol, caffeine, or nicotine, especially before bedtime
- Irregular sleep scheduling with frequent napping, spending extended amounts of time in bed, or waking and sleeping at different times
- Engagement in stimulating activities too close to bedtime
- Use of bed for activities other than sleeping, like watching television, working, studying, planning, snacking, etc.
If a patient regularly says they are tired at a checkup, consider asking them about their nighttime routine. It’s possible that their poor sleep hygiene affects the quality of their sleep and could have led to a sleep disorder.
Their Family Has a History of Sleep Disorders
Family history could also play a role in sleep disorders like insomnia and sleep apnea. Insomnia symptoms may be genetically inherited, just like your likelihood of being a “light” or “heavy” sleeper can be. Similarly, research suggests that sleep apnea is about 40 percent genetic, while the other 60 percent of causes are environmental. Plus, the more relatives you have with a sleep disorder, the higher your risk of also developing the condition.
If a patient mentions getting insufficient sleep, consider asking them if they know anyone who also struggles with sleep or has a sleep disorder. If they can think of several people in their family who also have problems sleeping, they could have sleep apnea or insomnia.
As a dentist, you need to look for signs of sleep disorders in your patients, especially breathing-related sleep disorders like sleep apnea. Not only are you best prepared to catch potential problems, but you may be the first or only line of defense for screening and helping those in need get the treatment they need to sleep well and improve their quality of life.