Snoring

There are many problems related with sleep, and they are highly frequent in general. Recently the interest they are arousing is increasing, because they have been related with cardiovascular, metabolic and neurologic diseases mainly. There are problems like the apnoea-hypopnoea obstructive syndrome, chronic insomnia, restless legs syndrome, hypersomnia … which have a considerable influence on the way of living of the patient who have them, and require many diagnostic and therapeutic tools, apart from constituting the cause of many work problems, and related to traffic and circulation. Not too long ago the importance of dental sleep medicine started to increase. For this reason, every day more importance is given to sleep medicine, and since then, many advances have been developed both in diagnosis and treatment. During 1990 the first edition of the International Classification of Sleep disorders was developed, with the corresponding actualisations. This Classification permits to study in a more exact way those clinical problems, and it is appropriate to evaluate recent diagnostic criteria. When we snore, the posterior part of the soft palate, the tongue or the uvula vibrate. They may even cause a complete block of the upper airways, impeding the circulation of the breathing air. The patient awakes with a louder snore, and goes back to sleep immediately. Nevertheless, this may cause sleep fragmentation, a bad oxygenation and exhaustion at the following day. The obstructive apnoea-hypopnoea obstructive syndrome (SAHOS) is a frequent situation with many patients who have not been diagnosed. Normally, the first option to treat this problem is a device with continuous positive air pressure (CPAP). Sometimes, some surgical options, ORL or even orthognathic surgery may be needed to solve the problem. Fortunately, since some years ago we can use with great success the mandibular advancement devices (DAM) for the treatment of SAHOS and snoring. This treatment has been proved many times in clinical studies, as it demonstrates a great efficacy in the maintenance of an airway that is not obstructed during sleep. Besides, they are usually therapeutic appliances that are very well tolerated, and for this reason they are in many cases a very valuable alternative in patients with light to moderate SAHOS, or in patients who do not find success with other therapeutic modalities. The patients with more predisposition to suffer from these problems are usually people with retruded mandible, as in them it is easier that the tongue and the soft tissues position backwards. It is also frequent in patients with a deep bite (the upper incisors are responsible that we can barely see the lower ones when the mouth is shut). Those problems are frequently related with pain and tmj dysfunction. For this reason, appliances or orthopaedic treatment of the airways is beneficial to avoid TMJ compressions and different types of headaches. The treatment performed by the dentist with knowledge of dental sleep medicine should be done in combination with the doctor, who is the responsible of the diagnosis and to establish the most appropriate case in every individual case, as well as confirming the efficacy of the DAM applied by the dentist. The treatment of snoring and apnoea with intraoral appliances is a very effective alternative for most patient who suffer from these problems. Before using these systems, we should have a diagnosis (polysomnography or some type of screening as that proposed by ApneaLink®). ApneaLink® is a small device that the patient uses during night sleep. Afterwards, the stored data are revised in the computer, which inform us about the number of apnoea events, snoring events, and makes a screening of the real intensity of the problem. In Clínica dental Padrós-Creus Muntaner we recommend, in the indicated cases, the use of the Orthoapnea splint, the PM Positioner, the NOA, or the FBS (Full Breath Solution) by Dr. Keropoian, to promote the mandibular advancement and be able to free the airway.