Sleep Problems? Only Your Dentist May Know for Sure

By Alex Dimitriu, MD

Have problems sleeping? You may have a little-known condition called upper airway resistance syndrome (UARS), and your dentist may be the first one to diagnose it. That’s because your teeth may show evidence of grinding, and the dentist’s check of your mouth and back of throat might indicate the tongue, uvula, adenoids or other structures could be causing obstructed breathing during sleep.

UARS is associated with chronic insomnia, difficulty falling asleep, excessive daytime sleepiness, fatigue, tension headaches – and, yes, teeth grinding.

It is often missed in sleep tests, such as polysomnography, and its symptoms can be dismissed by some physicians as caused by stress, hormonal imbalances or other issues.

Researchers and health care professionals continue to debate whether UARS is a separate disorder or simply a milder form of obstructive sleep apnea, although

More clinical studies need to be conducted.

Like sleep apnea, UARS is due to airway resistance during sleep. A narrowed air passageway, deviated septum, large tongue that falls back during sleep, loose tissue at the back of the throat, small jaw, crooked teeth, or other anatomical and craniofacial issues can cause this resistance, forcing the brain to rouse itself frequently during sleep to increase the body’s respiration.

Sleep apnea tends to develop in older individuals, affecting twice as many men as women, and is often linked to obesity. UARS can occur in younger patients of both genders equally, including in small children and those who are thin or of normal weight, but is not characterized by apnea or hypopnea, brief events in which breathing decreases or pauses entirely during sleep.

If left untreated, UARS can lead to chronic sleep deprivation, memory impairment, low-quality work performance – even psychosocial problems, including depression, and can progress into obstructive sleep apnea. Development of neuropsychological problems is not surprising since UARS prevents the brain from moving through restorative stages of sleep.

Some studies even suggest UARS and other sleep disorders increase a person’s risk for hypertension, cardiomyopathy and other heart diseases, and pulmonary dysfunction.

Surgery to correct the architecture in a patient’s mouth and throat or use of a CPAP (continuous positive airway pressure) mask while sleeping are options for treating UARS in adults, but should not be the initial line of defense, advises the American Sleep Association (ASA).

Patient lifestyle and behavioral changes, including practice of “good sleep hygiene,” and, if necessary, use of dental and oral appliances that move the jaw forward or keep the tongue in place to open a patient’s airway during sleep should be considered frontline approaches for alleviating UARS symptoms, the ASA says.

I define “good sleep hygiene” as development of healthy sleeping habits, which, coupled with lifestyle changes like improved nutrition, weight loss and regular exercise, can reduce or eliminate problems related to UARS and other sleep disorders.

I offer the following tips for getting a good night’s sleep:

• Establish a regular sleep schedule. Don’t go to bed unless you are sleepy but retire at a time that ensures you can achieve seven to eight hours rest. Try to arise about the same time every day, including holidays and weekends.
• Relax awhile before going to bed; turn off the mobile phone and other electronic devices at least a half hour before bedtime.
• Keep the bedroom comfortable and dark.
• Use the bed for sleeping – not for watching television, doing computer work or reading.
• Avoid eating a large meal just before going to bed and stop consuming alcoholic drinks and caffeinated products like coffee and chocolate at least several or more hours before bedtime.
• Maintain a regular exercise schedule and, if you smoke, stop!

Alex Dimitriu, MD, is double board-certified in psychiatry and sleep medicine and is the founder of the Menlo Park Psychiatry and Sleep Medicine Center in Menlo Park, CA. http://www.doctoralex.com