What is sleep apnea and why should I test for it?

Sleep apnea is characterized by repeated interruptions in breathing during sleep. This can occur when the muscles at the back of the throat fail to keep the airway open, causing an individual to struggle for air. Common symptoms of sleep apnea include loud snoring, daytime sleepiness, morning headaches, and difficulty concentrating. Sleep apnea can increase the risk of high blood pressure, heart disease, stroke, and other health problems. Contrary to common belief, thin people can suffer from sleep apnea and its consequences.

Why should I test for sleep apnea?

Sleep apnea has been found to contribute to:

• High blood pressure (proper treatment of sleep apnea can reduce or eliminate the need for blood pressure medications)

• Metabolic syndrome due to obesity (insulin resistance, prediabetes, Type 2 Diabetes)

• Atrial Fibrillation

• Dementia and other cognitive disorders

• Accidents and injuries

• Daytime fatigue/sleepiness

How do I test for sleep apnea?

Testing is now generally done at home with less expensive, user-friendly methods. In most cases, further testing is not necessary. Click here for a description of our favorite: EZ Slep. However, if additional testing and treatment is needed, we refer you to sleep specialists, including dentists, who focus on sleep and airway disturbances.

What are the treatment options?

Choice of treatment for sleep apnea depends on its severity, underlying causes and patient preference. The goal of general treatment is to improve breathing during sleep and reduce symptoms and risk of complications.

Some common treatments include (but are not limited to):

• Continuous Positive Airway Pressure (CPAP), which involves wearing a mask over your nose and mouth during sleep. CPAP opens your airway by delivering a steady stream of air under positive pressure.

• Bi-level Positive Airway Pressure (BiPAP), which is similar to a CPAP but delivers less air while the user is exhaling. This is in contrast to CPAP, which delivers a constant stream of air, sometimes making it difficult for the user to exhale.

• Mandibular advancement devices (MADs), also known as oral appliances, that can be worn in the mouth to help keep the airway open. They often accomplish this by bringing the jaw forward or holding the tongue in place.

• Lifestyle changes such as losing weight, quitting smoking, and avoiding alcohol before bedtime.
  While weight loss is helpful to treat sleep apnea (remove the root cause), often treatment of sleep apnea with CPAP or other measures enables weight loss. The cortisol and other stress consequences of sleep apnea make it harder to lose fat. It is a chicken/egg metaphor: Which comes first? In reality, obesity (even mild) and sleep apnea can be cause-and-effect for one another.

• Nasal Decongestants can sometimes be used to help open airways and improve breathing.

• Positional therapy, which involves using special devices or techniques to encourage sleeping on one’s side.

• Surgery, which is usually a last resort, can be used to treat sleep apnea. In these rare cases, excess tissue is removed from the throat, or the jaw is repositioned to improve breathing during sleep.

• Inspire

Don’t fear the diagnosis or the treatment of sleep apnea. Most who have been through it are grateful for better health and quality of life for themselves and their sleep partner.

What are LDL and HDL and how do they affect my health?

Low-Density Lipoprotein (LDL) and High-Density Lipoprotein (HDL) are two types of lipoproteins (particles made of protein and fats/lipids) that transport cholesterol in the bloodstream.

LDL is often referred to as the "bad" cholesterol because it carries cholesterol from the liver to the cells and can build up in the blood vessels, increasing the risk of heart disease. However, this happens primarily to OXIDIZED LDL. LDL is oxidized by accumulating oxidative stress from toxin exposure.

HDL is considered the "good" cholesterol as it picks up excess cholesterol from the artery walls and takes it back to the liver to be removed from the body. But larger HDL is primarily responsible for this beneficial activity.

Maintaining a healthy balance of LDL and HDL cholesterol is important for overall health as high levels of LDL and low levels of HDL can increase the risk of heart disease and stroke, while high levels of HDL and low levels of LDL can help protect against heart disease. Regular exercise, a healthy diet, and avoiding smoking and excessive alcohol consumption can help maintain a healthy balance of LDL and HDL cholesterol levels.

However, there is more to LDL and HDL than a single reading. Small and large LDL and HDL affect cardiovascular health.

Large LDL is less risky and is commonly referred to as “buoyant” because it stays in circulation. This makes it less likely to penetrate the artery protective inner layer, literally bouncing off the wall like a beach ball. A preponderance of Large LDL is called a Pattern A.

Small LDL is considered higher risk. It is more “dense,” penetrating, and prone to get stuck in the wall to become fuel for inflammation which creates atherosclerotic plaque. A preponderance of Small LDL is called a Pattern B. It is associated with insulin resistance, the most common driver of arterial inflammation.

Large HDL removes cholesterol from the artery more efficiently than small HDL, transporting it to the liver for processing and removal. 

To summarize, larger LDL and HDL particles reduce risk of arterial disease and events, while smaller LDL and HDL particles increase risk.

Image Source: Berkley Heart Lab

What causes smaller LDL and HDL in the body?

Smaller LDL and HDL particle size is commonly associated with insulin resistance (prediabetes, metabolic syndrome, Type 2 Diabetes), diets high in sugar and processed foods, smoking, and a sedentary lifestyle.

How can I increase the size of LDL and HDL in my body?

Lose fat (especially visceral fat), consume less sugar, starch and processed foods, including a significant amount of vegetables and fasting. Exercise (especially resistance training and increased muscle mass) is also a key driver of larger LDL and HDL production. Individuals with diabetes and prediabetes, should also work to improve control of these conditions, as they are also a factor in LDL and HDL size.

Heart Attack? Stroke? The smoking gun might be your “smoking” gums.

Oral health has a bigger impact on your overall health than you likely suspect. Inflammation associated disease in the mouth can have a negative impact throughout your whole body and lead to some very serious conditions. Bacterial, viral and fungal pathogens contribute to arterial disease (50% of heart attacks and strokes!) metabolic disease (insulin resistance, prediabetes, Type 2 Diabetes), cancer, dementia, high risk pregnancy, and inflammatory arthritis.

One of the key players in this oral systemic connection are the bacteria that live in your mouth. There are both good and bad bacteria that inhabit the mouth, the “oral microbiome.” The goal is to maintain barriers to invasion locally (gingivitis and periodontitis) and systemically (arterial injury) reduce the population of the bad bacteria and create an environment to promote good bacteria.

While colonization may be difficult or impossible to eliminate, prevention of infection of gums and systemic invasion are the primary goals of an optimal oral hygiene routine. Brushing and flossing are the foundation of good oral hygiene, but may not be enough if bad bacteria have taken hold.

How are bad bacteria detected?

Visual inspection alone will not pick up the presence of high risk bacteria. Even if your gum tissues appear healthy, these bacteria may invade subtle pockets of inflammation or be opportunistic for a lapse in hygiene or the barrier to invasion associated with healthy gums. This can turn colonization into infection and inflammation in the gums, arteries and elsewhere.

More and more dentists and hygienists are highlighting the connection between the mouth and the rest of the body. If your dental care providers are on board with this focus, you are fortunate. If your dentist is unaware or uninterested in this connection, The CureCenter can recommend oral health providers who are on board for at least a second opinion and perhaps a transfer of care.

We use saliva testing to measure the amount of bad or pathogenic bacteria in the mouth. The results will motivate a plan (provided by a dental professional) to address the concern. The key is to reduce the level of bad bacteria that contribute to chronic disease and preserve barriers to invasiveness locally and systemically. For more detail, click SimplyPerio. In general, I classify Fn as “bad, Td and Tf as “worse” and Pg and Aa as “the worst” bacteria to be present in the mouth.

For more details go to https://simplytest.solutions/testing/saliva-perio-testing/

What should my dentist be looking for?

Dentists who are on the leading edge of oral care use cone beam/3D CT scans to look for presymptomatic abscesses and other issues that may be missed by routine examination and standard x-rays. These conditions don't always cause symptoms that would cause concern. This can be dangerous because the first noticeable symptom could be a heart attack or stroke. High risk oral pathogens can also contribute to poor control of diabetes and prediabetes.

We recommend cone beam CT, especially for our patients who have had prior events or elevated myeloperoxidase (MPO). Traditional x-rays will routinely miss abscesses that could be driving arterial inflammation and increase the likelihood of heart attack or stroke. For example, old root canals can be sites of chronic inflammation but detection may not be possible without use of the cone beam CT. 

At the CureCenter, we will work with your current dentist to gather this type of information if they show an interest. If not, we can recommend a dentist who we know is on board with this process.

What can I do to avoid oral health issues?

Choose a dental professional who understands concerns beyond your teeth. You can find this out by learning if your dentist has participated in continuing education about the oral systemic connection. Regularly visit this dental professional and make sure they provide an ongoing treatment plan for any issues. Follow their plan.

Get saliva testing at least once to discover any bad bacteria that may be present. We have seen patients that have no obvious issues or new cavities that have had significant levels of dangerous bacteria in spite of their current dental plan. Don’t let colonization with these bacteria become invasive infection in your gums or arteries.

Associations between high risk (red complex) oral bacteria and serious medical conditions and complications.

Follow a daily routine to maintain proper oral care and prevent bad bacteria from growing in your mouth. Daily brushing and flossing can be augmented with use of a waterpik and dental picks. Use a pH neutral mouth rinse twice daily to help promote healthy bacteria that protect teeth and gums. Brush your entire mouth, not just the teeth and gums, and always go to bed with a clean mouth.

During the day, choose 100% xylitol gum or mints and eat tooth protecting foods (low carb/high protein) at the end of meals or snacks.

Get regular cleanings and follow the advice of your dental professional. They are your best resource for learning to avoid oral systemic disease.

Ask your dentist about PerioProtect, a system that delivers an antibacterial solution to the areas below the gumline where brushing and mouthwashes/rinses won’t reach. If your current dentist does not offer Perioprotect, we are happy to suggest one who will.

Watch and share: Oral Systemic Podcast