Jill* is in her late 40’s and has been suffering with insomnia, chronic fatigue, and excessive day time sleepiness. A home sleep test revealed that she definitely was suffering from moderate sleep apnea putting her at increased risk of heart disease, obesity, diabetes, and stroke, not to mention dental decay and periodontal infection. She was originally prescribed a CPAP machine but, like so many, was unable to tolerate it. Next, she tried a dental mandibular advancement device (MAD) which did help her feel much better, but retesting revealed that she was still experiencing a significant number of apneic episodes. It wasn’t until she added a wedge pillow to her nighttime sleep regimen that her test numbers also markedly improved.
What this case illustrates is the fact that quite frequently multiple factors need to be accounted for before medical and dental issues can be completely resolved. So often we hear patients say, “I tried but it didn’t work”. For Jill, it took the combination of a MAD and improved sleep position to resolve her issues. This can especially be true when approaching issues from a functional root cause perspective.
Functionally we often find that issues like Jill’s are actually caused by small dental arches (frequently displayed as crowded/crooked teeth) that force the tongue back just enough to crowd and shrink the airway leading to snoring and/or apnea such as Jill’s. But if that airway is not corrected (arches expanded) soon enough, other issues may also need to be corrected before we get complete resolution. Obesity (which may be an independent causative cofactor of, or concomitant result of, sleep apnea) may need to be resolved. Incorrect tongue swallowing habits may need to be retrained (myofunctional therapy) and tongue ties released. Sleeping habits and routines might need to be changed. Stress and/or allergies addressed. Or the soft palate in the back of the mouth may need to be shrunk if it has gotten stretched and is also now blocking the airway.
As a matter of fact, multi-factor causation is pervasive throughout life in general and is one of the main reasons classical science (and medicine) often fails. By definition, the scientific method only tests one variable at a time and too often excludes variables as insignificant that are actually very significant when viewed as a whole with other variables. This is especially true with functional lifestyle changes. And is why in our practice we place such an emphasis on the whole Cross of Dental Health (Restorative, Periodontal, Occlusal, and Systemic health) as well as the whole Cross of Systemic Health (Diet & Exercise, Sleep & Breathing, Environment & Biome, and Love & Meaning). Whole-health can only be achieved with a wholistic approach, and a medical/dental practice is only truly holistic when it has this same wholistic perspective.
*Jill is a real patient but, for obvious reasons, we are not using her real name here.
