When his family doctor couldn't determine why David Nall felt a frequent need to urinate at night, much more often than during the day, he sent him to a specialist for further tests.
The urologist's diagnosis surprised him.
Rather than a problem with his bladder or kidneys, "the doctor told me I had sleep apnea," says Nall, 69, of East Brainerd. "The sleep apnea was waking me up (at least eight times a night), so every time I woke up I thought it was because I needed to go to the bathroom."
Two nights at a sleep clinic confirmed the diagnosis.
Turns out, Nall might have saved himself a few sleepless nights if he'd mentioned his symptoms to his dentist.
While only a sleep specialist is qualified to diagnose obstructive sleep apnea, more and more dentists are trained to screen for such problems and make referrals for further testing.
Plus, their arsenal of treatments provides alternatives to CPAP, the common fix for the 12 million to 18 million Americans who suffer from sleep apnea. Short for continuous positive airway pressure, CPAP uses mild air pressure to keep the airways open and ease breathing issues.
Though it's an effective cure, it's also cumbersome. The machine includes a mask that fits over the nose and mouth with straps to keep it in place, a tube that connects the mask to a monitor and a motor that blows air into the tube, reports the National Institutes of Health.
Lindsey Lucenta, spokesperson for the American Academy of Dental Sleep Medicine, says that since 1981, additional treatments have been established so that dentists can now play a role in the management of snoring and sleep apnea with oral appliance therapy, also known as OAT.
"In fact," Lucenta says, "OAT has proven to have a significantly higher compliance rate among patients compared to the traditionally prescribed CPAP."
Nall, who used a CPAP machine for two years, was relieved when his dentist, Dr. Terrence Major, a member of the American Academy of Dental Sleep Medicine, identified him as a perfect candidate for oral appliance therapy.
"Most people are unaware of the possibility of treating sleep apnea with a dental appliance," Major says.
Nall didn't have to wear the mask over his nose and mouth, but tubes attached to "pillows" in his nostrils were hooked up to the machine.
"I got used to," he says. "(But) I could only sleep on one side," he says. "It was impossible to turn in a circle without getting wrapped up in tubes."
Nall now uses a Somnodent, a two-piece mouth appliance, made exclusively for each client, that fits snuggly over the upper and lower teeth. With it, he can sleep in any position.
"When you put it in, you know it's there but it doesn't hurt," he says.
The only thing that wakes him up during the night these days is the noise made by his two dogs playing, he says. "They sleep during the day."
Major says nearly 10 percent of his patients have some type of sleep issue. And, because of that, he encourages his peers to become trained in identifying sleep disorders.
In addition to physicians who are sleep disorder specialists, there are only two dentists in the area trained to identify sleep disorders, Major and Dr. Charles Owens of Fort Oglethorpe, Lucenta says. "The AADSM expects that number to increase as more patients are being diagnosed with sleep apnea and more physicians work with dentists to treat snoring and sleep apnea. Dental sleep medicine is, by all indicators, a fast-growing field of the medical industry."
Danny Thomas, 60, of Ooltewah, was diagnosed with sleep apnea in 2005.
Unlike Nall, Thomas' only indication he had a sleep disorder was his wife telling him he snored, he says. "It wasn't a problem sleeping that I knew of. It was keeping my wife awake with my incessant snoring."
Thomas's wife, Renee, says they tried "everything" to stop his snoring before seeking medical help.
No over-the-counter products worked, he says, including a molded mouth guard, nose adhesive strips, head gear designed to keep the mouth closed during sleep, a "snore" pillow and nose clip.
Finally, after his wife threatened to sleep in another room, Thomas went to a sleep specialist and, like Nall, spent time in a sleep clinic.
"I arrived at 7 p.m., was wired with electrodes from head to toe, and went to bed at 10 p.m.," he says. "(I) was awakened at 11:45 p.m. when they told me the study was over because I had stopped breathing 45 times in an hour. They put the CPAP on, and I slept restfully through the night and went home at 8 a.m."
Thomas says the machine has changed his life.
"It allows me to sleep through the night and be fully functional through the day," he says.
And though he plans to use the machine the rest of his life, there is a downside.
"I can't sleep on my left side due to the hose being across my face and body," Thomas says. "I use the nose pillows, not the full face mask. I have a 10-foot hose, but it limits me from turning over."
Major says that because dentists often see airway issues, he hopes more become trained to evaluate sleep issues.
"Creating a referral pattern with a sleep specialist is important for the well-being of our patients and can prevent serious health issues from occurring and could save lives."
Major says that football legend Reggie White, a Chattanooga native, died as a result of sleep apnea. "He did not use his CPAP," Major says.
According to a Reuters news article, the driver of the train that derailed last December in New York City, killing four passengers, had an undiagnosed sleep disorder at the time of the accident, the National Transportation Safety Board reported. The driver, William Rockefeller, suffered from severe sleep apnea. The report says Rockefeller was in a 'hypnotic' state the overcame him before he realized the train was derailing.