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If you have come to see a dentist about your teeth or jaws, you may be surprised to be asked how well you sleep.
You may also have been advised to consider a sleep apnoea assessment because you snore regularly, wake up tired after what should have been a full night’s rest, or because your partner has noticed that you stop breathing or gasp during the night.
For some people, these symptoms are linked to obstructive sleep apnoea (OSA), a condition in which the upper airway repeatedly narrows or closes during sleep. A sleep study, sometimes called a sleep apnoea test, is the way to find out what is really happening to your breathing overnight and to reach an accurate sleep apnoea diagnosis before any treatment begins.
Why would a dentist ask about my sleep?
Your mouth, jaws, tongue and upper airway are close neighbours, and what happens in one affects the others.
While you are awake, your muscles hold the airway open without you ever having to think about it. During sleep, those muscles naturally relax. In some people the airway then becomes narrower, and in obstructive sleep apnoea it can partly or completely close, over and over again through the night.
The shape and position of the jaw and the surrounding structures influence how much space there is within the upper airway. That is why a dentist working in sleep medicine will ask about your nights as well as your teeth, particularly if you report any of the following:
- Regular or loud snoring
- Grinding or clenching your teeth at night (bruxism)
- Being told that you stop breathing during sleep
- Waking gasping, choking or short of breath
- Excessive daytime sleepiness, despite seemingly getting enough sleep
- Regularly waking unrefreshed
- Morning headaches
- Difficulty falling asleep or staying asleep
- Unusual movements or behaviours during sleep
- Uncomfortable or restless sensations in your legs that disturb your sleep
None of these symptoms means that you definitely have sleep apnoea. What they do mean is that it is worth looking further.
This matters especially if a mandibular advancement device (MAD) is being considered to manage your snoring or OSA. An oral appliance is a highly effective treatment, but it should only be fitted once an appropriate assessment and diagnosis are in place. If snoring is your main symptom, a sleep study for snoring is often the simplest way to confirm whether OSA is present before any device is fitted.
What if I don’t snore? Upper airway resistance syndrome
One of the most commonly missed conditions in this field is upper airway resistance syndrome (UARS), and it is worth understanding why.
In UARS, the airway does not close completely and oxygen levels may stay within normal limits. Instead, the airway narrows just enough that you have to work harder to breathe. Each of those extra efforts pulls you briefly out of deep sleep. You will almost certainly not remember it happening, but it may be occurring hundreds of times a night.
The result is that the nights look unremarkable while the days feel anything but. People with UARS often describe:
- Persistent fatigue and unrefreshing sleep
- Difficulty concentrating, or “brain fog”
- Morning headaches
- Anxiety, low mood, or feeling constantly wired
- Light, fragmented sleep and frequent waking
- Cold hands and feet, or low blood pressure
- Little or no snoring, and no witnessed pauses in breathing
Because these patients do not snore loudly and do not stop breathing, both they and those around them tend to conclude that sleep is not the problem. UARS is also seen more often in women and in slimmer, younger patients, people who do not fit the picture many of us still hold of who gets sleep apnoea.
It is missed for a second reason too: a basic screening test that looks mainly at oxygen levels can return a reassuringly normal result in someone whose sleep is being fragmented all night long. This is exactly the situation in which a more detailed sleep study earns its place, and why the type of test chosen matters so much.
UARS responds well to treatment, including mandibular advancement devices. But it has to be identified first.
Why might I need a sleep study?
Snoring and tiredness are common, and they have many possible causes. A sleep study takes the guesswork out of it by recording objective information about what happens while you are asleep.
Where sleep-disordered breathing is suspected, testing can establish:
- Whether OSA is present
- Whether a subtler pattern such as UARS is disturbing your sleep
- How often breathing disturbances occur
- Whether your oxygen levels are affected
- How severe the condition is
- Whether further investigation or treatment is needed
There are several types of sleep study, and the one you need depends on your symptoms and clinical history. Not everyone requires the most comprehensive investigation.
The different types of sleep study
Your GP or sleep specialist will recommend the test most likely to answer the clinical question being asked. There are three broad levels of investigation.
1. Home sleep screening
Home screening devices, such as WatchPAT, SleepImage or ApneaLink, are designed to identify people at high risk of obstructive sleep apnoea. This type of home sleep study, sometimes described as a sleep apnoea test at home, is one of the most straightforward ways to begin an assessment.
These tests typically monitor:
- Oxygen levels
- Heart rate
- Breathing patterns
They are convenient, simple to use, and carried out in your own bed rather than in a hospital.
Screening devices work well for patients with a high likelihood of OSA, but they are not designed to diagnose every type of sleep disorder. If your symptoms point towards something more complex, further testing may be recommended.
2. Respiratory polygraphy
Respiratory polygraphy gives a more detailed picture of your breathing overnight and is widely used to investigate obstructive sleep apnoea and other sleep-related breathing disorders.
Measurements usually include:
- Airflow
- Breathing effort
- Oxygen levels
- Heart rate
- Body position
Like screening tests, respiratory polygraphy can be performed at home. It focuses specifically on breathing during sleep and is more sensitive at picking up events that a simple screening device may miss. If there is concern about another type of sleep disorder, a more comprehensive study may still be required.
3. Video polysomnography
For patients with more complex symptoms, a clinician may recommend a video polysomnography test, often referred to as PSG. This is the most detailed form of sleep investigation and is considered the gold-standard test for assessing many sleep disorders.
It can record:
- Brain activity
- Eye movements
- Muscle activity
- Heart rhythm
- Breathing
- Oxygen levels
- Video throughout the night
This level of detail allows specialists to investigate sleep-related breathing disorders alongside parasomnias such as sleepwalking or acting out dreams, nocturnal seizures, certain movement disorders and other complex conditions.
Reassuringly, comprehensive polysomnography can now also be carried out in your own home, avoiding an overnight hospital stay.
What happens after my sleep study?
Once your study is complete, the recording is analysed and interpreted by appropriately trained sleep professionals.
Depending on what the results show, recommendations may include:
- Lifestyle measures
- A mandibular advancement device (MAD)
- Continuous Positive Airway Pressure (CPAP) therapy
- Treatment for insomnia or another sleep disorder
- Referral to another specialist
- Advice on improving and optimising your sleep
If your sleep assessment was prompted by a dental consultation, the results also help your dentist and the other clinicians involved in your care to make well-informed treatment decisions together.
Final thoughts
Questions about sleep and breathing are an important part of a dental assessment, because the jaws and surrounding structures are so closely related to the upper airway.
Being asked to have a sleep assessment does not mean that you have sleep apnoea. The purpose is to investigate your symptoms properly, so that any treatment is built on an accurate diagnosis rather than an assumption.
For most patients, a sleep study at home is now perfectly possible, and the right type of study will depend on your symptoms and the question your clinician is trying to answer.
Good assessment is what makes good treatment possible, for your sleep and for your dental care.
If snoring, disturbed sleep or daytime tiredness is affecting you or your partner, Dr Aditi Desai can carry out a full dental and sleep-related evaluation and guide you towards the most appropriate next step.
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