Sleep Medicine
Dr Elaine Ng offers comprehensive sleep screening which includes a home sleep apnoea test,
chairside diagnostics and clinical assessment.
(This site is best viewed on computer screen format)
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IF YOU HAVE ALREADY BEEN DIAGNOSED WITH OBSTRUCTIVE SLEEP APNOEA
PLEASE CLICK HERE​
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IF YOU HAVE ISSUES WITH STAYING AWAKE DURING THE DAY, FALLING ASLEEP, STAYING ASLEEP, EXPERIENCE UNUSUAL LIMB MOVEMENTS DURING SLEEP, OR ACT OUT YOUR DREAMS
PLEASE CLICK HERE
Click here to watch video on how airway, breathing and swallowing function is related to the growth of the jaws, TMJ pain, bruxism (tooth grinding) and posture.
Sleep Breathing Disorders
STEP 1 : Do you suspect you may have an issue with your breathing during sleep?
If you have experienced choking, coughing gasping in the night or have been observed snoring or even completely stopped breathing, you have taken a step in the right direction by just reading this.
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Most of us know of a friend or family member who snores, and for years people falsely believed it is harmless.
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Snoring itself is the sound of airflow limitation, and may be the only sign indicating a serious underlying condition called obstructive sleep apnoea (OSA).
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OSA causes an individual to take very shallow breaths, or often stop breathing completely during the night.
​OSA is a condition that threatens not only our physical health, with effects on multiple organ systems in our body, but also our psychological and emotional well-being.
Patients are frequently elbowed by their bed-partners who report watching them snore night after night, and often witnessing long pauses in breathing, which is extremely frightening for a spouse to witness, and can be a major source of anxiety.
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Snoring should not be seen as shameful or embarrassing. The person who snores is not at fault, and should not be blamed as they have no control over the sound they make. Snoring does not impact just one person - bed-partners of snorers can suffer from many years of broken or insufficient sleep which has significant impacts on their health and quality of life. Studies have shown that partners of snorers sleep quality improves significantly when the snoring partner is treated for the condition. It is a condition that could be the alarm bell for a more serious underlying disorder which should not be ignored. Get screened today!
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Step 2 : Know what is Obstructive Sleep Apnoea
Obstructive sleep apnoea is due to a physical obstruction or collapse of the upper airways. It results in excessive daytime tiredness, impaired concentration, learning, memory consolidation and attention in the day, which seriously affects work and school performance, as well as driver safety. Cardiovascular, endocrine, digestive, immune, cognitive, psychological and emotional disorders are frequently associated with OSA.​​​​​​​​​​​​
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Specifically, it increases the risk for medical issues such as high blood pressure, heart attacks, atrial fibrillation(irregular heartbeat), stroke, obesity, Type 2 diabetes, erectile dysfunction, low libido, gastric acid reflux disease, frequent illness, asthma, upper respiratory tract infections, and recurrent sinusitis. It is also strongly associated with anxiety disorders and major depressive disorder.
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OSA can give impede and impair ovulation, the menstrual cycle, and implantation of the developing embryo. There are higher risks associated during pregnancy as it predisposes to gestational diabetes, hypertension, pre-eclampsia, and well as risk of miscarriage, low birth weight, pre term labour, higher likelihood of NICU admission and need for caesarean section.
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Audible symptoms such as snoring, choking, gasping and coughing can sometimes be observed, but can be silent in a significant number of people. Some may not complain of tiredness or any typical symptoms, but may manifest as unexplained high blood pressure, irregular heartbeats, acid reflux, hyper active bladder or even early onset glaucoma.
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As mentioned before, pure snoring is also not without its risks. Recent research has found that people who snore loudly for many years are at risk of developing OSA due to vibration and trauma to the soft tissues of the throat and soft palate, causing them to enlarge and become "floppier", as well as damage to the airway receptors, which leads to increasing severity of snoring and greater upper airway resistance. Also, cases of untreated OSA has been found to double in severity over a 10 year period.
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Step 3 : How do I get screened?
Consultation
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Since 2008, Dr Elaine established an effective and comprehensive Sleep-disordered breathing screening program, and is utilised by patients who are both self referred, or referred by their physicians, to help accurately detect and identify the nature of, and risk for sleep or sleep breathing disorders.
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A detailed examination of your head, neck, jaws, teeth and airways is conducted, along with specialised tests, standardised subjective questionnaires as well as in depth medical and sleep history to evaluate your level of risk.
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Sleep Screening
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Using high resolution pulse oximetry technology, we can conduct a non-invasive, single-night or multi-night sleep test in the comfort of your own home.
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The test is categorised as a high level 4 home sleep apnoea test, and differs from consumer wearables on the market. ​​​​​​​​​​
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It is highly accurate and reliably screens for a variety of sleep and sleep breathing disorders, as well as generates a detailed report including information about sleep architecture.
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Sleep-trained clinicians such as Dr Ng are able to interpret sleep study reports and advise patients on further steps to be taken.
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Screening is recommended for patients who have signs and symptoms, and also for patients who are unsure about their risk. Screening is also advisable for anyone who wishes to have knowledge about their sleep health condition in general.
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Assessment
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After a full assessment has been made, the patient will be given the results of the screening test and clinical findings, and referrals will be made to specialists within the multidisciplinary team of sleep practitioners - usually, this may involve ENT specialists (otolaryngologists), orthodontists, oral surgeons, respiratory specialists and neurologists.
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Often allied health care such as speech pathologists may be included for functional issues such as swallowing, feeding and speech
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​Sleep psychologists and mindfulness coaches are able to help and treat sleep issues such as insomnia, which can be effectively treated by cognitive behavioural therapy (CBTi) CBTi is scientifically proven to be more effective in the long term than treatment with medications. Mindfulness-based therapy (MBT) is an adjunct to CBTi, and can be effective for certain types of insomnia.
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It is important for patients to note that OSA is a chronic disorder
which requires life long monitoring.
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The respiratory physician or ENT specialist will prescribe the recommended treatment to the patient which may include the following:
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Treatment
For mild to moderate OSA it is a well-established, acceptable first-line treatment. For severe OSA patients, oral appliances are an acceptable alternative for patients who are intolerant of CPAP or have stopped using their CPAP. Oral appliances are an excellent solution for patients who wish to have a non-invasive, compact and portable solution alongside their CPAP, or for holidays or work travel. All treatments are FDA-approved, clinically validated and evidence based. Find out more here
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For patients who are needing short term therapy or interim therapy eg. patients who are undergoing complex dental work such as implant surgery, crown or extensive filling but require urgent treatment with MAD. A temporary adjustable and adaptable appliance will be able to help address the extended period where the patient may otherwise have to wait 6 months or more to fabricate a permanent appliance.​
Also during pregnancy, gestational weight gain can exacerbate and/or give rise to OSA, which can negatively affect maternal and neonatal outcomes. OSA increases the risk of gestational diabetes, hypertension, pre-eclampsia, low birth weight, preterm birth, cesarean delivery and NICU admission. (Xu, T. et al, 2014., Obstructive Sleep Apnea and the Risk of Perinatal Outcomes: A Meta-Analysis of Cohort Studies. Sci Rep 4.)
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Continous Positive Air Pressure Therapy
The gold standard treatment for OSA is continuous positive airway pressure (CPAP). This is air supplied to the wearer though a tube and delivered to the patient via face mask, nasal mask or nasal pillows. However there is a significant number of patients who are not able to tolerate CPAP on a nightly basis long term, and hence oral appliance therapy is a treatment alternative for these patients. Find out more here
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Surgery
Soft tissue surgical solutions, which reduce physical obstructions caused by overgrown tissues (tonsils, adenoids, turbinates), tumours, excessively long or stretched soft tissue (palate area) for example.
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In patients who have skeletal discrepancies or abnormal jaw growth patterns may be given the option for Orthognathic surgery + orthodontics in adults, and orthodontics + dentofacial orthopaedics in children. These will require consultation with an orthodontist as well as an oral maxillofacial surgeon.
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Hypoglossal nerve stimulation (HGNS) which is relatively new surgical intervention which may be performed in patients who are unable to tolerate or are not candidates for the treatments above.
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Treatment adjuncts
Positional therapy, weight loss, dietary counselling, avoidance of alcohol and sedative medications, and myofunctional therapy may be advised.
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Be patient with yourself and your body, as it takes time to respond to the challenges and changes it may encounter during treatment.
Most of all, stay focused on the goal of successful treatment by following the instructions given to you by your doctor during any course of treatment.
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Sleep Monitoring
Patients who have already been diagnosed with sleep disordered breathing and are on long-term oral appliance therapy, are advised to return for screening yearly to detect any break through apnoea or worsening of their condition, especially after menopause for women, or after weight gain for both sexes. Long-term monitoring is important to make sure that you have always have control over your condition, by ensuring your treatment is optimised.
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It is important for patients to remember that OSA is a disorder which affects multiple organ systems, hence being being referred to more than one specialist is not uncommon, and in some cases is necessary to ensure the condition is treated properly. OSA patients should keep their health records well organised, as they may need to be managed by multiple disciplines.
Airway and TMJ
Watch this 3 minute video to find out more about how breathing, the development of the face and dental arches relates to swallowing, grinding the teeth, TMJD (jaw joint/muscle dysfunction) and posture.
Start at the top of this page to understand the process of sleep screening and how to get started.
If you have general questions about the process go to FAQs or contact us via Whatsapp!
Sleep Movement &
Circadian Rhythm Disorders
People most commonly feel tired in the day, due to issues with breathing during sleep. However in some individuals, their airway and breathing is perfectly fine, and the problem is due to another type of sleep disorder. Excessive tiredness can by caused by movement disorders, nightmare disorders, circadian rhythm misalignment, and conditions of genetic or neurological origin. Sometimes the cause is as simple as poor sleep hygiene or insufficient sleep.
You can be screened for these less common disorders if you feel you are not getting a good night's rest despite going to bed early, eating well, exercising and doing all the "right things".
Sleep is the one thing you cannot "try harder" with. Most of us have tried it. The more you force yourself to sleep, the more you are unable to. This can give rise to chronic insomnia.
Sleep hygiene helps us to correct our habits and thoughts associated with sleep, and "retrain" our brain. Some patients will require cognitive behavioural therapy called CBTi, which is a highly effect treatment which is administered by qualified sleep psychologists, which is proven to be more effective than medication.
Nearly all of us have at one time or another experienced a terrifying nightmare. Or dreamt of going to school naked. How do you know when it is not normal? Does your child or spouse cry out in the night or scream, but wake up not remembering anything?
Sleep screening will help you to seek answers to identify abnormal sleep and hallucinations from normal dream sleep.
Some of us may have experienced sleep walking during childhood, a form of parasomnia that is sometimes carried into adulthood. If you're a male, above age 40 and ever been told by your bed partner that you've been acting out your dreams or kicking blankets, you should get screened for potential REM behaviour disorder. Research has shown more than 80% of cases will progress into neurodegenerative disorders such as Parkinsons' Disease or Lewy body Dementia.
Sleep disorders can affect anyone at any age from any background, race or nationality.
It can affect your neighbour, your doctor, your dad, your child's teacher, or your next taxi driver.
We need to be vigilant to help one another, by raising awareness of the dangers and complications of sleep disorders. Sleep disorders don't discriminate and neither should you. Everyone just wants to be able to have a restful sleep each night just like you.
Sleep disorders are still largely undiagnosed in sufferers, mainly due to lack of awareness or stigma of having an unusual condition.
We need to remove these barriers and allow people to seek screening and early treatment.
Sleep disorders account for a high number of work place related errors, accidents and car crashes.
This is due to impairment of daytime function, judgement and reaction time - leading to a state similar to being intoxicated by alcohol.
It can appear frightening to the bed partner or the family members, but the person with the sleep disorder may be completely unaware of the events when they wake up. Sometimes it may be as harmless as handwashing, but others may manifest sleep-eating and may put themselves in harm's way by eating inedible materials, or by walking out of the house. These individuals need to be treated with gentleness and understanding. They need our help in order to take the steps to seek treatment.
You may not have any issues with breathing, but just can't get to sleep no matter how hard you try. Insomnia is the condition where patients are unable to initiate and, or maintain the normal duration of sleep time. Screening for all sleep conditions is strongly advised, as the longer they are left untreated, they may increase in severity and/or lead to other associated medical conditions.
We regularly screen for all other health conditions, and sleep is no different.
Early detection and early treatment will give you better quality of life and function now, and prevent serious repercussions in your health and daily life in the future.
CONTACT US FOR AN APPOINTMENT
+65 8120 3858