Dentists have become more aware of the important correlation between airway, sleep and dentistry. My fellow Spear Resident Faculty member, Dr. Jeff Rouse, has provided us evidence and literature that supports the concepts of a definitive correlation between the reduction of airway space and the effect it has on overall health.
Sleep-disordered breathing is the second-most common sleep disorder in the U.S. (insomnia is No. 1). Nearly 70 million Americans report some form of undiagnosed sleep disorder. These undiagnosed and untreated sleep disorders put our patients at great risk for serious and chronic health problems.
Airway assessment is a critical component in the screening and evaluation of our patients. Spear faculty have placed airway at the top of the decision tree process in the Facially Generated Treatment Planning workshop. Airway assessment is one of the critical etiologies that need to be integrated into the treatment planning process of providing improved health for our patients.
Our goal as comprehensive relationship-based dental practitioners is to provide treatment and care for our patients that improves not only their dental health, but the patients' overall health, too. Our patients trust us to direct their care and treatment toward optimum health and longevity. It is our obligation to provide our patients information and opportunity to make healthy decisions and improve their lives.
[REGISTER NOW: Planning your 2020 CE? Get a seat in Dr. Jeff Rouse's March 12-13 ‘Airway Prosthodontics – Taking Dentistry Beyond Sleep Apnea and Advancement Appliances’ seminar before it sells out.]
There is significant detail around airway and determining causative effect of disordered breathing. We dentists need to develop our skills and understanding of the assessment concepts, tools, and ultimate treatments available for helping our patients who are losing sleep as a result of airway compromise.
It behooves us to develop our skills and understanding in the science of disordered breathing. The learning-integration process takes time and energy. But regardless of our present skill and knowledge level around this topic, we can, and must, provide guidance for our patients in understanding the systemic health effects that result from disordered breathing. There are some simple and direct tips for healthy sleep that we may provide for our patients.
By implementing simple screening tools to aide in initial patient assessment (e.g., Epworth scale, S.T.O.P.-B.A.N.G, Sleep/Snoring questionnaire, etc.), we can easily provide guidance and direction to those patients that report a concerning level of ineffective and inadequate sleep. It is important for these patients that we not only identify and elaborate our concerns, but we provide some initial guidance for those individuals to gain some immediate control of their sleep habits and deficiencies. As we work to improve our technical skills to provide more comprehensive airway control, at least we can start our patients on a healthy sleep pathway.
I encourage all dentists to read Dr. Matthew Walker’s “Why We Sleep: Unlocking the Power of Sleep and Dreams” (which Dr. Rouse referenced in a recent Spear Digest article) and review his tips with your office team members and your patients that report disordered sleep patterns.
12 tips for healthy sleep
- Stick to a sleep schedule
Go to bed and wake up at the same time each day, including on weekends. Consistency provides the greatest possibility of healthy sleep. This is the most important tip.
- Exercise, but no later than 2-3 hours before bedtime
Thirty minutes per day is recommended for good physical health, but too much activity too close to bedtime disrupts a normal sleep cycle.
- Avoid caffeine
Be mindful of your intake of coffee, tea, soda and nicotine. As a stimulant, caffeine and nicotine can take as long as eight hours to eliminate effects. Nicotine contributes to lighter sleeping patterns by preventing sufficient REM sleep.
- Avoid alcohol before bed
Heavy use of alcohol robs us of REM sleep. Remaining in lighter stages of sleep eliminates the health benefits of deeper sleep. Heavy alcohol impairs breathing, as well. Those individuals with disordered breathing patterns will be at even greater health risk.
- Avoid large meals and beverages at night
The indigestion that occurs from late-night snacking affects sleep. Frequent need for urination also disrupts sound sleep.
- Avoid medications that delay or disrupt sleep
Some commonly prescribed heart, blood pressure and asthma medications affect sleep patterns. It is wise to discuss alternative medications with your physician or pharmacist to aide in the insomnia produced. Is it possible to take these medications in a lower dose or a different time of day?
- Do not take a nap after 3 p.m.
Naps are helpful for re-energizing our bodies. They can make up for lost sleep. But a nap too late in the day can make it difficult to fall asleep at night, as it disrupts our circadian rhythm.
- Relax before bed
Do not overschedule your day so there is no time to unwind in the evening. Reading a book, listening to relaxing music or attending to a relaxing activity should be a daily sleep ritual.
- Take a hot bath before bed
The drop in body temperature that occurs following this activity will help make you sleepy. The relaxing water will slow you down and get your body ready for sleep.
- Create a dark, cool, gadget-free room for sleep
Eliminate anything in your bedroom that will distract you from sleep (e.g., noises, bright lights, LED lighting, uncomfortable bed, warm room, phones, TVs, computer, etc.). A cool room, comfortable bed and no distraction will promote sleep.
- Have the correct sunlight exposure
Daylight is the key to regulating daily sleep patterns. The rituals at night are important, but getting outside for natural light exposure for at least 30 minutes per day will help maintain our natural sleep clock. If you have trouble sleeping, it is recommended by sleep experts to achieve an hour of morning sun exposure each day and turn down the lights before bedtime.
- Do not lie in bed awake
If you are awake for 20 minutes with difficulty falling asleep, get out of bed. Begin an activity that is relaxing until you are sleepy. Remaining anxious and awake in bed will make it even more difficult to fall asleep.
This list represents the minimal recommendations necessary for producing good sleep habits and patterns. There is a tremendous amount of science and support for each of these 12 guidelines.
At a minimum, if we can encourage our patients to adhere to these basic steps, we will help them improve their sleep, their health and their lives. I encourage each of you to print or email this list for every patient, regardless of whether he or she has an existing sleep disorder. If they don't, they know or are acquainted with, someone who does. It is our obligation as health care providers to give our patients every opportunity to lead healthy and fulfilling lives. Cheers, to a good night’s sleep!
Jeffrey Bonk, D.D.S., is a member of Spear Resident Faculty.