Snoring & Sleep Apnoea

Is snoring disrupting more than just your partner’s peace and quiet?

It’s one of life’s closed door little secrets: many couples don’t share the same bed and it is not because they don’t like each other! Good quality sleep is so important that this may seem the only option. Poor sleep equates to a life less than it can be. Irritability, frustration, depression, difficulty concentrating at work and impaired memory become your new normal and it can creep up so insidiously that you put it down to stress or ageing or that you just need a holiday! (…You probably do need a holiday however there could be more to it!)

Snoring causes disrupted sleep for the bed partner and the snorer. Sometimes it may appear that the snorer has no trouble sleeping. They fall asleep “as soon as their head hits the pillow!” But that snoring may be leaving clues to a much more serious problem – sleep apnoea.

If you have sleep apnoea, even mild sleep apnoea, your airway is closing off repetitively while you sleep. When your airway closes off you can’t breathe. Your blood oxygen drops, your blood pressure rises, your heart slows down in a desperate attempt to conserve the rapidly diminishing oxygen until the blood sensors detect that you are in grave danger and partially rouse you from your sleep so that you take some breaths. As you rouse your heart races, you over breathe, your blood pressure increases even further and you drift off to sleep again only to have this same sequence repeat over and over again – sometimes hundreds of times per night. No wonder people with sleep apnoea are at high risk of dying from heart attack or stroke! In fact you are at a higher risk of dying from all causes. Sleep apnoea can rob you of years, if not decades, of your life.

As many as 80% of people with sleep apnoea do not know it. I am on a mission to change that! No more band aids. No more drugs to treat the outcome of sleep apnoea without treating the cause. We only get one life and this one is not the dress rehearsal. Diagnosis and treatment is easy compared to the consequences and prevention is so much better than the cure.

Call us today. Let’s rule out sleep apnoea, put some peace back into your bedroom and add some good quality years to your life!

Why is this important?

Many people don’t get treated for snoring or sleep apnoea because they think

  • “Just” snoring (not important)
  • Don’t want to have to wear the “machine’ (CPAP)
  • Too noisy
  • Uncomfortable
  • Difficult to travel with etc

Many people are not aware of the use of oral appliances to treat sleep apnoea and snoring. An oral appliance (or mandibular advancement splint or device) gently holds the lower jaw forward when you sleep. This opens up the airway to allow you to continue to breathe normally and in most cases can quieten down any snoring, commonly stopping it completely.

Some patients have told us that their bed partner was worried on the first night of ‘quiet” that they had stopped breathing because it was so quiet. Of course after confirming they were sleeping soundly, they got on enjoying their peace and quiet!

You will not hear me criticise CPAP. That machine has saved so many lives and if you need it, a whole new world of well-being awaits you. It is the gold standard for treating severe sleep apnoea for people who have serious medical conditions that put them at high risk for dying. The down side of CPAP is that many people who need it don’t use it on a regular basis or stop using it all together. If you are one of the people, please come to see us because studies have shown that the increased usage of an oral appliance offsets the better control of the airway that is achieved with CPAP and the medical outcomes are similar even for severe sleep apnoea sufferers.

If you have sleep apnoea – the important thing is to be treated.

What are some health consequences associated with untreated sleep apnoea?

If you have sleep apnoea, every time you go to sleep you start to suffocate over and over again and your emergency stress system has to save you or you will  die. When your emergency stress system gets switched on repeatedly, when it should be turning down during normal sleep, your health starts to suffer. Not only is your sleep fragmented and of very poor quality, you may develop:

  • Memory and mood changes
  • Feeling tired or sleepy
  • Not waking refreshed
  • Irritability
  • High blood pressure
  • High cholesterol
  • Diabetes
  • Heart attack
  • Stroke
  • Weight gain
  • Difficulty losing weight
  • Headaches
  • Neck pain
  • Macular degeneration
  • Glaucoma
  • Depression
  • Many people with Alzheimer’s Disease have sleep apnoea
  • And many other health consequences

Sleep apnoea is a serious medical condition with serious health outcomes. 80% of people with mild to moderate sleep apnoea do not know it. I am on a mission to change that. That is why I have embarked on this marketing program:

  • To raise awareness
  • To screen people for sleep apnoea
  • To facilitate referrals as necessary
  • To explain different treatment options available
  • To provide the most comfortable and effective oral appliances for those who would benefit from them
  • To follow-up to ensure best treatment outcomes
  • To work with and communicate with your healthcare providers

As you know, the only way to rule out high blood pressure is to take a measurement, so it is with sleep apnoea. You cannot assume that you have or do not have sleep apnoea without a test – called a sleep study

  • This can be done in a Sleep Centre
  • Or in your own bed
  • Dr Anne-Maree Cole can arrange the referral for you

A sleep physician then makes the diagnosis and recommendations for treatment

There are different levels of severity and increased severity means a higher risk of disease or death but all levels carry risk and in general sleep apnoea worsens with time, age and weight.

AHI (Apnoea-Hypopnoea Index) or RDI (Respiratory Disturbance Index) is the standard method of scoring and determining the level of sleep apnoea.

AHI or RDI:

  • <5         Normal
  • 5-15      Mild
  • 15-30    Moderate
  • >30       Severe

For patients with severe sleep apnoea, CPAP (continuous positive airway pressure) – often referred to as ‘the machine’ is the gold standard

But for patients with mild to moderate sleep apnoea, a carefully constructed adjustable oral appliance which optimises the airway and supports the jaw by an appropriately trained dentist can be a successful alternative

This therapy is often referred as:

  • Oral Appliance Therapy or
  • Mandibular Advancement Device or Appliance

Flex on Typomicro24

Many different dental appliances have been developed over the years to treat sleep apnoea but the best ones have the following features:

  • Custom made
  • Physiologic / balanced jaw position determined

o   Not just a protruded (forced forward) position

o   This is dependent upon the training of the dentist not the appliance

  • Supports jaw at a comfortable position
  • Titratable i.e. it can be adjusted if necessary to achieve a final optimal position that maintains the airway and manages the sleep apnoea and / or snoring
  • Can open mouth and speak if necessary
  • Takes up minimal space for the tongue which is extremely important for the control of the sleep apnoea
  • Comfortable to wear
  • Your treatment is followed up to ensure the sleep apnoea is under control

o   This is extremely important because in rare circumstances, the sleep apnoea could actually worsen with an oral appliance

o   Continued monitoring and measurement is essential for correct management of your sleep apnoea.

  • This is the standard of care with Dr Anne-Maree Cole
Muscle activity before determining bite registration for night appliance
Muscle activity before determining bite registration for night appliance

 

Muscle activity after determining bite registration for night appliance
Muscle activity after determining bite registration for night appliance

Considering the pros and cons of all the available appliances that have been developed over years and the methods of determining the best position for the jaw, Dr Cole believes in ‘no compromise’. When you are at your most vulnerable – asleep and lying down, suffering a condition over which you have no control and that could lead to your early death or disability, you want everything working in YOUR favour.

Dr Cole has studied extensively in the area of Sleep Medicine, is undertaking a Masters Degree in Science (Sleep Medicine) through the University of Sydney, teaches and lectures in Dental Sleep Medicine and the Physiology of Occlusion (Neuromuscular Dentistry) internationally and nationally to doctors and dentists, has been invited an editor on Dental Sleep Medicine for the international peer reviewed journal Cranio and is passionate about providing the very best care to her patients.

There is no pill for sleep apnoea yet patients are given pills all the time for the symptoms without determining the root cause of the problem. Dr Cole believes in treating the root cause and helping you take control of your health issues.

What is the process for having treatment for Sleep Apnoea & Snoring at Aesthetic Excellence?

Consultation
Neuromuscular Work Up
Delivery of Appliance
Follow up
The first step is to book a consultation with one of our dentists, so we can determine if a Mandibular Advancement Splint would be suitable for you. We will do a clinical examination, any necessary x-rays and review your PSG (Sleep Study) or sleep screening results. We will then discuss your options and provide you with a treatment plan to move forward.
This is where we are different to the traditional dental approach. We pride ourselves on our Physiologic Approach to treating sleep apnoea and snoring. This 3 hour appointment is scheduled to take impressions, TENS therapy to relax your jaw and neck muscles and finally the Neuromuscular bite registration (a bite taken at a relaxed, neutral jaw position - confirmed using our EMG's and K7 Evaluation System). This is the most important part of our approach, providing you with a muscle-comfortable jaw position and appliance.
After your work up, your impressions and bite registration will be sent to the lab. When it has returned from the lab 3-4 weeks after the Work Up, we will see you to deliver the appliance. We will ensure it fits comfortably and provide you with care instructions.
Another difference we have as part of the Physiologic Approach as opposed to traditional approach, is that we insist on following up the efficacy of the appliance. We do not provide you with the titration (adjustment) tool and we only adjust your appliance based on objective data. Therefore, we will get you do home-based follow up sleep screenings to ensure your sleep apnoea, snoring and symptoms are improving. We will adjust the appliance if necessary and follow up again, until we get you to your 'sweet spot'. We then recommend annual sleep screenings to ensure you sleep apnoea is still being managed adequately.
Our Expertise
Dr Anne-Maree Cole is passionate about helping people with problems with sleep and pain and they way the jaw works with the rest of the body. She understands the role that dentistry plays in treatment and prevention of these problems.

Completed Masters Degree in Sleep Medicine in 2014
Teaches nationally and internationally in dental sleep medicine
Invited speaker to medical and dental groups
Author : Guest editorial Cranio Journal: “The Role of Dentistry in the Field of Sleep Medicine … Are We Respecting the Physiology?” (Published January 2014)
Editorial Board of The Journal of Cranio Mandibular & Sleep Practice
Platinum provider of the Somnodent oral appliance
Advisor on the development of a recently FDA approved new oral appliance Micr02
My associate dentists have been hand picked and trained by me, are exceptional excellent dentists in their own right and are equally passionate to help people as I am. We are a team and we collaborate on all cases to ensure that our patients get the best possible treatment outcomes.

Ph: 07 3257 1577
Associated between poor sleep & chronic pain
Poor quality sleep over a prolonged period can end up leading to an experience of chronic pain.

Chronic pain results in a very significant quality and enjoyment of life diminishment.

It can rob you of precious life experience, can leave you without hope and breakdown of relationships is a common consequence.

Ruling out a sleep breathing disorder and understanding the close relationship between sleep and pain and the way the teeth and jaws come together is a vital component to receiving appropriate care and help for your condition.

Dr Cole has a special interest in this area and teaches and lectures on the subject nationally and internationally to Doctors and dentists to spread this knowledge to reach more people suffering unnecessarily.

If you are suffering any chronic head and neck pain, please call to reserve an appointment with Dr Cole so that she help you with both diagnosis, and treatment, where appropriate, so that you can start to get back in control of your life.

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Our expertise in the Physiologic Dental Approach to treating sleep apnoea and snoring is unrivalled. We will not compromise on your care and will work with you to improve you and your bed partner's sleep quality.