Friday, March 31, 2017

Sleep Apnea: It's Consequences and Symptoms

Medical Conditions Related to Sleep Apnea

Diabetes. Diabetes is associated with sleep apnea and snoring. It is not clear if there is an independent relationship between the two conditions or whether obesity is the only common factor.
Gastroesophageal Reflux Disease (GERD). GERD is a condition caused by acid backing up into the esophagus. It is a common cause of heartburn. GERD and sleep apnea often coincide. Research suggests that the backup of stomach acid in GERD may produce spasms in the vocal cords (larynx), thereby blocking the flow of air to the lungs and causing apnea. Apnea itself may also cause pressure changes that trigger GERD. Obesity is common in both conditions, and more research is needed to clarify the association.
Polycystic Ovary Syndrome (PCOS). Obstructive sleep apnea and excessive daytime sleepiness appear to be associated with polycystic ovary syndrome (PCOS), a female endocrine disorder. About half of patients with PCOS also have diabetes. Obesity and diabetes are associated with both sleep apnea and PCOS and may be the common factors.


Sleep apnea can lead to a number of complications, ranging from daytime sleepiness to possible increased risk of death. Sleep apnea has a strong association with several diseases, particularly those related to the heart and circulation.

Daytime Sleepiness

Daytime sleepiness is the most noticeable, and one of the most serious, complications of sleep apnea. It interferes with mental alertness and quality of life. Daytime sleepiness can also increase the risk for accident-related injuries. Several studies have suggested that people with sleep apnea have two to three times as many car accidents, and five to seven times the risk for multiple accidents. Undertreated sleep apnea is a major risk factor for injury at factory and construction work sites.

Effects of Sleep Apnea on Heart and Circulation

Sleep-disordered breathing is very common among patients with heart problems such as high blood pressure, heart failure, stroke, heart attack, and atrial fibrillation. This link may be because both cardiovascular conditions and sleep apnea share a common risk factor of obesity. However, increasing evidence suggests that severe OSA is an independent risk factor that may cause or worsen a number of heart-related conditions.
High Blood Pressure. Moderate-to-severe sleep apnea definitely increases the risk for high blood pressure (hypertension) even when obesity is not a factor. Doctors are not certain whether treating OSA with CPAP reduces the risk for high blood pressure, but studies indicate that CPAP may help prevent or decrease high blood pressure.
Coronary Artery Disease and Heart Attack. Sleep apnea appears to be associated with heart disease regardless of the presence of high blood pressure or other heart risk factors. Studies suggest that patients with moderate-to-severe obstructive sleep apnea have a higher risk for heart attack.
Stroke. Sleep apnea may increase the risk of death in patients who have previously had a stroke.
Heart Failure. Up to a third of patients with heart failure also have sleep apnea. Central sleep apnea often results from heart failure. Obstructive sleep apnea can cause heart damage that worsens heart failure and increases the risk for death.
Atrial Fibrillation. Sleep apnea may be a cause of atrial fibrillation (irregular heartbeat).

Other Adverse Effects on Health

Sleep apnea is associated with a higher incidence of many medical conditions, besides heart and circulation. The links between apneas and these conditions are unclear.
  • Diabetes. Severe obstructive sleep apnea is associated with type 2 diabetes.
  • Obesity. When it comes to sleep apnea and obesity, it is not always clear which condition is responsible for the other. For example, obesity is often a risk factor and possibly a cause of sleep apnea, but it is also likely that sleep apnea increases the risk for weight gain.
  • Pulmonary hypertension (high pressure in the arteries of the lungs).
  • Asthma. Sleep apnea may worsen asthma symptoms and interfere with the effectiveness of asthma medications. Treating the apnea may help asthma control.
  • Seizures, epilepsy, and other nerve disorders. There may be an association between seizures and obstructive sleep apnea, especially in older adults. Some studies have shown treatment of obstructive sleep apnea may help in the control of refractory seizures.
  • Headaches. Sleep disorders, including apnea, may be the underlying causes of some chronic headaches. In some patients with both chronic headaches and apnea, treating the sleep disorder may cure the headache.
  • High-risk pregnancies. Sleep apnea may increase the risk of pregnancy complications, including gestational diabetes and high blood pressure.
  • Eye disorders, including glaucoma, floppy eyelid syndrome, optic neuropathy conjunctivitis, dry eye, and various other infections and irritations. Some of these latter symptoms may be associated with CPAP treatments for sleep apnea.

Psychological Effects

Studies report an association between severe apnea and psychological problems. The risk for depression rises with increasing severity of sleep apnea. Sleep-related breathing disorders can also worsen nightmares and post-traumatic stress disorder.

Effects on Bed Partners

Because sleep apnea so often includes noisy snoring, the condition can adversely affect the sleep quality of the bed partner. Spouses or partners may also suffer from sleeplessness and fatigue. In some cases, the snoring can disrupt relationships. Diagnosis and treatment of sleep apnea in the patient can help eliminate these problems.

Effects in Infants and Children

Failure to Thrive. Small children with undiagnosed sleep apnea may "fail to thrive," that is, they do not gain weight or grow at a normal rate and they have low levels of growth hormone. In severe cases, this may affect the heart and central nervous system.
Attention Deficits and Hyperactivity. Problems in attention and hyperactivity are common in children with sleep apnea. There is some evidence that such children may be misdiagnosed with attention-deficit hyperactivity disorder. Even children who snore and do not have sleep apnea may be at higher risk for poor concentration.


People with sleep apnea usually do not remember waking during the night.

Symptoms in Adults

Symptoms may include:
  • Excessive daytime sleepiness. Generally, patients risk falling asleep during the day while performing routine activities such as reading, watching TV, sitting inactively, lying down, or riding in a car while a passenger or stopped for a few minutes in traffic. Usually, these brief episodes of sleep do not relieve their overall sense of sleepiness.
  • Morning headaches.
  • Irritability and impaired mental or emotional functioning. These types of symptoms are directly related to interrupted sleep.
  • Snoring. Bed partners may report very loud and interrupted snoring. Patients experience snoring associated with choking or gasps. This often occurs in a crescendo pattern with the loudest noises occurring at the very end. Snoring is more likely to occur when lying on the back. Patients often suffer from frequent arousals during sleep because of snoring.

Symptoms in Children

Sleep apnea occurs in about 2% of children. They may have symptoms that differ from adults, including:
  • Longer total sleep time than normal in some children, especially obese children or those with severe apnea.
  • More effort in breathing (flaring nostrils, heaving chests, sweating). The chest may have an inward motion during sleep.
  • Behavioral difficulties without any obvious cause, such as hyperactivity and inattention.
  • Irritability
  • Bed-wetting
  • Morning headaches
  • Failure to grow and gain weight


The symptoms of obstructive sleep apnea are not very specific. This means that most people who snore at night or who feel tired during the day probably do not have sleep apnea. Other medical reasons for daytime sleepiness should be considered by your doctor before referral to a sleep center for diagnostic sleep tests. They include:
  • Having to work excessive hours or varying shifts (nights, weekends)
  • Medications (tranquilizers, sleeping pills, antihistamines beta blockers, many others)
  • Alcohol abuse
  • Medical conditions (such as underactive thyroid, abnormal blood sodium levels, high blood calcium levels)
  • Self-imposed short sleep time
  • Other sleep disorders, such as narcolepsy, insomnia, or restless legs syndrome
  • Chronic fatigue syndrome
  • Depression or dysthymia
Symptoms or findings that make the need for evaluation by a sleep specialist include:
  • Sleepiness is affecting patient's quality of life
  • Sleepiness on-the-job places the patient or others in danger
  • Others have observed apnea or breath-holding episodes while asleep
  • Other medical illnesses that may be worsened by obstructive sleep apnea are present.
  • Children who are snoring a lot and are irritable, not thriving or growing well, or having behavioral issues

If symptoms suggest obstructive sleep apnea or other sleep disorders, further diagnostic testing will be performed. A sleep specialist or sleep disorders center will perform an in-depth medical and sleep history and physical exam. Centers should be accredited by the American Academy of Sleep Medicine.

Friday, March 24, 2017

March is Oral Health month in the Philippines, So let's join in to Protect Our Oral Health!

Congratulations! You’ve already taken the first step towards good oral health by pursuing active
periodontal therapy. You’re already beginning to enjoy some of the benefits of treatment- a healthy
mouth and a happy smile. Now that you’ve made the commitment to good oral health, it’s important for you to protect it. Without careful, ongoing monitoring and treatment, periodontal disease can recur. Left untreated, periodontal disease can lead to bone and tooth loss. With help from periodontists, dentists who specialize in the prevention, diagnosis and treatment of periodontal disease, you have an excellent chance of keeping your teeth for a lifetime!

How do I protect my oral health?
Once you’ve been diagnosed with and treated for periodontal disease, regular periodontal maintenance enables you to gain control of the disease and increases your chances
of keeping your natural teeth. Periodontal maintenance is a specialized treatment to protect your
gums and the bone that supports your teeth. This treatment is different from traditional six-month
dental cleanings from your general dentist, which also help to protect the health of your teeth.

During a periodontal maintenance visit, your periodontist updates your dental and medical histories to note any factors that may influence your periodontal health. In addition to a dental examination, a thorough periodontal evaluation is performed, which may include an assessment of your probing depths, oral cancer screening, and x-rays to evaluate the bone supporting your teeth. Plaque and calculus are then removed from above and below the gum line, and your periodontist will
review your at-home oral hygiene routine. If new or recurrent periodontal disease is identified,
additional treatment may be recommended.

How will I benefit from periodontal maintenance?
Periodontal disease is similar to other chronic diseases, such as diabetes; the key to control is early
diagnosis and prompt treatment. Periodontal maintenance is a way for you to protect your oral health by helping to prevent or minimize the recurrence and progression of periodontal disease. If the disease returns, careful monitoring increases the likelihood of locating and treating it in a timely manner before tooth-threatening bone loss becomes uncontrollable.

Protecting your periodontal health brings a lifetime of benefits. You keep dental costs down by
preventing future visits. You smile, speak, and eat with comfort and confidence. More importantly,
research has linked periodontal disease to other health problems such as cardiovascular disease and
diabetes. As research continues to define how periodontal disease is linked to these and other health
problems, oral maintenance is essential. As you can see, gum disease is more than just gums; a
commitment to oral maintenance is a commitment to better health!

How often do I need periodontal maintenance?
The answer to this question varies from person to person. Your periodontist will work with you  to create a schedule that best protects your oral health. The intervals between periodontal maintenance visits may range from every few weeks to a few times a year, and the frequency  may be influenced by:
• Risk factors such as genetics or tobacco use
• Severity of periodontal disease
• Severity of bone loss
• Overall general health
• At-home oral hygiene
At each periodontal maintenance visit, your periodontist will monitor your disease progression and treatment effectiveness, and may increase or decrease the frequency of your visits accordingly.

Friday, March 10, 2017

Studies continue to link your mouth to your health!


Each week as I go through the articles and recent research looking for interesting things to share with my blog followers, it is astounding how many studies are correlating disease in the mouth to some health condition.

The shear number of diseases and their links to the oral microbiome are compelling. Here are just a few of the conditions I've seen mentioned in recent studies:

  • Alzheimer's disease
  • Migraine headaches
  • Cancers
  • Stroke
  • Heart disease
  • Erectile dysfunction
  • Estrogen therapy
  • Diabetes
  • Depression
  • Chronic systemic diseases
  • Pre-term babies & low birth weights
  • Testerone levels
  • Kidney disease
  • Bacterial pneumonia
  • Chronic inflammatory diseases
  • Nutritional deficiency
This is a huge warning that your health is tied to the choices you make related to caring for not only your body but your mouth. After all, the mouth is the first place that food enters the body and in many cases it is the first place that bacteria enter the body. 

In an unhealthy mouth, red swollen bleedy gums give bacteria access to your blood stream and thereby they have access to your entire body! Many studies have shown that when a mouth is healthy or when an unhealthy mouth is treated hospitalization rates are reduced and medical expenditures go down.

In all of my years in the dental field the number one excuse for not doing dental treatment has been lack of insurance and the cost of dental treatment, not fear! But it is FEAR of NOT doing treatment that should motivate people to seek treatment for their dental disease! It has become clear that dental disease, cavities and gum disease, are linked to systemic diseases that at the very least can reduce the quality of your life and at the very worst can be the cause of an early death.

Dental disease is relatively easy to prevent in the early stages with excellent home care routines. Daily removal of the bacterial colonies that accumulate on the teeth and at the gumline by brushing twice a day, daily flossing and rinsing with an alcohol free mouthwash after brushing are the first defense against oral disease. The second defense is regular checkups with your dentist to educate you in oral hygiene techniques and to stop/treat disease early before it progresses. So go ahead save your life today and get and appointment with a competent dental provider!

Friday, March 3, 2017

Estrogen Therapy Reduces Periodontitis for Postmenopausal Women

The Role of Estrogen Therapy in Controlling Periodontal Disease

Estrogen therapy helps women in menopause reduce hot flashes, improve heart health and bone density, and maintain levels of sexual satisfaction. Plus, the same therapy that treats osteoporosis may lead to healthier teeth and gums as well, reports the North American Menopause Society (NAMS). 
As estrogen levels fall during menopause, women become vulnerable to numerous health issues including loss of bone mineral density, which can lead to osteoporosis. Around the same time, changes in oral health also are common as teeth and gums become more susceptible to disease, which can lead to inflammation, pain, bleeding, and loose or missing teeth.  
Researchers have found an association between osteoporosis treatment and severe periodontitis in postmenopausal women. They evaluated 492 postmenopausal Brazilian women between the ages of 50 and 87 years, with 113 in osteoporosis treatment and 379 not treated, to determine whether osteoporosis treatment could help increase the bone mineral density in their jaws and improve overall oral health.
According to the study, the rate of occurrence of severe periodontitis was 44% lower in the postmenopausal osteoporosis treatment group than in the untreated group. The treatment comprised systemic estrogen alone or estrogen plus progestin, in addition to calcium and vitamin D supplements, for at least 6 months.
“Osteoporosis can occur throughout the body, including the jaw, and lead to an increased risk of periodontal disease,” said Dr. JoAnn Pinkerton, NAMS executive director. “This study demonstrates that estrogen therapy, which has proven to be effective in preventing bone loss, may also prevent the worsening of tooth and gum disease. All women, but especially those with low estrogen or on bisphosphonate treatment for osteoporosis, should make good dental care a part of their healthy lifestyles.”
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This article is from Dentistry Today 2-22-17

For more information about Periodontal disease and Osteoporosis, see our blog post of September 11, 2015