How Dentists (and Oral Appliances for Sleep Apnea) Can Help Save Marriages

The negative impact of poor sleep has become all but common knowledge among patients let alone medical and dental health professionals. Decades of research have shown that most if not all health conditions—and overall quality of life—are worsened by lack of adequate sleep.1 Among the extensive research on this topic, researchers have also found that abnormal or unhealthy sleep patterns can also negatively affect marriages and other romantic partnerships.2,3

When a patient has an ongoing sleep disorder, not only can frequent sleep disruptions negatively impact that patient’s health, but they can also harm the sleep of their partner and their relationship.2 When health care providers—including physicians, dentists, and dental sleep specialists—understand the physical and social harm these conditions cause, they can better diagnose, educate, and treat patients with disorders like obstructive sleep apnea (OSA).

How Chronic Sleep Conditions Like OSA Affect Relationship Health

Sleep-related breathing disorders are associated with a variety of harmful symptoms that reduce quality of life and cognitive performance. OSA in particular commonly presents with4

  • Persistent daytime sleepiness
  • Overall cognitive impairment
  • Depression and other mood disorders
  • Sexual dysfunction

Often, research on the broader impact of OSA focuses on the economic consequences of the disorder’s symptoms.5 Research on the prevalence of OSA in the adult population has shown that many sufferers remain undiagnosed, which means these symptoms—and the associated public costs—are only worsened over time.6

On a population level, OSA incidence affects everyone through increased rates of workplace injuries, car accidents, and other emergencies. But the disorder also impacts public health spending by increasing the risk of costly chronic illnesses such as cardiovascular disease, Type 2 diabetes, cancer, hypertension, and stroke.

While these societal costs are important to recognize, they often overshadow the harm done to social and behavioral health. Research has shown that chronic sleep issues are correlated with relationship problems and increased rates of partner conflicts,6 which can significantly affect patients’ well-being and mental health.

Path to Better Sleep for Healthy Relationships: Treating OSA Effectively

Developing effective treatment plans for chronic sleep disorders like OSA is key for improving overall health outcomes for patients, but there are 2 primary obstacles to addressing this public health issue among OSA sufferers4,7:

  1. Widespread underdiagnosis of patients with OSA
  2. Poor compliance (and therefore poor health outcomes) among those diagnosed with OSA

Many patients may easily dismiss some of the most common warning signs of OSA (eg, daytime sleepiness, poor cognitive performance, mood disorders), attributing them to other causes unrelated to quality of sleep.4 As a consequence, patients with moderate to severe OSA symptoms continue to experience poor sleep, which can negatively impact their partners’ sleep quality and quantity and deteriorate the health of their relationship.6

When this happens, how couples handle the issue can vary between8 

  • Both becoming resigned to poor sleep and suffering the health consequences together (damaging their long-term health and quality of life)
  • Seeking and receiving diagnosis and effective treatment from health care providers
  • Deciding to sleep separately, an approach that has earned the label of “sleep divorce”

Clearly, the second option is the most ideal, but many undiagnosed patients don’t understand that their symptoms are even related to poor sleep and may not advocate for the right testing during infrequent visits to see a physician.6 The fact that snoring is considered commonplace and normal likely exacerbates this issue. However, dentists can play a vital role in improving the diagnosis and treatment rate of OSA by incorporating relevant assessment criteria and questions as part of routine oral examinations and patient intake.7

Dentists’ Role in Screening for, Diagnosing, and Treating OSA

Due to their specialized training in oral health, as well as how frequently they may see patients for routine dental care, dentists have the knowledge and opportunity to spot telling signs of potential OSA cases.4 In addition to symptoms like fatigue and cognitive impairment, OSA also commonly presents with oral or craniofacial abnormalities that dentists can more easily identify, such as an enlarged tongue or tonsils, retrognathia, or micrognathia.4 

Adapting oral cavity examinations and patient history surveys to account for OSA gives dentists the opportunity to get more involved in holistic health care. Additionally, dentists can also recommend more convenient testing technology, such as home sleep apnea tests (HSATs), as an alternative to polysomnography (PSG) for diagnostics.

Dentists can also improve treatment outcomes and compliance for OSA patients by working collaboratively with physicians and sleep specialists treating OSA patients.4 In recent years, the American Academy of Sleep Medicine (AASM) and the American Academy of Dental Sleep Medicine (AADSM) have worked together to encourage clinical cooperation between physicians and dentists to improve health outcomes for OSA patients, especially those who may better comply with or respond to oral appliance therapy as opposed to traditional continuous positive airway pressure (CPAP) therapy.7

By adopting this role and screening for OSA using convenient HSAT over costly PSGs, dentists can ensure more patients with OSA are properly diagnosed and treated, helping them avoid serious long-term consequences to their physical and mental health, as well as the health of their marriages and partnerships.

REFERENCES

  1. Irish LA, Kline CE, Gunn HE, Buysse DJ, Hall MH. The role of sleep hygiene in promoting public health: a review of empirical evidence. Sleep Med Rev. 2015;22:23-36. doi:10.1016/j.smrv.2014.10.001
  2. Richter K, Adam S, Geiss L, Peter L, Niklewski G. Two in a bed: the influence of couple sleeping and chronotypes on relationship and sleep. An overview. Chronobiol Int. 2016;33(10):1464-1472. doi:10.1080/07420528.2016.1220388
  3. Kalmbach DA, Arnedt JT, Pillai V, Ciesla JA. The impact of sleep on female sexual response and behavior: a pilot study. J Sex Med. 2015;12(5):1221-1232. doi: 10.1111/jsm.12858
  4. American Dental Association. Sleep apnea (obstructive). March 10, 2020. Accessed December 19, 2021. https://www.ada.org/resources/research/science-and-research-institute/oral-health-topics/sleep-apnea-obstructive
  5. American Academy of Sleep Medicine. Economic burden of undiagnosed sleep apnea in US is nearly $150B per year. November 8, 2017. Accessed December 19, 2021. https://aasm.org/economic-burden-of-undiagnosed-sleep-apnea-in-u-s-is-nearly-150b-per-year/ 
  6. Goodchild TT, Lefer DJ. Obstructive sleep apnea. Circ Res. 2020;126(2):229-231. doi:10.1161/circresaha.119.316359
  7. American Academy of Sleep Medicine. AASM and AADSM issue new joint clinical practice guideline for oral appliance therapy. October 5, 2017. Accessed December 19, 2021. https://aasm.org/aasm-and-aadsm-issue-new-joint-clinical-practice-guideline-for-oral-appliance-therapy/ 
  8. Manners I. Is it time for a sleep divorce? The New York Times. July 31, 2019. Accessed December 19, 2021. https://www.nytimes.com/2019/07/31/fashion/weddings/is-it-time-for-a-sleep-divorce.html