Dr. Good Sleep

Can you breathe out of your nose?” Is the first question Dr. Dennis Nagata’s patients hear during their SEMIannual sleep apnea screening. It’s a rare thing for a dentist to offer this test along with regular checkups, but Dr. Nagata feels it’s his ethical responsibility to help apnea sufferers catch and treat issues before they cause irreversible harm. He also examines their posture and mouth anatomy, and discusses lifestyle habits including sleep patterns. “If you snore, you have to prove to me you don’t have sleep apnea,” he says. “It’s a sure sign of some kind of obstruction.”

In his practice, Dental Sleep Medicine Hawaii, Dr. Nagata is creating better sleep and longer lives by integrating state-of-the-art sleep apnea screening into every dental visit. He pioneered cosmetic dentistry here in the islands, but switched his focus to airway-focused dental treatment because of the incredible reward he gets from seeing his patients’ quality of life improve dramatically after treatment. “We’ve been relying on pharmaceuticals to cure all kinds of issues, and it all comes down to a good night’s sleep,” he says. “I want to bring back this fundamental concept.”

It all started eight years ago when Dr. Nagata was diagnosed with Obstructive Sleep Apnea, or OSA, a potentially life-threatening condition where sufferers experience frequent episodes of stopped breathing during the night. He jumped in with both feet, researching causes, effects and treatments, and found that the repeated lack of oxygen to the cells can contribute to or cause serious health problems in the heart, lungs and limbic system—heart disease, stroke high blood pressure, diabetes and hypertension. But he also discovered that it is a highly treatable—and largely preventable condition. After studying the physiology of sleep medicine, Dr. Nagata became certified in oral appliance therapy, and joined the American Sleep and Breathing Academy and American Academy of Dental Sleep Medicine.

Though sleep apnea is still largely ignored among primary care physicians—an estimated 90 percent of sufferers are undiagnosed Dr. Nagata is set on changing those numbers here in Hawai‘i with his screenings. In addition to the more obvious symptom of chronic snoring, sleep apnea can cause headaches, dry mouth, fatigue, short attention span, inability to concentrate—all signs that enough oxygen is not reaching the body at night. “The first thing I look for is an obstruction. If I can’t see the back of the throat, it’s a red flag,” he says. Things like narrow dental arches, flabby soft tissue, enlarged tongue and complaints of poor sleep might cause a screening “fail” and prompt Dr. Nagata to refer a patient to a local sleep center for a clinical diagnosis. Following an overnight sleep study, most find relief with the Continuous Positive Airway Pressure (CPAP) machine, a mask device that sends air into the airways at night to counteract obstruction and promote clear breathing. When used consistently, CPAP is the optimal treatment for sleep apnea, but many patients struggle with compliance: They may not get the full benefit due to air leakage, or have claustrophobic issues because of the straps required to secure the mask.

Since sleep-center physicians can diagnose OSA and treat with the CPAP, but aren’t trained in small oral appliance therapy, Dr. Nagata comes to the rescue with less invasive alternatives like the MicrO2® Sleep and Snore Device or SomnoDent™ that are custom-made from digital molds. Compact and comfortable, much like sports mouth guards, they position the lower jaw forward to find the “sweet spot” where patients can breathe easy. Since neuromuscular issues are often a contributing factor, Dr. Nagata uses high-tech jaw tracking technology to find the optimal bite position that will encourage healthy airflow during sleep. Fitting these devices based on each individual anatomy is key, and in some cases, they can be used in conjunction with the CPAP. The general consensus with the medical community is that the dental sleep appliance is a valid alternative for mild-tomoderate cases, but, says Dr. Nagata, “Even if they have severe sleep apnea, using the dental appliance is better than using nothing at all.”

One big misconception Dr. Nagata is set on reversing is the belief that only men or overweight people suffer from sleep apnea. “We have an epidemic on our hands … it’s becoming more common in women, and we’re seeing more cases of pediatric apnea,” he says. He wants parents to be on the lookout for pre-apnea symptoms in children, since spotting risk factors early—like teeth grinding and mouth breathing—can actually prevent OSA. “Children grind their teeth because they’re searching for oxygen,” he says. “I’m so interested in getting this disease under control … the solutions are right at our fingertips. Sleep apnea screening should be a no-brainer for every family.”

After treatment, Dr. Nagata’s patients often report feeling refreshed and energized, and demonstrate lower blood pressure and other markers of improved health. “You’d be surprised how many couples sleep in different rooms because of this thing. I’ve actually saved a few marriages!” he says. As for Dr. Nagata’s personal progress with OSA, he says dental sleep appliance therapy made him a new man: “I lost 10 pounds, I don’t wake up foggy and I have enough energy for the day. I’m a much happier person now.”

Dr. Nagata offers a quick Self Sleep Test at dentalsleepmedicinehawaii.com, and an in-person screening for sleep apnea is recommended every six months.

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