Oral Appliance Therapy
According to AADSM (American Academy of Dental Sleep Medicine); 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.
How does an Oral Appliance Work?
Re-positioning the lower jaw, tongue, soft palate and uvula. Stabilizing the lower jaw and tongue. Increasing the muscle tone of the tongue.
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.
Types of Oral Appliances
With so many different oral appliances available, selection of a specific appliance may appear somewhat overwhelming. Nearly all appliances fall into one of two categories. The diverse variety is simply a variation of a few major themes. Oral appliances can be classified by mode of action or design variation.
- Mandibular Re-positioning Appliances
- Mandibular re-positioning appliances re-position and maintain the lower jaw in a protruded position during sleep. The device serves to open the airway by indirectly pulling the tongue forward, stimulating activity of the muscles in the tongue and making it more rigid. The device also holds the lower jaw and other structures in a stable position to prevent the mouth from opening.
- Tongue Retaining Appliances
- Tongue retaining appliances hold the tongue in a forward position using a suction bulb. When the tongue is in a forward position, it serves to keep the back of the tongue from collapsing during sleep and obstructing the airway.
Life With an Oral Appliance
Dental appliances are an effective solution for snoring problems and for patients with mild or moderate sleep apnea as a first-line treatment. They are the #1 non-surgical treatment solution recommended by the American Academy of Sleep Medicine (AASM) when the CPAP cannot be tolerated. Dentists are now able to play a very important role in the treatment of snoring problems as well as in the recognition and treatment of the life threatening condition known as Sleep Apnea. Like CPAP, oral appliance therapy for snoring and sleep apnea is not a cure. The dental device must be worn every night for it to be effective.
Your progress with the oral
appliance should be monitored over time to ensure that the appliance continues
to do its job in providing relief of snoring and sleep apnea and to ensure that
you remain symptom free. Your provider will carefully follow and guide
your progress throughout your treatment. You will be seen in the office several
times to ensure acceptance, comfort and effectiveness of the therapy.
Instructions will be given on proper adjustment of the appliance and any areas
of discomfort will be addressed through providers and their staff. The
objective will be to resolve the snoring and daytime tiredness through gently
and gradually repositioning the lower jaw. Your personal feedback and several
simple in-home dental sleep studies will provide guidance. Once active therapy
is completed you will be reevaluated on a six month or one year visit depending
on your individual case.
Continuous positive airway pressure (CPAP) therapy is a common treatment for obstructive sleep apnea. It includes a small machine that supplies a constant and steady air pressure, a hose, and a mask or nose piece. Machine helps a person who has obstructive sleep apnea (OSA) breathe more easily during sleep.
Common problems with CPAP include a leaky mask, trouble falling asleep for both patient and bed partner, and a dry mouth or nose. Some patients find the device to be too constrictive and cumbersome, particularly when traveling. Unfortunately, these complaints sometimes lead to inconsistent use or abandonment of the device altogether. Lifestyle change including weight loss and exercise can help to improve sleep apnea and its related health problems. Sleep positioning and oral appliances have also been found to be effective.
Selecting a CPAP Machine and Mask
CPAP units come with many features designed to improve fit and comfort. Your home equipment provider will help you select a machine based on your prescription and the features that meet your needs. You might be able to use the CPAP unit for a trial period to make sure you're happy with your choice. There are many types of CPAP masks. The fit of your mask is important, not only for comfort, but also to keep air from leaking out. A mask that fits will help maintain proper air pressure and keep your airway open.
CPAP masks come in many shapes, sizes, and materials. Some fit over your nose and mouth; others cover only your nose. Some masks can be worn with eyeglasses. If you need oxygen, masks are available that have room for an oxygen tube. You may want to try nasal pillows instead of a mask. Nasal pillows are small, flexible, mushroom-shaped cones that fit into each nostril. Let your home equipment provider know whether you sleep on your back, side, or stomach. Different types of plastic tubing connect the mask to the CPAP machine. Some types may make it easier for you to sleep on your side or stomach.
Living With a CPAP
CPAP is a long-term treatment. To achieve the full benefits of CPAP, use it every time you sleep—during naps and at night. Most people should use CPAP for at least 7.5 hours each night for the best results. CPAP machines are small, lightweight, and fairly quiet. You can take your machine with you when you travel
sometimes recommended, usually by ear, nose, and throat specialists, for severe
obstructive sleep apnea. A patient should be sure to seek a second opinion from
a specialist in sleep disorders. Few randomized clinical trials, the gold
standard of medical research, have been conducted to verify the long-term
efficacy of sleep apnea surgery. Surgery known as uvulopalatopharyngoplasty
(UPPP) removes soft tissue on the back of the throat. Such tissue includes all
or part of the uvula (the soft flap of tissue that hangs down at the back of
the mouth) and parts of the soft palate and the throat tissue behind it. If
tonsils and adenoids are present, they are removed.
The surgery typically requires a stay in the hospital. There is limited evidence as to the effectiveness of UPPP. Studies suggest that success rates for sleep apnea surgery are rarely higher than 65% and often deteriorate with time, averaging about 50% or less over the long term. Few studies have been conducted on which patients make the best candidates. Some studies suggest that surgery is best suited for patients with abnormalities in the soft palate. Results are poor if the problems involve other areas or the full palate. In such cases, CPAP or Oral Appliance Therapy are superior and should always be tried first. Many or most patients with moderate or severe sleep apnea will likely still require CPAP or Oral Appliance Therapy after surgery.