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Blog Post

Sleep Apnea Medications

Aug 02, 2022

Obstructive sleep apnea (OSA) causes significant stress on your body, jeopardizing your health.  Still, millions of Americans unknowingly experience OSA. It’s estimated that up to 80% of OSA sufferers go undiagnosed. 


Characterized by throat muscles intermittently relaxing and blocking your upper airway during sleep, OSA deprives your body and brain of oxygen. Your brain reacts by briefly awakening you to restart breathing, which may occur hundreds of times a night. By robbing you of sound, restorative sleep, OSA can lead to an overall lower quality of life. Getting diagnosed and treated for OSA is crucial to your well-being. 


In addition to surgery that addresses physical anomalies and obstructions, OSA treatment options include wearing a CPAP (continuous positive air pressure) device or a custom-made dental appliance to keep your airway open when you sleep. Sometimes, medications are an option to help with the symptoms associated with OSA, depending on your diagnosis. Below we review various sleep apnea medications and some potential side effects. 

Sleep Apnea Diagnosis

Getting diagnosed with OSA is the first step toward a better quality of life and improved health. Your doctor will perform an initial evaluation that includes examining your eyes, mouth, and throat. The exam can reveal symptoms of OSA as well as physical abnormalities that may be causing your OSA.  In some cases, you may be required to complete an at-home sleep test; otherwise, you’ll be referred to a sleep clinic for a polysomnography (PSG) recorded during an overnight sleep study.


Causes of Sleep Apnea


Many risk factors can increase your chances of  OSA, including excess weight and obesity, a thick neck circumference, smoking, high blood pressure, type 2 diabetes, and the use of alcohol, tranquilizers, or sedatives. In addition, incidence can increase with age, and men are two to three times more likely to have OSA than women. 


Additional causes that can contribute to OSA either singularly or in combination include:


  • Narrow airway - Symptoms of OSA can be exacerbated by an airway that’s structurally narrower than normal. OSA occurs when the muscles in the back of your throat relax.  A narrow airway may collapse more easily, preventing airflow and causing OSA.
  • Unstable breathing - Sleep-related breathing disorders such as hypoventilation due to lung conditions such as COPD (chronic obstructive pulmonary disease) can contribute to the development of OSA by amplifying the effects of airway blockage.
  • Light sleeping (waking up easily) - Light sleepers often have difficulty staying asleep. Treating OSA successfully for these individuals means finding a method that doesn’t disturb their ability to sleep. 



Types of Medication Used for Patients with Sleep Apnea


Most of us know CPAP and dental appliances as nonsurgical treatments for OSA, but there are also a few pharmacologic treatment options ranging from prescription medications to common over-the-counter drugs that can be used as adjunctive therapies.


Over the Counter


Always consult your doctor before taking any OTC medicines or supplements.


  • Melatonin - Melatonin is a hormone made by the pineal gland that helps your body know when to sleep and wake up and may help with insomnia that can occur with sleep related breathing disorders..
  • Afrin (oxymetazoline) - Helps relieve nasal congestion from colds and allergies. Studies reveal associations between impaired breathing and sleep disorders such as OSA and that opening nasal passages with a decongestant can improve sleep quality.
  • Sudafed (pseudoephedrine) - This sinus decongestant works by narrowing the blood vessels to decrease swelling and congestion and may be used to treat mild cases of snoring associated with OSA.


Prescription


Your doctor may prescribe
various medications to help relieve some symptoms of OSA based on your diagnosis, although generally speaking, prescription medications typically aren’t recommended as a primary treatment for OSA.  Medications that may be prescribed include:


  • Provigil (modafinil)- Provigil is FDA-cleared to treat excessive daytime sleepiness due to OSA, shift work sleep disorder, and narcolepsy. This federally controlled wakefulness-promoting substance (C-IV) can boost energy and enhance focus. It must be used with caution in patients with health conditions such as cardiovascular disease.
  • Halcion (triazolam) - Another federally controlled substance (C-IV), Halcion is used to treat insomnia. It may also be prescribed to address OSA by increasing the arousal threshold to airway occlusion while being used cautiously.
  • Valium (diazepam) - Some physicians have prescribed valium in the past to help relieve OSA, but the consensus today is that benzodiazepines such as Valium may worsen OSA.
  • Ambien (zolpidem) - A pilot study investigating the effects of Ambien in OSA indicates that Ambien may help “improve sleep efficiency in people with OSA.” 


Side Effects of Medication


Talk with your doctor about potential side effects that may occur with both OTC and prescription medications, which can range from mild to severe. Your physician will also check for interactions with other prescriptions you’re taking. Per RXlist.com, side effects include, but are not limited to:


  • Headache - Headache is listed as an adverse side effect for many medications, including Provigil and Halcion. 
  • Nausea - Stomach discomfort, often accompanied by the urge to vomit, is another common side effect for numerous medications, including Provigil and Ambien. 
  • Insomnia - Insomnia is a possible side effect for Provigil and Ambien. 
  • Anxiety - Anxiety is a potential side effect associated with many prescription medications, including Provigil.
  • Stomach aches - Digestive problems such as diarrhea, constipation, 
  • Grogginess - General tiredness and even memory problems may be attributed to a variety of medications, including Halcion, Valium, and Ambien.


Primary Treatment Options for Sleep Apnea


A thorough exam and diagnosis by a qualified medical professional are required before any kind of OSA treatment.  Currently, nonpharmacologic treatment options are recommended as first line therapy for sleep apnea.


In addition to weight loss and sleep position therapy, non-pharmacologic alternatives include:


  • Oral appliance therapy (OAT) - The American Academy of Dental Sleep Medicine and the American Academy of Sleep Medicine recommend OAT for consideration as a first-line treatment for mild to moderate OSA. OAT involves wearing a custom-made oral appliance called a splint while you sleep, similar to wearing a mouthguard. A mandibular advancement splint (MAS) moves the jaw and tongue slightly forward, opening up the back of the throat and prevents the base of the tongue from collapsing against the airway. Careful adjustments are made to correctly position your lower jaw to bring the tongue forward and away from the back of your throat, making it easier to breathe. A trained specialist like Dr. Katherine Phillips can help determine if this type of treatment is right for you. 


  • CPAP (continuous positive airway pressure) - CPAP, considered the gold standard for OSA treatment, uses pressurized air to keep the airway open. Your sleep physician will determine the pressure settings and follow up to help ensure the device remains effective. Unfortunately, many CPAP users find it uncomfortable to wear and seek alternative treatment such as oral appliance therapy.


  • Surgery - Surgical solutions include uvulopalatopharyngoplasty (UPPP), removing excess tissue in the throat to widen the airway, and endoscopic procedures that open identified airway obstructions. Orthognathic surgery is another option that permanently opens a narrow airway by advancing the jaw, and nasal procedures are used to reduce blockages caused by tissues, cartilage, and bone to address OSA.


  • Inspire - This FDA-approved treatment involves a surgically implanted device called Inspire, which sends a gentle pulse to key airway muscles, causing the tongue to move forward during sleep.


  • Behavioral Modification - avoidance of alcohol and smoking, side sleeping, increased exercise and weight loss.


Next Steps


If you’re suffering from obstructive sleep apnea symptoms, it’s important to seek diagnosis and treatment from an expert like Dr. Katherine Phillips. She is board-certified in dental sleep medicine, has over a decade of experience, and has successfully treated more than 5,000 patients with obstructive sleep apnea. She can provide lasting relief with the use of oral appliances and other less invasive treatments. This can be a refreshing alternative to bulky CPAP machines, surgery, and other inconvenient methods. All of her treatments are research-based, patient-focused, and customized to your individual needs.

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Dr. Kathrine Phillips
About The Author
Dr. Katherine Phillips, DDS, MS received her undergraduate degree from the University of Michigan and her dental degree from the University of Detroit Mercy School of Dentistry. She currently serves as the Secretary/Treasurer on the American Board of Dental Sleep Medicine (ABDSM) Board of Directors and treats TMD and sleep disordered breathing at Restore TMJ & Sleep Therapy in the Houston, TX area. 
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Teeth grinding is the most common cause of jaw pain. Grinding your teeth also results in fractured teeth and the destruction of dental work, which can even change how you look. People who grind their teeth during the day can make conscious changes to reduce their teeth grinding for those who grind their teeth at night . Fortunately, with a visit to Dr. Phillips, you can discover how to stop grinding your teeth. What is Teeth Grinding, and What Causes it? Grinding or clenching your teeth, or bruxism , is a common condition affecting millions of people and, if left untreated, can lead to broader health issues. According to the American Dental Association (ADA), a 2020 ADA Health Policy Institute report stated that half of the dentists saw a rise in clients with stress-related dental problems, primarily due to teeth grinding and jaw clenching. It can happen during the day or night and often goes unnoticed until the person is alerted by a partner or family member. Treating bruxism can prevent further damage to the teeth and relieve any symptoms associated with the condition, and there are several steps you can take to stop grinding your teeth and protect your oral health. People grind and clench their teeth for various reasons, including stress and anxiety, misalignment of the teeth and jaw, or an abnormal bite. In adults, teeth grinding is often caused by emotional tension and stress and can become a subconscious habit. In children, teeth grinding is usually due to an immature bite and can be triggered by new teeth erupting or the recent placement of braces. How Do You Know if You're Grinding or Clenching Your Teeth? Grinding or clenching your teeth can be challenging to identify since it usually happens when you are unconscious or sleeping. However, several signs could indicate you are grinding your teeth. Common symptoms of teeth grinding include: Waking up with a sore jaw Frequent headaches Increased sensitivity or pain in your teeth Tired or tight jaw muscles Pain that feels like an earache, but there is nothing wrong with your ear A locked jaw that is difficult to open or close completely Neck or face pain Noticing that your teeth feel different or worn down You or your sleep partner may also notice that you make clenching or grinding sounds during the night. At a dental appointment, your dentist may suspect teeth grinding if you have the following: Teeth that are chipped, loose, flattened, or fractured Worn enamel on your teeth Gum recession Possible Causes of Teeth Grinding Many people grind their teeth and tighten their jaws without realizing it, especially at night. Although stress and anxiety can lead to teeth grinding, other common causes are: Posture. Poor posture is not only horrible for your back; it's also bad for your teeth. When the body's joints aren't in proper alignment, it can result in jaw clenching and grinding. Misaligned teeth. If the upper and lower teeth don't fit together correctly, the misalignment may result in the tendency to grind teeth or clench jaw muscles. Sleep disorders. Sleep habits and sleep disorders can lead to teeth grinding at night. Chronic obstructive sleep disorder , also known as sleep apnea , is a known cause of sleep bruxism. Resolving sleep apnea can help stop teeth grinding. Sleep terrors and insomnia may also result in grinding teeth at night. Joint disorders. The temporomandibular region is around the jaw, mouth, and ears. This area contains the temporomandibular joints and jaw muscles, which allow the jaw to open and close. Disorders in this area can affect teeth grinding and a sore jaw. Stimulants. Stimulants like caffeine, nicotine, and alcohol can trigger teeth grinding. Avoiding these can help prevent teeth grinding. Stress. Stress is a common cause of teeth grinding and clenching. Finding ways to manage and reduce stress can help decrease teeth grinding. These can include relaxation techniques such as progressive muscle relaxation, yoga, deep breathing, meditation, and guided imagery can help relax the jaw muscles and stop teeth grinding. Chewing on Objects. Chewing on objects such as pencils or fingernails can trigger teeth grinding. You may also need to avoid chewing gum, which can exacerbate teeth grinding. Finding out how to stop grinding teeth at night takes getting to the root cause of grinding. Discovering the cause provides clues, pointing to the appropriate solutions. Prevent teeth grinding during the day. It is crucial to identify triggers that cause teeth grinding if you intend to stop grinding them during the day. Pay attention to your habits during the day and see if you notice when and if your grinding or clenching is worse. A TMJ specialist or dentist specializing in bruxism can provide you with exercises or relaxation techniques you can do throughout the day if you notice yourself clenching and, in some cases, offer medical treatment like muscle relaxants or Botox for bruxism. Prevent teeth grinding and clenching at night/in your sleep. You'll have to make changes during the day to stop grinding or clenching your teeth at night or in your sleep. Start by talking to your dentist or doctor to determine if you have underlying medical issues that could be causing the grinding. Additionally, your dentist may suggest you wear a mouthguard, splint, or other oral appliance. At the same time, you sleep to protect your teeth from further damage and keep your mouth in the proper alignment, helping your TMJ to relax. A custom-fitted mouthguard also helps lessen the impact of teeth grinding by covering the teeth to create a physical barrier that reduces damage. How To Stop Child/Baby Grinding Teeth Many children grind their teeth at night, but most grow out of it. If your child or baby grinds their teeth, the first thing to do is identify what might be causing the behavior. Stress, anxiety, or an underlying medical condition can cause your child to grind their teeth. If the grinding is stress-related, identifying and addressing the source of the stress, such as an overly demanding school schedule or peer pressure, may help. If a medical or dental condition causes the grinding, your child's dentist or doctor can help you determine the best action. If the grinding results from a habit, it can help redirect your child's attention when they start to grind and provide them with other activities that may help reduce their stress and anxiety. Side Effects of Teeth Grinding Grinding your teeth may seem like a harmless habit. After all, it's easier to notice this behavior if you're not on the lookout for it. And unless your significant other or family members complain about the noise from your nighttime teeth grinding, it's difficult to find proof of the act. However, long-term grinding of teeth at night can lead to significant side effects like: Pain in the jaw. The pressure and movement from teeth can lead to tenderness in the muscles, causing jaw pain . For some people, the pain may become chronic and severe. Headaches. The constant back-and-forth movement and clenching can impact the muscles around the neck and head, resulting in headaches due to muscle fatigue and tension. Wearing down teeth. Like sandpaper eventually smooths a surface, the repetitive motion from teeth grinding can flatten teeth and wear the enamel down over time. Teeth grinding can change the appearance of your teeth, causing them to look shorter and making chewing more difficult. Damage or fractured teeth. Grinding can destabilize teeth, making them shift and feel wobbly. The force from grinding may also crack teeth, causing pain and affecting oral health. Misalignment and cracked teeth can result in gum disease, cavities, and tooth loss — leading to poor overall health. Chronic ear pain. The temporomandibular area is closely connected. If the muscles around the ear become affected due to teeth grinding, chronic ear pain may occur. Facial muscle changes. Most people need to be aware that teeth grinding can change the shape of your face. Long-term bruxism can cause shorter teeth. Shorter teeth, in turn, change the structure of the face and jaw — leading to a sunken appearance. In addition, other muscles around the face can enlarge to compensate for dental changes. If you're concerned about your appearance, you may want to note that chronic teeth grinding can change the way you look. Remedies for Teeth Grinding The methods for how to stop teeth grinding at night versus teeth grinding when you are awake are typically the same. Although some treatments aren't quite possible when you're asleep, their benefits can last even after you've gone to bed. Reductive coronoplasty. Reductive coronoplasty directly involves changing or leveling the biting surface of teeth. This procedure reshapes crowded or crooked teeth, improving teeth alignment. Conversely, additive coronoplasty can add to the surface of teeth to help treat bruxism. Dental Appliances: Mouthguards, night guards, and splints. A mouthguard does just that — it guards teeth. Typically used for sports, a mouth guard keeps teeth from injuries sustained during activity. A night guard protects teeth from grinding at night. Lastly, a bit splint guides jaw movement, enabling the jaw to land in the appropriate position. These appliances protect teeth differently, and finding the right one for your situation is essential. Biofeedback. Biofeedback allows a person to train themselves by monitoring auditory and visual stimuli from the body. Although biofeedback needs a person to be alert, the technique can still help sleep bruxism by reducing overall stress. Stress reduction techniques. Though implementing stress reduction techniques such as yoga, exercise, and meditation requires a person to be awake, they can also help with nighttime teeth grinding. Allowing muscles to decompress and relieve tension alleviates stress-induced teeth grinding, even at night. Tongue and jaw muscle exercises. Most people don't stop to think about it, but their faces and mouth are a team of tissue, muscles, bones, and joints that closely affect each other. The tongue, for example, affects how the jaw moves. You reduce teeth grinding by exercising the right muscles — like the tongue and jaw. Behavior changes. Behavioral modifications like changing your posture and avoiding environments that cause stress can reduce instances of teeth grinding. Cognitive Behavioral Therapy (CBT) can help change behavior and thought patterns that lead to teeth grinding. Medications. A doctor can prescribe medication to help treat bruxism if all other treatments don't work. When used for short periods, muscle relaxants can relieve tension in the temporomandibular area. In severe cases of teeth grinding, botox injections can alleviate muscle tension. Antidepressants and anti-anxiety medications assist in decreasing anxiety, allowing jaw muscles to relax and reduce bruxism. How Can a TMJ Specialist Help with Teeth Grinding and Clenching? A TMJ specialist is a dentist board-certified in orofacial pain and conditions affecting the TMJ. TMJ specialists have extensive knowledge and experience regarding the structure, function, and pathology of TMJ. In addition to more thorough diagnostic evaluations, they can often provide more effective and long-term solutions for teeth grinding than your doctor or dentist alone. This is because TMJ specialists use a holistic approach to treatment, focusing on the underlying causes of the teeth grinding, such as stress, anxiety, or misaligned teeth, rather than just treating the symptoms. They often work with other medical experts like dentists or sleep physicians for more comprehensive care and treatment. Protecting Your Oral Health Protecting your teeth is critical to taking care of your overall health. Chronic teeth grinding can result in costly dental work, poor oral health, and chronic pain. If you're experiencing a sore jaw, headaches, or cracked teeth, seeking an expert diagnosis to find the cause is the first step to finding a solution. Get the answers you need on how to stop grinding your teeth at night or keep from grinding in the daytime to protect your oral health. As a TMJ and sleep apnea dentist, Dr. Katherine Phillips specializes in diagnosing and treating bruxism. With her Master of Science in Orofacial Pain From USC and extensive experience in TMJ therapy, Dr. Phillips utilizes proven and effective evidence-based medical interventions to identify bruxism and help find the right treatments to suit your needs. Get in touch today for more information.
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The temporomandibular joint, or TMJ, is an anatomically complex joint, composed of muscles, joints, ligaments, bones, and discs. Proper jaw movement requires a high level of interaction and coordination among all these components, especially the articular disc (which absorbs stress), the adductors (jaw-closing muscles), the abductors (jaw-opening muscles), and jaw ligaments. This makes diagnosing problems or dysfunction with the TMJ extremely difficult. Properly diagnosing disorders of the TMJ—collectively referred to as TMD—requires both clinical examinations and medical imaging in order to develop an accurate assessment of the joint, its function, and its surrounding bone and tissue. If you are experiencing pain, discomfort, or dysfunction in your TMJ, you will first have a clinical evaluation. This is when your doctor or TMJ specialist will discuss your symptoms with you and examine your jaw, pressing on areas around it to identify any sensitivity. He or she will also observe the range of motion of your jaw and listen to and feel around your jaw while you open and close your mouth. In some cases, the doctor’s clinical findings are enough to diagnose a TMD and begin treatment. Other times, additional diagnostic imaging will be necessary to confirm the presence of a TMD.
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