Snoring, Sleep Apnea and Dentistry

Continuing our discussion concerning the health connection between the mouth and the body, we will review the condition known as Obstructive Sleep Apnea, its common symptoms and what can be done to minimize the potentially devastating effects of this disease.

Obstructive Sleep Apnea or OSA is a potentially serious sleep disorder in which patients repeatedly stop and restart breathing during sleep. The throat muscles intermittently relax during the sleep cycles, and the airway becomes  temporarily blocked.  The muscles normally support the soft palate and tongue. When these muscles relax, the airway either narrows or closes as a breath is taken, and the flow of air is blocked. As a result the blood level of oxygen is reduced, the nervous system thereby senses impaired breathing and awakens the patient so that an open airway is restored. These events can occur as many as forty or even more times each hour throughout the night. The end result is an inability to reach the normal, deep, restful and necessary phases of sleep.  This lack of quality sleep results in sleep deprivation.


People with sleep apnea usually snore (often loudly), may wake during the night with  gasping or choking, or may seem to stop breathing periodically according to their bed partners. OSA is most commonly seen in middle-aged and older adults and people who are overweight.  Men are more frequently affected, but women and children may also exhibit symptoms of Sleep Apnea.

Common signs and symptoms of obstructive sleep apnea include:

  • Snoring (often loudly)
  • Episodes of interrupted breathing during sleep
  • Abrupt  awakenings during the night
  • Daytime drowsiness
  • Dry mouth or sore throat in the morning
  • Morning headaches
  • Mood changes including depression or irritability insomnia

In addition, certain factors increase the likelihood of a patient’s having Obstructive Sleep Apnea.  Those with one or more of these signs are urged to speak with their primary care physician about the need to be tested for OSA. These factors include:

  • Being overweight
  • Having a neck size greater than 17 inches for men and 16 inches for women
  • Having high blood pressure especially if resistant to medications
  • Having a narrow airway possibly due to enlarged tonsils and/or adenoids
  • Chronic nasal congestion
  • Diabetes — type I or 2
  • Family history of sleep apnea
  • Smoking
  • Frequent use of alcohol


If a patient is unaware of their Sleep Apnea condition or if is left untreated, a variety of complications may develop.  Conditions associated with OSA include:

  • Cardiovascular problems including high blood pressure, coronary artery disease, heart attack, as well as heart failure and stroke and heart arrhythmias.
  • Daytime drowsiness, fatigue and irritability as well as difficulty concentrating.
  • Children with OSA may have problems in school and commonly have attention or behavior disorders.
  • Sleep deprived partners — commonly bed partners may choose to sleep in a separate room.


In addition to seeking the advice of your doctor, there are steps that you can take to at least minimize the effects of OSA.

  • Try to sleep on your side
  • Avoid drinking alcohol close to bedtime
  • If you are drowsy, avoid driving or using machinery
  • If you are overweight  lose weigh
  • Exercise regularly
  • Quit smoking
  • Use nasal decongestant

If you are diagnosed as having Obstructive Sleep Apnea, there are three traditional therapies which are used to control this condition.   The first is positive airway pressure in which a device called a CPAP is worn over the nose and/or mouth while you sleep.   It employs a steady stream of air to maintain an open airway.

Continuous Positive Air Pressure (CPAP)

Continuous Positive Air Pressure (CPAP)

The second is a dental appliance which is designed to hold the jaw in a downward and forward position.  In this position, the tongue and soft tissue at the back of the mouth are held  to effectively maintain an open airway. These devices are also used to minimize or eliminate snoring.

                                      Sleep Appliance
                                              Somnodent Sleep Appliance

Third, there are various surgical procedures which may be appropriate for some patients.

If you have any questions about obstructive sleep apnea or the oral appliances which are used to treat this disease, please call us at 908.359.6655 or via our website at




Crooked Teeth and Sleep Apnea

As I mentioned in our last blog, we will be describing various connections between oral health and systemic (or total body) health. Today, I’d like to report on a very interesting class which I attended about a week ago. This was an Invisalign Study Club meeting which was meant to increase our skills in planning Invisalign orthodontic cases. But, every now and then, we watch a gifted speaker provide you with much more information than the announced topic would suggest.

My longtime patients know that I have been a lifelong student of dentistry and especially occlusion’s (the bite’s) role in preserving dental health for the long term. I have studied the various connections between occlusion and overall health including TMD and head/neck pain, occlusion and advancing gum disease, as well as occlusion and the airway to name but a few.

Well, at this particular lecture, the speaker showed slides of various patients with crowded teeth as well as some with narrow dental arches. Many of these patients, like many of those I see every day in my office, have what we call, tori, on the inside of their lower jaws. Patients are often aware of these tori, most are generally not bothered by them, but some ask if they should be concerned about them. I had always considered these to be a sign of patients who are chronic clenchers of their teeth, and many of them are. However, the speaker made a legitimate case for the chronic growth of these tori in patients whose teeth are tipped towards the tongue.

Anatomy-of-Obstructive-Sleep-Apnea (1)

But perhaps I am getting off of the point. The combination of people who have narrow jaws and tooth crowding are very likely to have sleep apnea. I have always known that there is a connection between narrow jaws and sleep apnea, but this presentation made it so clear that patients like those described above do not have adequate space in their mouth for their tongues. As a result, their tongues are forced back into their airways, and the result is sleep apnea.

Such patients may have had orthodontics when they were children,and had four teeth extracted because of their crowding. Such patients are quite likely to have sleep apnea because their jaws are narrow and their teeth have been moved back to where the tongue wants to be to close the space created by the extracted teeth. The tongue is thereby forced to rest towards the airway. Now, I am considering whether or not to treat such patients orthodontically to expand their arches. This is one means of improving their airways and reducing their likelihood of developing obstructive sleep apnea.

When such patients come to my office, they must be carefully screened for obstructive sleep apnea, high blood pressure, adult onset diabetes, cardiovascular disease and other systemic issues which are related to obstructive sleep apnea.

If you have a bite which sounds like the type that I have described above, please contact us so that we can perform a proper screening for obstructive sleep apnea. If you have any questions about your occlusion or sleep apnea, please feel free to contact us by telephone at 609.359.6655 or via our website at

Healthcare Versus Sickcare and the Mouth–Body Connection

Our current healthcare system should more aptly be named “ sick care.” It seems to me that the times are changing and we are at the beginning of a new kind of healthcare which might be called “Integrative Medicine.”

Integrative Medicine focuses on health and wellness rather than just the treatment of disease. Such “healthcare” is dependent on a different relationship between doctors and patients – including dentists. Patients are not just seen when treatment for illness is required. But, this kind of doctoring involves a closer relationship with each patient to determine the specifics of his or her current condition, risk factors, concerns, medical history, family history, nutrition, etc. In this way, the “whole person” is evaluated and using “alternative” medicine as well as traditional “evidence–based” medicine, appropriate personalized care can be provided. Wellness, rather than disease, is emphasized. Prevention rather than just treatment for illness is provided. Wellness and healing are the primary goals.

Did you know that a healthy mouth can add 7.5 years to your life?

From our dental perspective, you may notice some changes in the emphasis of our treatment. We’ll want to stay current with your overall health, the medicines which you are using and your goals for your desired level of well-being.

We hope provide you with adequate information so that you may better understand the interconnectedness of you your “oral” health and your “body” health. Such a relationship is referred to as the oral–systemic connection and explains the relationship between oral–dental health and various body systems’ health issues including:

  •         Heart disease
  •         Diabetes
  •          Pregnancy and childbirth issues
  •         Obstructive sleep apnea
  •         Oral cancer
  •         Inflammatory disease
  •          Nutrition and the ability to chew
  •         Chronic disease
  •         Emotional health and confidence
  •          Etc.

It is our intention to write a series of blog articles about the different connections between diseases of the various body systems and oral health. We will also ask your help by keeping us apprised of your current health and all medicines including non-–prescription supplements which you are taking. We will also, with your permission, keep your primary health professional abreast of your dental condition so that your overall wellness can better be served.

We will offer newer options for your care in our office including DNA testing to better determine your risks of developing chronic oral diseases which research has proven can have detrimental effects on your overall health. It is our goal to help you achieve a higher and more informed level of oral health that has been the norm during the first three decades of my practice of dentistry.

Feel free to ask us about anything “new” which you notice during your upcoming visits. We welcome your comments and thoughts on the subject. Feel free to call us at 908-359-6655 or via our website for questions and additional information. 

Free Sleep Apnea Screenings Offered in November

Again this year, we are offering free Obstructive Sleep Apnea (OSA) screenings during the month of November. This is our way of giving thanks for all the blessings which we have received during the year, and it is our hope that we may potentially save a life by providing this service.

 Sleep apnea is a serious condition with potentially life-threatening side effects. Most people are not at all aware of this condition and certainly do not think that it affects them.  People who have Obstructive Sleep Apnea are at risk for various medical conditions including:

  •  Adult onset diabetes (the #1 growing disease currently in the US!)
  • High blood pressure (especially when resistant to treatment)
  • Anxiety and depression
  •   Daytime sleepiness
  •  Heart attacks and strokes
  •   Gastro-esophageal reflux disease (GERD)

In addition, OSA patients are prone to daytime sleepiness which places them at risk when driving. Also, these patients may struggle with diet-resistant weight gain.  Such patients frequently lose significant weight when treated for their sleep apnea condition.

If you have any of the above symptoms or conditions, or have been told that you snore or stop breathing while asleep – or you just sleep poorly – perhaps finding out if sleep apnea is the problem may be the prudent thing to do. The screening is very quick and easy. It involves a history form and a brief examination, after which a preliminary diagnosis can immediately be made.

This offer is available to all of our patients as well as their friends, family, and coworkers. Please take advantage of this service! The first step is to determine if you are at risk for sleep apnea.   Once a diagnosis is established, there are various ways to control the condition, allow you to sleep better, live healthier and feel great!

Call us at 908.359.6655 or visit our website at to schedule your free screening.

Have a wonderful holiday!

Richard M Nadler DMD, FAGD and the Designs For Dental Health Team

Giving Thanks with FREE Sleep Apnea Screenings in November

Free Obstructive Sleep Apnea Screenings in November 

Obstructive Sleep Apnea (OSA) is a serious condition with potentially severe side effects.  People are very often unaware that they have a problem, or that they are at risk for or have conditions which are the result of  OSA. 

Conditions include:

  • Adult onset diabetes
  • High blood pressure, especially when resistant to treatment
  • Anxiety and depression
  • Daytime sleepiness
  • Heart attacks and strokes
  • Gastro-esophageal reflux disease (GERD)

If you have any the these conditions or have been told that you snore or stop breathing while asleep or you just sleep poorly perhaps finding out if sleep apnea is the problem may be the smart thing to do. We are excited about all that we have been learning about Obstructive Sleep Apnea and the potential to actually help save lives. So, since November is the month of Thanksgiving, we are offering free OSA screenings to you as our way of giving THANKS for all our blessings.

Please take advantage of this service!  The first step is to determine if you are at risk for OSA.  Once a diagnosis is established, there are various ways to control OSA and allow you to sleep better, live healthier and feel great!

This offer is open to all of our community members and their family, friends and coworkers.  Call us at 908.359.6655 or visit our website at to schedule your free screening.  Live healthy and happy!


Happily Ever After: A Snoring Appliance Leads to Love

Editors Note: This story is from a peer of ours who attends our same post-doctoral institute. We all know about the dangers of drunk driving; but, in fact, sleepy drivers are perhaps more dangerous and more common!  The patient described in this story realized he needed a snoring appliance for just that reason.  In the end, it helped him far more than for just getting a restful night’s sleep to drive safer…

I will never, make that NEVER, forget the second “snoring device” I ever made was for a guy sitting in the next operatory. He overheard me as I was describing the first snoring device I had ever made.  He came into the room and said, “I have to have one of those!  I just fell asleep during a red light on my way over here!”

This was 1984-5 and this was a “Snoring Appliance”.  I was, to indulge in some understatement, blithely unaware of all the health-related issues that this entailed.

While discussing his problem at the appointment the next day, he looked at me in that vulnerable, sleepy-eyed, basset hound way and said words to this effect: 

“Doc, I am serious about a woman. We have both been married and divorced, and have been dating for a couple of years. We think it is the real thing and we want to get married. We really love each other. So, we took the trip of a Lifetime together to Hawaii. It was a wonderful trip except………


the first morning I woke up and there was a note on her pillow:


Dear XX,

I love you dearly.  But, I cannot marry you and sleep in the same bed with you because of your snoring. I am in room #201, call me to discuss this.


Doc, can you help me?”

Well, I made him the appliance that I knew at the time. And it, luckily, stopped him from snoring. I got a call from the newly wed Mrs. XX, who called and said, graciously, “Thank You”. She also shared with me what a dilemma she faced when confronted for the first time as an adult sleeping with a freight train sound next to her. And that this crazy device saved their relationship and they got married after all!


True story.  And because it happened so early in my efforts, I have always believed we can help, at least in some way or another.


Busting the Sleep Apnea Stereotype


What pops into your mind at the mention of sleep apnea (OSA)?  Do you automatically think of the sleep apnea stereotype:  A middle-aged, overweight man who wears a massive spaceman machine (CPAP) on his head and face at night to keep him from snoring at the decibel level of a herd of buffalo stampeding through the room…?

But sleep apnea doesn’t discriminate, and there truly is no stereotypical snorer.   OSA can affect men and women of all ages and levels of fitness, even affecting children and professional athletes.  On the same token, the CPAP machine, so often associated with OSA, is not the only form of sleep apnea treatment.

Not getting enough rest can have associated health risks

Image courtesy of David Castillo Dominici /

The problem with the stereotype is that it prevents people from getting diagnosed and treated, leaving them at risk for many additional health problems associated with Sleep Apnea like diabetes, stroke and even cancer.  Up to 75% of the people who suffer from OSA remain undiagnosed and untreated.  A broader awareness of who sleep apnea affects and how it can be treated is necessary to address and treat this sleep disorder that affects an estimated 12 million Americans.


Sleep Apnea Doesn't Discriminate - Young Man Yawning

Image courtesy of imagerymajestic /

We can’t reiterate enough that there is no one type of person who is affected by Sleep Apnea.  Although it does affect more men than women, and the risk of OSA goes up as weight and age increase, anyone can be affected by sleep apnea.  Children and even infants can suffer from sleep breathing disorders .  An estimated 2% of all women have a form of sleep apnea.  Even professional athletes like Shaquille O’Neal have OSA.  In our office we screen all of our patients for sleep apnea, regardless of age, gender, weight and health history.  Screening all patients can help detect sleep issues and assist our patients in maintaining their overall health and wellness.


Sleep Apnea treatment is usually associated with the CPAP machine, a mask worn over the face and head to help patients get necessary amounts of oxygen, stop snoring and sleep through the night.  However, that is not the only treatment option.  Other options include oral appliances and, in some cases, surgery.  These alternatives are often sought by patients who cannot tolerate the CPAP or who have not achieved acceptable  results with the apparatus.  Recommended by the American Academy of Sleep Medicine for mild to moderate sleep apnea, we provide our patients with custom made dental appliances, which position the jaw forward and down to hold the airway open and allow patients to breathe and sleep soundly through the night.


(list from the New York Times Guide to Dental Devices for Sleep Apnea)

  • Significant reduction in apneas for those with mild-to-moderate apnea, particularly if patients sleep either on their backs or stomachs.  The devices also improve airflow for some patients with severe apnea and are excellent when used in conjunction with CPAP to allow lower airflow through the mask resulting in greater comfort and compliance.
  • Improvement in sleep in many patients.
  • Reduction in the frequency and loudness of snoring in most patients.
  • Higher compliance rates than with CPAP alone.
  • Dental devices have shown better long-term control of sleep apnea when compared to uvulopalatopharyngoplasty (UPPP), a common surgical treatment.


Couple sleeping...getting a good night's rest

Image courtesy of imagerymajestic /

Dr. Nadler screens all patients for Obstructive Sleep Apnea and recommends a sleep study to diagnose any possible cases.  He makes custom dental appliances to treat sleep apnea, helping his patients sleep comfortably through the night, stop snoring and reduce the health risks related to sleep apnea.  If you have any questions about OSA or how dental sleep appliances can help in relieving symptoms and treating OSA, don’t hesitate to call our office at 908-359-6655.



Visit our website to learn more about how Dr. Nadler treats Obstructive Sleep Apnea.

American Academy of Dental Sleep Medicine: Oral Appliances

New York Times Guide to Dental Devices for Sleep Apnea:

Hidden Health Risks: Sleep Apnea and Brain Abnomalities

Can A Child Have Sleep Apnea?

Treatment of childhood OSA actually reverses brain abnormalities!

Sleep Apnea, a sleep disorder that too often goes undiagnosed and untreated, does not limit itself to a specific portion of the population. A common misperception is that OSA only affects middle aged, overweight men. However, it is a disorder that affects an estimated 12 to 28 million Americans, including women and children.

Sleep Apnea affects children too!

According to the American Academy of Family Physicians:

“Obstructive sleep-disordered breathing is common in children. From 3 percent to 12 percent of children snore, while obstructive sleep apnea syndrome affects 1 percent to 10 percent of children. The majority of these children have mild symptoms, and many outgrow the condition. Consequences of untreated obstructive sleep apnea include failure to thrive, enuresis, attention-deficit disorder, behavior problems, poor academic performance, and cardiopulmonary disease. “

A recent article published in ScienceDaily highlights the positive effects of treatment of Obstructive Sleep Apnea in children, detailing the relationship between OSA and brain abnormalities in children aged 8-11 due to neural network damage. The article highlights a recent study that shows the reversal of these abnormalities when properly treated.

The article reports, “‘OSA is known to be associated with deficits in attention, cognition, and executive function,” said lead author Ann Halbower, MD, Associate Professor at the Children’s Hospital Sleep Center and University of Colorado Denver. In the study, the treatment of OSA is related to improvements in attention and verbal memory. The authors of the study also speculate that the earlier the disorder is diagnosed and treated, the quicker the improvements to these executive brain functions.

‘”Our results point to the importance of early diagnosis and treatment of OSA in children, as it could potentially have profound effects on their development.”’

For anyone, going undiagnosed and untreated can increase many hidden health risks of Obstructive Sleep Apnea, including diabetes, stroke and cancer. Treatment of OSA helps to decrease these related health risks. We cannot stress this enough, and so we screen all of our patients for Obstructive Sleep Apnea, hoping to detect any airway related problems and helping all of our patients maintain their health and wellness.

If you have any questions about sleep apnea and your health, please call us at 908-359-6655.




Read the original article in ScienceDaily

The American Academy of Family Physicians Journal Article About Sleep Apnea in Children

Diagnosis and Treatment of Childhood Sleep Apnea

For Your Health: Sleeping in Sync with Your Partner

Sleep Disorders and Sleep Problems

“A 2005 survey by the non-profit advocacy group National Sleep Foundation found that more than a quarter of co-habitating American adults lose sleep from their partner’s sleep issues, and nearly one in four adults spend the night in separate beds or bedrooms because of those problems.”

       -Huffington Post

Sleep problems affect your sleep partner too!There are many sleep issues that can affect not just the person with the problem, but also the person sleeping (or trying to sleep) next to them.  From the noise of snoring, grinding and sleep talking to nighttime ninja fights with those who thrash in their sleep, sleeping partners can suffer from a lack of sleep.

Percentage of Americans suffering from sleep problems:

  • Thrashing 0.5%
  • Sleep Walking   3.6%
  • Sleep Talking    5%
  • Grinding Teeth/Bruxism   8%
  • Chronic Insomnia 10-15%
  • Snoring   59%

Of all of these problems, snoring is by far the most common and widespread, keeping partners from getting a good night of restful sleep.  The lack of sleep can affect their daily life, their ability to concentrate, their attitude and mood, even their health.  According to the Huffington Post article Sleep Problems, “The health benefits of sleep go far beyond feeling rested the next day. Insufficient sleep has been linked with numerous chronic conditions, including diabetes, cardiovascular disease and depression. So much so that the Centers for Disease Control and Prevention now considers getting sufficient ZZZs — from seven to nine hours per night — an important matter of public health.”

What exactly can you do if your partner’s sleep problems or sleep disorder is becoming your own sleep problem?

Couples have many ways of dealing with these sleep problems.  As mentioned above, almost 25% of American couples have gone so far as to sleep in separate rooms or beds.  If the problems are affecting the couple’s health and relationship, there are ways that professionals can help, depending on the issue.  Sleep studies, medications, behavioral therapy, nighttime orthotics and snoring appliances may help bring some nighttime rest depending on the specific problem.  Sometimes the solution can be as small as rearranging the sleep environment to help promote more restful sleep.

The solutions vary greatly depending on the problems, and whether they are due to a full-blown sleep disorder or just a few minor, manageable symptoms.  However, no matter how minor it may seem, if your sleep is being affected by your partner’s sleeping problems, there will be a toll on your physical and emotional health — as well your relationship.

If you have any questions about how sleep problems and disorders can affect your health we’ll be happy to send pertinent information to you.  If you would like to make an appointment for a sleep apnea screening, please call 908-359-6655.


2005 Sleep Survey by the Sleep Foundation: 

Sleep Problems: How Your And Your Partner Can Sleep In Sync

WebMD: What to Do When Your Sleep Partner Has a Sleep Disorder

Learn more about the hidden health risks of sleep disorders in our series of articles and posts about Sleep Apnea


Hidden Health Risks: Sleep Apnea and Depression

A recent New York Times article highlights a connection between Sleep Apnea and Depression.  The article cites a study by the Centers for Disease Control and Prevention which found that adult men diagnosed with Obstructive Sleep Apnea are twice as likely to suffer from depression, and women are five times as likely as adults who do not exhibit this sleep disorder.

The study also showed that even those who did not have severe enough symptoms to be diagnosed with Sleep Apnea, but whose sleeping partners reported they snore, snort or stop breathing during sleep were still at a higher risk for depression.  Whether diagnosed or not, the higher the frequency of sleep disturbances, the greater the risk for depression.

Sleep Apnea is linked with depression (photo: cc Flicker)The study only highlights an association, not precise causes-and-effects, but there are several possible contributing factors. Those with Obstructive Sleep Apnea stop breathing repeatedly throughout the night, often for ten to twenty seconds or more.  These pauses in breathing cut off oxygen to the brain, not allowing all brain cells to function at full capacity and causing the person’s mental and physical health to suffer.  Also, OSA patients’ experience fragmented sleep, waking up often to begin breathing again, which can contribute to an imbalance in mental and emotional well-being.  OSA patients have disturbed sleep cycles preventing them from having adequate REM sleep.  If you have ever been sleep deprived, you will understand how never getting adequate sleep can wreak havoc with your health and well-being – just imagine being sleep deprived for months or years!

According to the Sleep Foundation:

The relationship between sleep and depressive illness is complex – depression may cause sleep problems and sleep problems may cause or contribute to depressive disorders. For some people, symptoms of depression occur before the onset of sleep problems. For others, sleep problems appear first. Sleep problems and depression may also share risk factors and biological features and the two conditions may respond to some of the same treatment strategies.

The good news is that treatment of Sleep Apnea has relieved and reversed major depression in European studies.  However, almost 50% of people who suffer from OSA go undiagnosed and untreated, increasing the related health risks and hidden dangers of Sleep Apnea.

At Designs for Dental Health, Dr. Nadler screens all patients for Obstructive Sleep Apnea and also makes custom sleep appliances to treat OSA by allowing patients to breathe more normally while sleeping.  If you have any questions about OSA or how dental sleep appliances can help in relieving symptoms and treating OSA, don’t hesitate to call our office at 908-359-6655.



Read the New York Times article

Learn more about the connection between sleep and depression on The Sleep Foundation’s website