Many years ago, a man in his late 50s named Scott came to my dental office for an appointment. His wife complained about his snoring and gasping for air at night. I referred Scott to a sleep doctor who diagnosed him with sleep apnea and recommended that he use a continuous positive airway pressure (CPAP) machine to keep him breathing steadily throughout the night.
Like many people his age, Scott had been taking three different blood pressure medications. After he started using the CPAP machine, his quality of sleep improved, as did his blood pressure control. In fact, his primary care doctor was able to reduce the dose of his drugs.
This alone is a success story, but over time, Scott started to find the CPAP machine cumbersome. At his next visit to my office, he asked if there were any other options for managing his sleep apnea.
We provided him with oral appliance therapy, which used a custom-made mouthpiece to reposition the jaw and tongue, keeping his airway open while he slept. Scott responded well to this therapy, and his blood pressure remained under control with a decreased dose of medications.
Understanding Sleep Apnea
In patients with Sleep Disordered Breathing (SDB) or sleep apnea, the throat can narrow or close partially or completely, causing interruptions in breathing during sleep. When this happens, the levels of carbon dioxide in the blood go up, and levels of oxygen go down. This can lead to hypertension, cardiac diseases and even premature death. SDB is also associated with snoring, mood disorders, disruptive behavior and a decreased quality of life.1,2,3,4
Roughly six million Americans have been diagnosed with sleep apnea, but this sleep disorder is thought to affect 30 million people in the U.S., with many cases going unreported.5 Older adults are much more likely to have sleep apnea than younger people.6
What Causes Sleep Apnea?
While sleep apnea is a prevalent condition, it’s technically broken up into two types: obstructive sleep apnea (the most common type) and central sleep apnea.7
Obstructive sleep apnea occurs when something is blocking your upper airway during sleep, obstructing airflow.
Central sleep apnea occurs when the brain does not properly send signals to your body to breathe. This is often caused by specific medical conditions.
Obstructive sleep apnea (OSA) can be caused by a wide variety of factors; some we can control, and others we can’t. For instance, being born with larger tonsils or a thicker neck can lead to sleep apnea, but so can drinking, since alcohol can relax the muscles in your face and neck, possibly closing your upper airway.8
Some other risk factors for developing obstructive sleep apnea include:
- Age: As we get older, fatty tissue can build up in the neck and tongue area.
- Changes to hormones: Fluctuating hormone levels (such as low thyroid hormone) can affect the size and shape of your face and airway.
- Family history: Your genes can affect the size and shape of your skull and airway, and if someone in your direct family has been diagnosed with sleep apnea, it’s possible you may be as well.
- Sex: Men are more likely to develop sleep apnea than women.
- Obesity: Individuals living with obesity can have fat deposits in their neck area that can increase the possibility of sleep apnea.
In addition to these risk factors, in today’s modern world, we are all eating softer foods, which can hinder proper jaw development.9 The air we breathe is also not as clean, leading to increased exposure to pollutants. As a result of these pollutants, many people develop allergies, which contribute to the development of SDB and sleep apnea.10
Whatever the cause of one’s sleep apnea, the increase in diagnoses is likely influenced by our modern lifestyle and environment. You could also say: It’s an epidemic. As Kaitlyn Tarbert, RDH, pediatric oral myofunctional therapist, was quoted as saying in the book, “Gasp!: Airway Health – The Hidden Path To Wellness”: “You know we have an epidemic of obstructive sleep apnea when you see a ‘travel CPAP’ machine for sale in a ‘Sky Mile Magazine.’”11
Does Sleep Apnea Cause High Blood Pressure and Other Conditions?
Studies have shown that sleep apnea disrupts nocturnal blood pressure, preventing it from dipping as low as it should.12 In his book, “Treat the Cause… Treat the Airway,” Steven Lamberg, DDS, a dentist in New York, suggests that this condition can lead to both hypertension and atrial fibrillation (AFib).13
In my patients, I see the connection between persistent conditions and sleep apnea, as well. When reviewing medical history, I often find new drugs added for various reasons, including high blood pressure, AFib and gastroesophageal reflux disease (GERD). All of these issues are related to sleep, and improving sleep has the potential to reduce the reliance on prescriptions.
In fact, Dr. Lamberg in his book suggests you request a sleep study if you are taking any of the following medications for high blood pressure or heart disease:
- Angiotensin receptor blockers: Irbesartan (Avapro); Losartan (Cozaar); Olmesartan (Benicar); Valsartan (Diovan); and others
- Angiotensin-converting enzyme: Lisinopril (Zestril or Prinivil); Enalapril (Vasotec); Captopril (Capoten); Benazepril (Lotensin); and others
- Beta blockers: Atenolol (Tenormin); Bisoprolol (Cardicor or Emcor); Metoprolol (Betaloc or Lopresor); and others
- Calcium channel blockers: Amlodipine (Norvasc); Diltiazem (Cardizem, Tiazac, others); Nifedipine (Procardia); and others
- Diuretics: Hydrochlorothiazide; Furosemide (Lasix); Spironolactone (Aldactone or Carospir); Chlorthalidone (Thalitone); and others
- Alpha-blockers: Tamsulosin (Flomax); Doxazosin (Cardura); Terazosin (Hytrin); and others
- Alpha-beta blockers: Carvedilol (Coreg); Labetalol (Trandate); and others13
CPAP Machines: Understanding the Benefits and Risks
The most common treatment for sleep apnea is CPAP, or continuous positive airway pressure.14 It works by delivering a steady stream of air through a mask to keep the airway open while you sleep. CPAP often shows very positive results, which is why many doctors recommend it as the first treatment choice. However, there are challenges with using CPAP. Some people find it uncomfortable to breathe against the pressure, and those with claustrophobia or insomnia often struggle to wear the mask and sleep well with it on.
According to recent studies, only 30–60% of patients remain compliant with CPAP therapy after one year.15 Common issues with CPAP include discomfort from wearing the mask, dryness in the nose and throat, facial skin irritation, air in the stomach and difficulty changing positions at night while attached to the machine. Additionally, if not properly maintained, CPAP machines can harbor bacteria, leading to respiratory infections.
In some cases, CPAP also increases the risk of central sleep apnea, where the brain temporarily stops signaling the muscles to breathe.16
CPAP Alternatives
Many people I meet in my practice lament the difficulties in adjusting to a CPAP machine, which can be uncomfortable.
Dr. Audrey Wells, founder of SleepWellMD, said, “CPAP is a great treatment modality but adjustment takes a lot of work and you only see results if you use it.” However, there are other treatment strategies to address sleep apnea to prevent you from sleeping in a position where the airway collapses.
These alternative therapies have the potential to improve your health by addressing low quality, fragmented sleep that can underlie conditions like hypertension, AFib, GERD, diabetes and more.17 Here are a few to consider:
Oral Appliance Therapy
OAT uses custom-made oral appliances (mouthpieces) to reposition the jaw and tongue to keep the airway open during sleep. Patients who find CPAP uncomfortable often prefer this option. OAT can be effective for mild to moderate OSA.
Hypoglossal Nerve Stimulation
This is a newer treatment option for moderate to severe OSA, in which a device is surgically implanted to stimulate the hypoglossal nerve (which controls the muscles in the tongue) and move the tongue forward during sleep. This keeps your airway open. It’s usually used for patients who can’t tolerate CPAP or OAT.
Weight Management
Obesity is a significant risk factor. Losing weight through diet and exercise can reduce the severity of sleep apnea or even eliminate it in some cases. Combining weight loss with other therapies like CPAP or OAT can also make treatment more effective.18
Positional Therapy
Positional therapy involves using devices or techniques to encourage sleeping in positions that prevent airway obstruction, such as on your side. It can be effective for patients whose sleep apnea is primarily positional. Sleep apnea tends to be worse in those who sleep on their backs.19
Myofunctional Therapy
Myofunctional therapy is physical therapy for the muscles of the airway. It can include exercises like tongue push-ups, lip press or stretch and diaphragmatic breathing. This is a great addition to any of the above therapies because it can increase the tone of your tongue and airway muscles, as well as improve nasal breathing. Research on myofunctional therapy found that after 24 weeks, half of the adults and over 60% of the children had improved oxygen levels, felt less sleepy during the day, snored less and experienced milder sleep apnea.20
Benefits of Treating Sleep Apnea
By addressing sleep apnea, you can significantly improve your health and potentially reduce your dependence on medications.
Eventually, my patient Scott grew tired of using the oral appliance and reverted back to using CPAP, but he still wanted a solution that didn’t require cumbersome medical equipment. I helped him start myofunctional therapy to strengthen his tongue and lips and establish diaphragmatic breathing. Scott is a very disciplined man who meticulously followed an exercise program.
Following the therapy, Scott underwent a sleep study, and his sleep doctor was pleasantly surprised not to detect any episodes of snoring or gasping for air, telltale signs of sleep apnea.
And he’s not the only one. Another one of my patients, John, had similarly impressive results after treating his sleep apnea with an oral appliance and myofunctional therapy. “I used to have sinus infections and required antibiotic treatment twice a year. Since I started this treatment, I haven’t been sick for three years,” he said.
