Sleep Apnea

Obstructive sleep apnea is a sleep-related breathing disorder in which the airway partially or completely collapses during sleep, causing repeated pauses in breathing. These pauses reduce oxygen levels and fragment sleep, preventing restorative deep and REM sleep stages. Over time, untreated sleep apnea can contribute to daytime sleepiness, impaired concentration, and reduced quality of life.

The physiological impact can extend beyond sleepiness: repeated oxygen drops and arousals provoke sympathetic nervous system activation, which raises heart rate and blood pressure transiently. Chronic exposure to these stressors is linked to increased risk for hypertension, cardiovascular disease, and metabolic disturbances. Early recognition and appropriate treatment reduce symptoms and may lower some long-term health risks associated with the condition.

Nighttime signs often include loud, irregular snoring, gasping or choking sounds, and witnessed pauses in breathing as reported by a bed partner. Many patients also wake frequently, experience restless sleep, or notice a dry mouth or sore throat on awakening. These nighttime clues are important because people with sleep apnea may be unaware of events that occur while they sleep.

Daytime symptoms commonly involve excessive sleepiness, difficulty concentrating, memory lapses, morning headaches, and mood changes such as irritability or low mood. Some patients report decreased work performance or driving near-misses due to drowsiness. Because symptoms overlap with other conditions, a careful assessment helps determine whether sleep-disordered breathing is the underlying cause.

Diagnosis typically starts with a clinical evaluation that includes symptom review, medical history, and assessment of risk factors such as obesity, a large neck circumference, and anatomical features of the airway. Screening questionnaires can estimate the likelihood of sleep apnea but cannot confirm the diagnosis. When screening suggests sleep-disordered breathing, objective testing is the next step.

Formal testing ranges from home sleep apnea tests, which measure airflow and oxygen levels, to in-lab polysomnography, which records breathing, oxygenation, heart rate, and sleep stages. The choice of test depends on clinical complexity and comorbid conditions; sleep specialists determine the most appropriate study. Test results quantify the frequency and severity of breathing disruptions and inform individualized treatment planning.

Treatment is individualized according to severity, anatomy, and patient preference. For many patients with moderate to severe obstructive sleep apnea, positive airway pressure therapy, commonly delivered by a CPAP device, is the most effective way to keep the airway open during sleep. Lifestyle measures such as weight management, avoiding alcohol near bedtime, and positional therapy can complement medical treatments and reduce symptom burden for some patients.

When CPAP is not tolerated or when apnea is mild to moderate, alternatives include custom oral appliances and, in select cases, surgical interventions targeted to specific anatomical contributors. A multidisciplinary approach that includes dentists trained in dental sleep medicine, sleep physicians, and other clinicians produces the best outcomes by matching treatment to the patient’s needs and monitoring effectiveness over time.

Oral appliance therapy uses a custom-made device worn during sleep to reposition the lower jaw and tongue, helping keep the airway open. These devices resemble retainers or mouthguards and are designed and fitted by dental clinicians experienced in sleep medicine. Oral appliances are often recommended for patients with mild to moderate obstructive sleep apnea or for those who cannot tolerate positive airway pressure devices.

Candidate suitability depends on dental health, jaw alignment, and the nature of the airway obstruction; patients with inadequate dentition or severe periodontal disease may require dental care before an appliance can be used. Success also relies on careful titration and follow-up to optimize fit and function, with coordination between the dental provider and a sleep physician to confirm clinical improvement. Regular monitoring helps detect bite changes and ensures ongoing effectiveness.

A dental sleep medicine evaluation begins with a thorough oral and medical history, an examination of the teeth, jaw, and airway structures, and a review of any prior sleep testing. The dentist assesses factors such as jaw mobility, bite relationships, and soft tissue anatomy to determine whether an oral appliance is a reasonable option. This evaluation also includes discussion of symptoms, lifestyle factors, and expectations for therapy.

If an appliance is appropriate, impressions or digital scans are taken to fabricate a custom device and an initial fitting is scheduled. Follow-up visits are planned to adjust the device and monitor symptom changes, with periodic communication with the patient’s sleep physician as needed. At Nova Dental's offices in North Haven and Cromwell, this collaborative workflow aims to provide coordinated, patient-centered care.

CPAP remains the most consistently effective therapy for opening the airway and reducing apneic events, particularly in moderate to severe cases, because it provides continuous positive pressure to splint the airway. Oral appliances tend to be less effective than CPAP at eliminating events in every patient, but they offer important advantages in comfort, portability, and patient adherence. For many patients who cannot tolerate CPAP, an oral appliance can provide meaningful symptom relief and improve sleep quality.

Comparative effectiveness often depends on individual anatomy, severity of apnea, and whether the patient uses the prescribed therapy regularly. Clinical follow-up and objective testing help determine whether an oral appliance achieves sufficient improvement or whether additional or combined treatments are needed. Shared decision-making with dental and medical providers helps patients choose the option most likely to control their condition and fit their lifestyle.

Initial follow-up typically occurs within a few weeks of fitting to adjust the device, assess comfort, and address any fit-related issues. Subsequent visits focus on symptom review, evaluation of sleep quality, and monitoring for dental or bite changes that can result from prolonged appliance use. Periodic sleep testing or communication with the sleep physician may be used to confirm that apneic events have decreased and oxygenation has improved.

Long-term care includes regular dental checkups to monitor oral health, appliance integrity, and occlusal changes, as well as troubleshooting for any emerging issues. Patients should report new symptoms such as increased daytime sleepiness, jaw pain, or tooth mobility promptly so providers can make timely adjustments. A proactive follow-up schedule supports sustained effectiveness and minimizes potential side effects of therapy.

Treating sleep apnea can reduce daytime sleepiness and improve cognitive function, mood, and overall quality of life for many patients. Because sleep-disordered breathing contributes to intermittent hypoxia and sympathetic activation, effective therapy may help lower cardiovascular strain and improve blood pressure control in conjunction with standard medical care. Improvements in metabolic regulation and daytime functioning have also been observed when sleep apnea is addressed as part of a comprehensive treatment plan.

While treating sleep apnea can positively affect related conditions, it is usually one component of a broader medical strategy rather than a sole cure for chronic diseases. Coordination between dental providers, primary care clinicians, and specialists ensures that sleep therapy complements other treatments for conditions such as hypertension, diabetes, and gastroesophageal reflux. Ongoing monitoring helps evaluate whether sleep-focused interventions are contributing to measurable improvements in overall health.

To begin an evaluation, patients typically schedule a consultation with a provider experienced in dental sleep medicine and bring a summary of their symptoms and any relevant medical records, including prior sleep study reports if available. It is helpful to note sleep patterns, daytime symptoms, and any observations from bed partners about snoring or witnessed pauses. Bring a list of current medications and summaries of major medical conditions to provide a complete picture for the clinical team.

During the visit, the clinician will review your history, perform an oral and airway examination, and discuss potential next steps such as referral for sleep testing or the possibility of an oral appliance. If device therapy is recommended, the practice will outline the fitting and follow-up process and coordinate care with your sleep physician as appropriate. Contact Nova Dental to schedule an appointment at the North Haven or Cromwell office and to confirm any required documentation for your initial visit.