Sleep Apnea/Oral Appliance Therapy
The Greek word “apnea” literally means “without breath.” Sleep apnea is an involuntary cessation of breathing that occurs while the patient is asleep. There are three types of sleep apnea: obstructive, central, and mixed. Of the three, obstructive sleep apnea, often called OSA for short, is the most common. Despite the difference in the root cause of each type, in all three, people with untreated sleep apnea stop breathing repeatedly during their sleep, sometimes hundreds of times during the night and often for a minute or longer. In most cases the sleeper is unaware of these breath stoppages because they don’t trigger a full awakening.
Left untreated, sleep apnea can have serious and life-consequences: high blood pressure, heart disease, stroke, automobile accidents caused by falling asleep at the wheel, diabetes, depression, and other ailments.
Sleep apnea is seen more frequently among men than among women, particularly African-American and Hispanic men. A major symptom is extremely loud snoring, sometimes so loud that bed partners find it intolerable. Other indications that sleep apnea may be present are obesity, persistent daytime sleepiness, bouts of awakening out of breath during the night, and frequently waking in the morning with a dry mouth or a headache. But none of these symptoms is always present. Only a sleep study in a sleep laboratory or a home sleep study can show definitively that sleep apnea is present and how severe it is.
Sleep apnea is very common, as common as type 2 affects more than 18 million Americans, according to the National Sleep Foundation. Risk factors include being male, overweight, and over the age of 40, but sleep apnea can strike anyone at any age, even children. Yet still because of the lack of awareness by the public and health care professionals, the vast majority of sleep apnea patients remain undiagnosed and therefore untreated, despite the fact that this serious disorder can have significant consequences.
Untreated, sleep apnea can cause high blood pressure and other cardiovascular disease, memory problems, weight gain, impotence, and headaches. Moreover, untreated sleep apnea may be responsible for job impairment and motor vehicle crashes. Fortunately, sleep apnea can be diagnosed and treated. Several treatment options exist, and research into additional options continues. One treatment option is through the use of an oral appliance.
Oral appliances (OA) are a front-line treatment for patients with mild to moderate Obstructive Sleep Apnea (OSA) who prefer OAs to continuous positive airway pressure (CPAP), or who do not respond to CPAP, are not appropriate candidates for CPAP, or who fail treatment attempts with CPAP or treatment with behavioral measures such as weight loss or sleep position change. This small plastic device fits in the mouth during sleep like a sports mouth guard or orthodontic retainer. Oral appliances help prevent the collapse of the tongue and soft tissues in the back of the throat, keeping the airway open during sleep and promoting adequate air intake. Oral appliances may be used alone or in combination with other treatments for sleep-related breathing disorders, such as weight management, surgery or CPAP.
Standards of Care
- Patients with primary snoring or mild OSA who do not respond to, or are not appropriate candidates for treatment with behavioral measures such as weight loss or sleep-position change.
- Patients with moderate to severe OSA should have an initial trial of nasal CPAP, due to greater effectiveness with the use of oral appliances.
- Patients with moderate to severe OSA who are intolerant of or refuse treatment with nasal CPAP. Oral appliances are also indicated for patients who refuse treatment, or are not candidates for tonsillectomy and adenoidectomy, cranofacial operations, or tracheostomy.
Oral Appliance Therapy
Oral appliance therapy involves the selection, fitting and use of a specially designed oral appliance that maintains an open, unobstructed airway in the throat when worn during sleep. Custom-made oral appliances are proven to be more effective than over-the-counter devices, which are not recommended as a screening tool nor as a therapeutic option.
Dentists with training in oral appliance therapy are familiar with the various designs of appliances and can help determine which is best suited for your specific needs. A board certified sleep medicine physician must first provide a diagnosis and recommend the most effective treatment approach. A dental sleep medicine specialist may then provide treatment and follow-up.
The initial evaluation phase of oral appliance therapy can take several weeks or months to complete. This includes examination, evaluation to determine the most appropriate oral appliance, fitting, maximizing adaptation of the appliance, and the function.
Ongoing care, including short- and long-term follow-up is an essential step in the treatment of snoring and Obstructive Sleep Apnea with Oral Appliance Therapy. Follow-up care serves to assess the treatment of your sleep disorder, the condition of your appliance, your physical response to your appliance, and to ensure that it is comfortable and effective.
Advantages of Oral Appliance Therapy
- Oral appliances are comfortable and easy to wear. Most people find that it only takes a couple of weeks to become acclimated to wearing the appliance.
- Oral appliances are small and convenient making them easy to carry when traveling.
- Treatment with oral appliances is reversible and non-invasive
How Oral Appliances Work
- Repositioning the lower jaw, tongue, soft palate and uvula
- Stabilizing the lower jaw and tongue
- Increasing the muscle tone of the tongue