Dr. David W. Regiani on
Treating Sleep Disordered Breathing with Holistic Dentistry
David W. Regiani, BS, DDS, has been involved in learning about and treating sleep disordered breathing and bite disturbances since 1993. His first classes were in February of that year, through the American Equilibration Society, and he is still an active member and takes annual classes in Chicago. In the last 26 years, he has received training on MyoFacial Pain Dysfunction / Occlusion; Advanced Problem Solving for TM Disorders; Passion for Dentists: Dentistry’s Role in Sleep Disorders; Sleep Solutions in Dentistry and Aligner Therapy. In 2013 Dr. Regiani completed a year-long mini-residency from the American Academy of Craniofacial Pain in Dallas, TX; and in 2015 at the School of Integrated Biologic Dental Medicine, he became a Board Certified Naturopathic Physician and Certified in Integrative Biologic Dental Medicine.
What are some common issues you see in patients, for which holistic dentistry can provide relief?
I’m seeing almost epidemic numbers of people with sleep disordered breathing, and not just in adults. A dentist looks at the entire mouth and oral environment, not only looking for cavities and broken fillings. A few years ago, I purchased a Galileos Comfort CBCT, or Cone Beam x-ray machine. It’s three-dimensional and allows me to see much more than a flat two- dimensional image.
One thing that surprised me is the ability to see the size of a person’s airway. When I talk with my patients about these findings, I’ve learned many people have been told they need to be tested for sleep apnea and are afraid to do so. Others who have been diagnosed tell me they don’t want to wear a CPAP.
What are symptoms people see?
A person would not necessarily see symptoms themselves. They may think that waking up during the middle of the night is normal for them. They may be told by a bed partner that their snoring is loud and wakes the partner. They might even pause their breathing and then make a choking sound as they try to take in oxygen. Most people with these symptoms feel tired during the daytime and find it hard to concentrate on a task, especially in the afternoon. Dark circles under the eyes are often mistaken for lack of sleep, but it’s not for lack of trying to sleep.
What are the causes sleep disordered breathing in people?
There are two main type of sleep disordered breathing. One is Obstructive Sleep Apnea (OSA), which can be successfully treated by a trained and skilled dentist. The other is Central Sleep Apnea (CSA), where the brain doesn’t send the right message to breathe. CSA is usually treated by a neurologist.
Obstructive sleep apnea is the more common and serious sleep disorder that causes someone to stop breathing for 10 seconds or more during sleep. The airway repeatedly becomes blocked, limiting the amount of air that reaches your lungs. When brain and body become oxygen deprived, there is often a sudden wakening. This is your body’s way of saying, “Wake up! Wake up! Or you’re going to die!” It may happen a few times a night, or in more severe cases, several hundred times a night, even though the person might not be conscious of this happening.
Often this is caused by the tissue in the back of the throat collapsing. Those with a narrowed airway when standing or sitting are especially vulnerable. The muscles of the upper airway relax when you fall asleep. If you sleep on your back, gravity can cause the tongue to fall back. This narrows the airway even further, which reduces the amount of air that can reach your lungs. The narrowed airway causes snoring by making the tissue in back of the throat vibrate as you breathe.
Of course, this all comes down to a lack of oxygen to your brain and other parts of the body. There are negative long-term health consequences, including: High blood pressure, Heart disease, Stroke, Pre-diabetes/diabetes and Depression.
In children with Sleep Disordered Breathing, the symptoms often mimic those of ADD and ADHD. Additional symptoms can include bed-wetting, extreme sensory issues, and/or acting out inappropriately.
How is sleep disordered breathing best treated?
First things first. A person has to be tested, and those tests must be evaluated by a Board-Certified Sleep Physician before getting a diagnosis of sleep disordered breathing. Then, a dentist who is trained and skilled in the treatment of these disorders can help you find relief.
In my office, we offer a “Home Sleep Study” that does exactly what it sounds like. It allows someone to stay with their own bedtime routine. Have a beer or a glass or wine before bed? Read or use a device before turning in? Sleep with a TV on? Do whatever you’d normally do. We review the directions for preparing for sleep and wearing the device. Once it’s returned the next day, the study is downloaded to a secure server where it is read and analyzed. Any cause for concern is sent to Board-Certified Sleep Physician who makes the diagnosis and recommendation. At this point, a copy of the report can be sent to your own health-care provider.
Not so long ago, treatment meant wearing a CPAP for the rest of your life. Things have changed. We have a number of options starting with a very inexpensive nasal dilator, to laser treatment in the back of your soft palate to tighten up those loose tissues, to one of several customized orthotic devices to wear at night. We even offer OroMyoFunctional Therapy to train for a healthier tongue posture.
For children, we have a program called “The Healthy Start,” which we have been offering since 2017. It works on proper growth and development, so a child with sleep disordered breathing is not destined to become an adult with apnea.
It’s like a breath of fresh air!
Dr. David W. Regiani practices at Regiani Holistic Dental Center, 10435 Ortonville Rd., Suite B, Clarkston, MI. For more information, call 248-625-5222 or visit RegianiDental.com.