A good night sleep is everything

A good night sleep is everything
As featured in Australasian Dental Practice – March/April 2023

“Steve had a great life and was no more than 55 when a blood clot in his brain tore it apart, leaving him a shell of his former, confident self. Steve suffered from sleep apnoea… the suffering and frustration became too much for him and he pulled the ejection lever for the last time…”

As I strode up the ramp of the dilapidated PCYC on Monaco street, the scent of sweat and the distant rumblings of 80s rock music greeted me as I approached the door. It was my first day on the job as a freshly minted Exercise Physiologist and I was filled with a sense of trepidation and accomplishment.

Finally, I’d arrived at the point where I could treat my first patient!

I met Steve (not his real name) at 7:00am on a Monday morning, sometime back in 2008. He had suffered a stroke 12 months prior and was left with almost complete paralysis on his right side, as well as aphasia affecting his speech. Our first encounter was brief and awkward, with a shaky handshake between my right and his left hand, followed by my briefing him on how we would begin. I’m sure he was thinking, “Who the f*%k is this Kid who’s meant to be rehabbing me?”

Over the next six months, Steve and I trained together every week, sometimes twice a week. We eventually hit it off and I won’t lie, he was my favourite patient and probably the best I’ve had to this day. I learned a lot from him about his two beautiful daughters, his 30 years as an airline pilot (which he missed dearly) and most impressively, his time as a Navy pilot, during which he was invited to what is essentially the “Top Gun” program in the United States.

Steve had a great life and was no more than 55 when a blood clot in his brain tore it apart, leaving him a shell of his former, confident self. Steve suffered from sleep apnoea and six months after I had finished his structured rehabilitation program, the suffering and frustration became too much for him and he pulled the ejection lever for the last time.

It wasn’t until years later, when I underwent training in the field of sleep disordered breathing, that I thought back on Steve. For years, he had received regular check-ups, dental visits and screenings by GPs and specialists as part of his job. What was passed off as sustained, almost untreatable hypertension was likely caused by something as simple as sleep apnoea, which he was only diagnosed with after his stroke.

Steve’s story is one of the saddest I’ve personally dealt with in my time working in healthcare but by no means is it unusual.

With one in every four men suspected of having sleep apnoea and only 20% of patients having received a formal diagnosis, there are plenty of Steve’s walking in our clinics each day. The question that haunts me the most is where does our obligation start and where does it end? Is it the patients responsibility to recognise warning signs and risks or are we as health professionals able to identify and lead a patient on the path to diagnosis and eventual treatment. Knowing that treating a patient with sleep apnoea results in a 30% reduction in 5-year mortality by drastically reducing cardiovascular risk, how can you not act?

Thankfully, over the last 15 years, the sleep disordered breathing space has innovated and grown in leaps and bounds. We now have access to dozens of home sleep testing options, some as small as a ring on your finger. With the integration of wearables, cloud computing and artificial intelligence, we’re able to more accurately diagnose in the home in a way that is comfortable and accommodating of normal sleep (more so than the “wired for sound” devices of the past).

However, even with the gold standard treatment of obstructive sleep apnoea (OSA) being positive airway pressure (PAP), many patients stop using their devices within the first two years of treatment (60% or more). This highlights the need for alternative treatments, such as oral appliances, which have a compliance rate of close to 90% after two years of use and are becoming more prevalent in the field.

As more research and development is focused on monitoring patients and interpreting data to improve therapy, we are witnessing a new era of OSA treatment emerging as a potential market leader in the field.

Devices for the treatment of sleep disordered breathing have greatly improved over the years due to advancements in 3D printing technology, stronger biocompatible materials and a better understanding of airway and TMJ biomechanics. As a result, these devices now provide better efficacy and comfort compared to older designs. For dentists, there are now hundreds of courses and programs available worldwide, providing easy access to education in dental sleep medicine. Physicians are also favouring oral appliance therapy over PAP, leading to a 300% growth in oral appliance sales compared to PAP systems.

Dentists, who have a unique understanding of the mouth and upper airway, are perfectly positioned to identify patients at risk of sleep disorders and to provide them with appropriate treatment. With access to education in dental sleep medicine, dentists can upskill and become part of one of the fastest-growing fields in healthcare, while also giving their patients the opportunity to improve their quality of life.

Ultimately, the obligation of dentists is to their patients and upskilling in dental sleep medicine is one way to ensure that they are providing the best possible care. By identifying and treating sleep disorders, dentists can help their patients live longer, healthier lives, giving them the opportunity to enjoy time with their loved ones and engage in the activities that bring them joy. We look forward to having you join the field.

About the author
Joel is one of the founding directors of Good Sleep Co. He has over 12 years experience in the sleep apnoea and snoring treatment market to the development of Good Sleep Co products. Contact Joel via email for info - joel@goodsleepco.health