Month: May 2021

How Do You Know if You Have Sleep Apnea?

Sleep Apnea SyndromeSleep apnea affects more than 22 million Americans, and about 2 – 9% of the adults have them, most of which (around 80%) are undiagnosed. A person with sleep apnea may not be clocking the entire 7 – 8 hours of sleep as they may think.

Besides the quality of sleep, sleep apnea is also a life-threatening condition that causes the patients to stop breathing intermittently. Unless you know the symptoms, you would not be able to get to take the next steps.

Our article takes you through everything you need to know about sleep apnea: the types, signs to watch out for, diagnosis, causes, risks, treatment, and much more.

What Is Sleep Apnea Syndrome?

Sleep apnea is a potentially serious sleep disorder marked by an abnormal breathing condition where the breath starts and stops throughout the sleep cycle. The starts and stops happen when there is a partial or complete obstruction in the upper respiratory system.

People with this disorder have several long lapses in breath, especially while sleeping. These pauses reduce the level of oxygen in the body and bring about poor quality sleep leading to grave health consequences. With each event, the brain awakens the sleeper, reminding him/her to breathe.

Sleep apnea is quite common in the United States. While it predominantly afflicts men, it can affect adults of both sexes and children, too.


Sleep apnea is of two types depending on the breathing:

  • Obstructive Sleep Apnea (OSA): OSA is where your airway is partially or wholly blocked. In this case, your chest muscles work harder to draw air despite the block. Treatment for OSA includes weight loss, positional therapy, and other lifestyle changes.
  • Central Sleep Apnea (CSA): While the airway is not blocked with central sleep apnea or CSA, the brain fails to signal the muscles to breathe. Hence you simply lack the drive to breathe, which results in reduced respiratory events. CSA is usually associated with illnesses that affect the lower brain stem, which controls breathing.

Finally, there is complex or mixed sleep apnea, a combination of both types, as mentioned earlier.

Signs and Symptoms

Symptoms of Sleep ApneaThough the warning signs of sleep apnea are different for obstructive and central, both share a few common symptoms. Most of these are a result of reduced oxygen levels, poor sleep, and interrupted breathing.

  • Disrupted Breathing – Breathing that is disturbed repeatedly or even stops intermittently
  • Daytime Sleepiness & Fatigue – You are constantly tired and exhausted even after getting 7 – 9 hours of sleep
  • Restless Sleep or Insomnia – Having trouble falling asleep or remaining asleep
  • Loud Snoring – Includes snorting, choking, grasping, etc.
  • Mood Swings & Irritability
  • Forgetfulness
  • Anxiety
  • Depression
  • Morning Headaches – Headaches akin to tension headaches or migraines
  • Dry Mouth and/or Sore Throat upon Waking
  • Limited Attention Span – Difficulty concentrating on simple, everyday tasks
  • Heartburn – Changes in airway pressure that causes nighttime acid reflux
  • Nocturia – The need to urinate multiple times throughout the night

You may want to remember that not everyone with sleep apnea snores. While snoring is the most common symptom of OSA, it is not so in the case of CSA. Generally, a person with sleep apnea is not aware of their breathing problems until their roommates’ or bed partner tells them.

Risk Factors

While there are several reasons for sleep apnea, certain risk factors can increase the occurrence more than others. They may be the result of your lifestyle or even heredity.

  • Male gender
  • Obesity
  • Large neck circumference
  • Hypothyroidism (low level of crucial hormones produced in the thyroid gland)
  • Family history of sleep apnea
  • Post-menopausal (women)
  • Small lower jaw
  • Hypertension (high blood pressure)
  • Large tonsils
  • Alcohol misuse at bedtime
  • Acromegaly (high levels of growth hormone)


To start with, you need a proper sleep apnea diagnosis from a doctor. Based on your symptoms and sleep history, he/she makes an evaluation and then most likely referred to a sleep disorder center. A sleep specialist then conducts a sleep study.

It involves overnight monitoring called a Nocturnal Polysomnography. During the test, you are hooked to equipment that monitors your:

  • Brain activity
  • Heart
  • Lungs
  • Breathing movements
  • Arm and leg patterns
  • Blood oxygen level

Apart from that, you also have Home Sleep Tests where your doctor may provide you with a simple test kit that can be used at home. The tests monitor your:

  • Heart rate
  • Blood oxygen level
  • Airflow
  • Breathing patterns

Not every home test is successful. If the results are ambiguous, your doctor may still suggest a Polysomnography.

In case of constructive sleep apnea, your doctor may refer you to an ENT specialist (Ear, Nose, Throat) for further testing. For central sleep apnea, you may need an evaluation from a cardiologist or a neurologist.

Treatment Options for Sleep Apnea

Treatment approaches for sleep apnea vary depending on the severity.

Mild conditions may be treated via lifestyle changes such as quitting alcohol and weight loss.

However, moderate and severe sleep apnea requires medical attention in the form of devices or even surgery.

CPAP MachineBreathing Devices

  • CPAP: Otherwise called Continuous Positive Airway Pressure, the device delivers a consistent pressure slightly greater than the surrounding air. This keeps your upper airways open, preventing apnea.
  • Bi-PAP: Otherwise called Bilevel Positive Airway Pressure, the device provides more pressure when inhaling and less when exhaling.
  • Adaptive Servo-Ventilation (ASV): The latest treatment approach where the device learns your breathing pattern and stores the information in a built-in computer. When you fall asleep, it uses pressure to normalize the airflow.

Oral Appliances

Oral appliances are custom-fit devices used to open the airway when you sleep.

  • Mandibular repositioning mouthpieces hold the upper and lower jaw in a position such that it doesn’t block the airways.
  • Tongue retaining devices hold the tongue open to prevent it from blocking the airways.


  • The device senses breathing patterns and mild stimulation to open the airways.
  • A nerve stimulator is placed in the hypoglossal nerve, which controls tongue movement. Increased stimulation helps position the tongue properly.

Orofacial Therapy

Orofacial therapy helps position the tongue better and strengthen the muscles that control the face, tongue, lips, lateral pharyngeal wall, and soft palate.

Surgical Procedures

Severe obstructive sleep apnea that doesn’t respond to other devices or obstructs the upper airway is treated by surgery. However, this is the final resort.

  • Tonsillectomy: Surgery to remove tonsils, an organ present in the back of the throat.
  • Uvulopalatopharyngoplasty: Surgery to remove tissue from the rear of the mouth and top of the throat.
  • Maxillary or Jaw Advancement: Surgery to move the upper and lower jaw forward.
  • Tracheostomy: Surgery to make a hole in the trachea to fit a breathing tube called a trach tube.

Natural Cures

Unless you have a severe case, you can control sleep apnea with self-care and a few changes to your lifestyle, diet, etc.

  • Quit smoking
  • Reduce the use of alcohol, especially close to bedtime
  • Sleeping on your side. Avoid sleeping on your back.
  • Reduce weight if obese. Even a 5-10 pound loss can make a remarkable difference in sleep quality.
  • Treat allergies or nasal congestion.
  • Mindful diet
  • Regular physical activity
  • Avoid fatty foods
  • Healthy sleeping habit

Obstructive Sleep Apnea

Obstructive Sleep Apnea

OSA is one of the common sleep disorders, so much so that 4% of American men and 2% of women have the condition. However, it is a conservative number since most cases are not diagnosed. OSA happens when the throat muscles relax and breathing stops involuntarily for a short period of time.

The warning signs of OSA include:

  • Excessive daytime sleepiness
  • Memory problems
  • Mood swings including irritability or depression
  • Loud snoring
  • Difficulty concentrating on simple, everyday tasks
  • Dry mouth and/or sore throat
  • Episodes of stopped breaths
  • Abrupt awakenings accompanied by gasping or choking
  • High blood pressure
  • Nighttime sweating
  • Decreased libido


Obstructive sleep apnea happens when the muscles in your throat relax way too much and disrupt airflow. These muscles support the soft palate, uvula, tonsils, and tongue.

When these relax, the airways narrow or closes for maybe 10 seconds or longer. Repeated episodes can lower the oxygen levels in the blood. When your brain senses the impaired breathing, it wakes you up so that you can reopen the airway. However, the periods of awakenings are so brief that you probably do not remember them.

Central Sleep Apnea

CSA happens when your brain fails to signal the breathing muscles, and there is a lack of respiratory effort. It is common among people who have underlying medical conditions that affect the lower brain stem.

Generally, your brain sends signals to the muscles in the rib cage and the diaphragm to contract to initiate an inhalation. In the case of central sleep apnea, there is a lack of communication between the brain and these muscles.


The symptoms of CSA are pretty similar to that of OSA. However, people suffering from CSA have distinct periods of awakenings, most commonly noted by the bed partner.

Having said that, since the airway is not obstructed, there is little to no chance of snoring.

  • Being tired throughout the day
  • Daytime sleepiness
  • Abrupt awakenings accompanied by breathlessness
  • Headaches early in the morning
  • Trouble concentrating
  • Memory problems
  • Mood swings
  • Lower tolerance for exercise
  • Difficulty staying asleep

Risk Factors

CSA is common among older people over 65 years old who have underlying health conditions. People with the following conditions are highly likely to get CSA:

  • Congestive heart failure
  • Hypothyroidism
  • Kidney failure
  • Neurological diseases
  • Damage to the brain stem due to stroke, encephalitis, etc

Health Problems due to Untreated Sleep Apnea

The quality of sleep is also vital to your well-being. Having said that, untreated sleep apnea can affect your cardiovascular and metabolic health.

Sleep apnea increases the risk of:

  • Diabetes
  • Stroke
  • Heart attack
  • Short life span

OSA vs Heart Disease

OSA increases the risk of heart disease by 30%, heart failure by 140%, and stroke by 60%. People with OSA have a reduced oxygen level in the blood, leading to stress in their heart, which negatively affects heart health.

Additionally, every time the airflow stops, the body releases stress hormones, leading to heart diseases and failure in due course. Heart diseases are the leading cause of death in the United States.

Heart diseases are also associated with obesity, the same as sleep apnea. Ironically, sleep apnea can also be the cause of an increase in weight.

Sleep Apnea Treatment without a CPAP Machine

CPAP is one of the most common treatment approaches for sleep apnea. However, it is not a very pleasant experience and can affect the quality of sleep.

Here are a few alternative methods for people who want to avoid CPAP altogether:

  • Wear an oral appliance

Oral appliances work by holding the tongue in place or pulling the lower and upper jaw forward so that the airways do not collapse. You can get it fitted by a dentist specializing in sleep medicine.

  • Surgery

Surgeries for sleep apnea may range from minimally invasive to more complex ones. Generally, the most common option is to remove the extra tissue in your throat that collapses and blocks the airways when you are sleeping. It may include:

  • Soft palate and uvula
  • Tonsils and adenoids
  • Tongue
  • Upper and lower jaw

Keep in mind that your jaw may be wired shut, and you would have to be on a modified diet until it heals.

  • Lose your weight

In the case of obese and overweight people, weight loss can help improve the patient’s sleep. Their thick necks carry extra tissue that may block the airway.

However, there is no guarantee that it will help with your sleep apnea.

  • Positional therapy

Positional therapy involves a device which when worn around your waist, helps you to stay in the side position. Sleep apnea is primarily seen when in the supine position (sleeping on their backs).

  • Behavioral Changes

Consumption of alcohol and smoking can cause your airway to collapse, causing respiratory issues. The reason being alcohol relaxes your throat muscles.

In cases of allergies, a decongestant can help improve the airflow through the nose.


Young Man Sleeping with CPAP MachineSleep apnea is manageable but only when treated at the right time. Uncontrollable sleep apnea can lead to a multitude of other health conditions, which in turn can worsen your condition. The result is a vicious circle that never stops.

There are quite a few treatment approaches when it comes to controlling the signs of sleep apnea. There are no one-size-fits-all when it comes to sleep disorders. It requires a personalized and multi-faceted plan to find the one that works for you.

Make an appointment with a sleep medicine specialist to discuss your concerns, symptoms, treatment options, etc.

One of the best dentists in the Tucson area is Dr. Dalesandro, who has experience with patients with special needs and can help recommend the best oral appliance in order to prevent airway blockage.

Dental Implants – Replacing Teeth

Patient Having His Teeth ReplacedA statistic by the American College of Prosthodontics states that more than 120 million Americans miss at least one tooth, and 36 million Americans do not have any teeth. However, only 15% of the latter have dentures.

Loss of a tooth can lead to several problems down the road if you do not replace it in time. Missing teeth can affect the ability to chew your food, the ability to speak, and the integrity of the jaw bone. Fortunately, there are quite a few options to replace your teeth and restore the beautiful smile.

Our article walks you through the different tooth replacement options, costs, cheaper alternatives, and much more.

Options for Replacing Missing Tooth

No matter how you lost, a missing tooth can negatively impact the appearance and alignment if not replaced soon enough. Here are a few replacement options to help restore your smile:

  • Dental Implants

Being the most common replacement option, dental implants are very reliable and feel similar to a natural tooth. They can also be permanent options not just for a single tooth but also for multiple teeth in different areas. However, they can also be expensive and is a long process.

  • Implant-Supported Bridge

An implant-supported bridge is an excellent option if multiple teeth are missing in a row. Instead of having individual implants for every missing tooth, the teeth at both ends are implants and hold the rest in place without any screws. They are as effective as implants and also an economical option.

However, they are not a permanent option and will need to be replaced. Similar to implants, they are also a lengthy process.

  • Tooth-Supported Bridge

Similar to an implant-supported bridge, the tooth-supported bridge uses the existing teeth to support the bridge rather than placing implants. The dentist places a crown on the healthy teeth next to the missing ones and cements them into place.

However, you run the risk of damaging the adjacent teeth if fitted poorly. When not cleaned properly, food particles can get under the bridge leading to decay and bone loss.

  • Removable Partial Dentures

Removable partial dentures are a comparatively cheaper option than the above and replace the missing teeth. The partial dentures are fixed into position using metal clasps, ensuring that the false teeth do not fall out.

The disadvantage with removable partial dentures is that they have to be removed every night before sleeping and are not natural since the metal clasp is visible.

  • Flipper

Flipper is a temporary partial denture that flips in and out of position. They are relatively cheap and a painless option. They also do not depend on the surrounding teeth.

On the other hand, they are bulky and can be uncomfortable.

Permanent Tooth Replacement Option

Dental implants are permanent tooth replacement options that look very much closer to natural teeth. American Association of Oral and Maxillofacial Surgeons (AAOMS) reports that dental implants are 95% effective. But people with risk of gum disease like diabetes may not be eligible for the procedure. Beyond the aesthetic factor with your smile, they help you carry on with your daily activities without any issues.

The procedure for dental implants starts with a titanium screw in the place of your tooth’s root. This acts as an anchor and holds the tooth in place. The implant is left to heal for several months when it fuses to your jaw bone. Once healed, your dentist places the crown on top.

Temporary Tooth Replacement

Flipper, otherwise called a temporary partial denture, is a removable denture that fits the roof of your mouth or to the lower jaw. It is made from acrylic dental-grade resin and doesn’t take long to prepare since all your dentist needs are impressions of your mouth which are then fabricated at a laboratory.

Flipper is less expensive and looks relatively natural. They are easy to wear but can cause discomfort, especially in the beginning. On the downside, people with flippers run the risk of developing gum disease and gum recession. Due to these reasons, they are usually a temporary replacement until the dental implant treatment is completed.

Cost for Replacing Missing Teeth

Cost for Replacing Missing TeethThere are quite a few treatments for missing tooth and in varying price ranges:

Dental Implants: A surgical procedure that may cost anywhere between $3,000 – $6,000 for a single tooth. Generally, your insurance may cover the treatment, but you will be responsible for the deductibles and the co-pays.

Dental Bridge: A non-surgical option that costs from $3,000 – $5,000 for a single bridge. Again you may want to check with your insurance about coverage.

Removable Partial Denture: A removable option that can cost between $1,500 – $3,000.

Flipper – The least expensive partial denture costs anywhere from $300 to $500 for the front set of flipper tooth.

Full Teeth Replacement

Dental Implants - Full Teeth ReplacementDue to recent technological advancement, a full teeth replacement is possible and is not as scary as before. Here are a few complete teeth replacement options:

  • Traditional Dentures

Traditional complete mouth dentures have a full set of prosthetic teeth in a gum-colored acrylic base. They are held in place with denture adhesive and need to be cleaned every day. While the initial cost is lower, the ongoing expenses make up for it since you need frequent replacements every two years or so.

Though implants fit better with modern advances in prosthetic dentistry, they only replace the crowns of the teeth and not the root leading to jawbone shrinkage. The dentures also make it difficult to eat hard and tough food. A complete set of dentures can cost as much as $2000.

  • Implant-supported Dentures

Implant-supported dentures are similar to traditional dentures but are held together by implants and not adhesives. The most significant advantage is that they maintain the size and shape of the jaw. They also last as long as 15 years, contrary to the traditional ones. Moreover, they are stable and provide up to 100% chewing function like your natural teeth making it easy to eat all kinds of food.

The disadvantages are the time taken to complete the treatment and the up-front cost, which can be up to $5000.

Consequences of Not Replacing Missing Teeth

When it comes to tooth loss, the consequences are far-reaching beyond the appearance and much more than a cosmetic issue. Here are some of the health issues of missing teeth:

  • Increased chances of infection: A tooth loss leaves the sides and the root of the adjacent teeth exposed, leading to more chances of infection. The empty dental socket acts as the entry point for the bacteria leading to bone loss and decay in the future.
  • Gums and jawbone deterioration: Without the teeth, your body absorbs parts of the gums and bone, which accelerates the process of tooth fall. And it also changes the structure of the face leading to a facial collapse.
  • Teeth misalignment: Teeth stay in alignment by exerting constant pressure on both sides. After a loss, the teeth on either side drift inward, causing misalignment.

Hence it is imperative that you replace missing teeth as soon as possible.

Cheap Missing Tooth Replacement Options

Dentures are the most affordable options to replace a missing tooth. It is non-invasive and takes less time to create (a matter of few weeks). They are more natural-looking and are easy to wear. On the downside, you cannot eat certain foods and lose the ability to experience the food thoroughly.

Another less expensive yet more secure replacement option is the implant-supported denture. Here the denture is held in position by a dental implant.

Dental Implants vs. Dentures & Bridges

Dental implants are the most natural-looking replacement option for missing teeth. However, it is a surgical procedure and takes several months to heal before placing the false teeth. It can last as long as 15 years with no health issues.

On the other hand, Bridges are less invasive but are fixed and have a lower cost than a dental implant. The downside is that they last just around 5-7 years.

The denture can either be removable partial dentures or a complete set of dentures. The former is held in place with clasps, and the latter is held by dental adhesive.

Benefits and Risks of Dental Implants

Though dental implants the best possible option to replace missing teeth, it is an invasive treatment and, as such, carries some risk. Here are the benefits and risks of dental implants.

Benefits of Dental ImplantsBenefits

  • Once the implant is set, it becomes natural, eliminating the discomfort associated with a denture.
  • A dental implant gives your smile back and elevates your confidence.
  • Since it doesn’t require support from adjacent teeth, it improves overall oral health and hygiene.
  • Implants are durable and last a long time with proper care.

Risks of Dental ImplantsRisks

  • If your jawbone cannot support an implant, your dentist will restore it with a bone graft.
  • Never damage due to surgery can lead to numbness and tingling.
  • Upper implants can lead to issues with the sinus cavity.
  • The implant has a longer treatment time and will require a great number of dental visits.

Cost of Dental Implants

The average cost of a single tooth dental implant can be between $1000 to $4000, depending on your oral health and needs. The cost of the procedure alone can go as much as $6000 and includes:

  • Crown
  • Abutment
  • Implant
  • Tooth extraction
  • Bone Graft

This is a wide range and may change depending on the individual person.

Do Dental Implants Feel Natural?

A dental implant doesn’t have a root hence cannot process sensations such as heat, cold, etc. Other than that, it feels natural much more than any other dental treatment. Furthermore, dentists mold and shape the crowns to match the natural tooth appearance-wise.

Alternatives for Dental Implants

Dental BridgeThe most common alternative to dental implants is the tooth-supported fixed bridge. Fixed bridges involve grinding the healthy adjacent teeth to attach the bridge. Since the bridge provides just the crowns, the bone beneath may worsen over time. Also, they can last as much as five years before failing.


A tooth loss should be taken seriously as it has cascading effects on oral health. A tooth replacement is the only way to minimize the impact. A dental implant, denture, partial denture, dental bridge, tooth-supported bridge, and flipper are some options for replacing missing teeth.

If cost isn’t an issue, an implant is the better tooth replacement option since it doesn’t affect or damage the adjacent teeth. However, you may want to consult with your dentist to choose an option that best suits your situation.

One of the best dentists in the Tucson area is Dr. Dalesandro, who has the experience you want to help you with your dental problems; call today for your next appointment.

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