Sleep Apnea
Sleep apnea is a serious medical condition in which breathing can stop during sleep. Apnea means without breath. Breathing stops when the back of the tongue relaxes and blocks the airway in the back of the throat. Episodes of apnea can occur only several times a night in normal people but can occur hundreds of times in severe cases. Each episode of sleep apnea is accomlpanied by a drop in oxygen levels.
Sleep apnea has been associated with heart disease, sudden cardiac death during sleep, high blood pressure, stroke, depression, obesity and diabetes. And because the apnea episodes can interupt sleep, people with sleep apnea are often tired during the day and tend to fall asleep. This excessive daytime sleepiness can lead to drowsy driving, vehicular and workplace accidents.
Sleep apnea is often accompaned by snoring which can be the first sign of a problem. Both snoring and sleep apnea are problems that require intervention by a physician and often a dentist. It is a mistake to think that snoring is a minor problem that can be treated by an over-the-counter mouthpiece or device advertised on the Internet.
Dentistry's Role in the Recognition and Management of Sleep Apnea
Only one dental school now offers post-doctoral training in sleep medicine and oral appliance therapy so that most dentists will have received their education through continuing education courses. This makes it necessary for you to determine whether the dentist you choose to treat your apnea problem has received sufficient education to be qualified.
Dentists cannot diagnose sleep apnea or determine whether your problem is primary (simple and uncomplicated) snoring or whether it is a sign of sleep apnea. Making a diagnosis of sleepl apnea is outside the scope of dental licensure. It is, therefore, essential for your dentist to work closely with your physician to determine the diagnosis andthe proper course of therapy. Most insurance companies also require a diagnosis and referral from a physician to reimburse you on your MEDICAL (not dental) insurance.
Because of this, we strongly recommmend that you do not choose a dentist who agrees to treat your snoring without a medical consultation.
Treating Sleep Apnea
There are 3 main treaments for sleep apnea:
- CPAP
- Surgery
- Oral appliances
In addtion, weight loss, cessation of smoking, avoiding alcoholic beverages before sleep and changing sleep position can often help as well.
CPAP
CPAP (continuous positive air pressure)is the most widely prescribed solution by sleep physicians. When used properly, it is 100% effective. Unfortunately, many people cannot tolerate the mask or the air pressure forced into the nose and throat that acts as a splint for the airway. In these cases, a properly fitted oral appliance can provide the necessary forward jaw placement to support the airway during sleep.
Surgery
There are several surgical approaches to stabilizing the airway. These include removal of the soft palate, stabilization of a small bone in the throat, creation of a permanent opening in the throat and forward surgical repositioning of the upper and lower jaws. Since surgery is irreversible and carries with it side effects (difficulty drinking fluids, cosmetic changes in appearance, difficult recovery period), surgery should only be utilized when less invasive methods (CPAP, Oral Appliances) have been determined to be ineffective.
Oral Appliances
Oral Appliances are placed in the mouth and are worn much like an orthodontic appliance or sports mouth protector. They are worn during sleep to prevent the collapse of the tongue and soft tissues in the back of the throat so that the airway stays open during sleep. The appliances promote adequate air intake and help to provide normal sleep in people who snore and have sleep apnea. Oral appliances can be used alone or in conjunction with other means of therapy such as continuous positive air pressure (CPAP). Determination of proper therapy can only be made by joint consultation of your sleep apnea dentist and sleep physician.
Do you have a list of all appliances that are available?
Certainly ,a list of appliances and descriptions can be found on our sister site at SnoringIsntSexy.com.
Types of sleep apnea dental appliances
Currently, over 80 different types of sleep apnea dental devices for snoring and sleep apnea are available to specially trained dentists to treat sleep disordered breathing. At first glance, this number appears overwhelming but on close examination each of the appliances falls basically into one of two categories and the diverse variety is simply a variation of a few major themes. Oral appliances can be classified by mode of action or design variation.
Tongue Retaining Appliances
There are very few tongue retaining devices available, but they have been well studied and shown to be effective in many patients. Tongue retainers function by directly holding the tongue in a forward position by means of a suction bulb that holds the tongue. When the tongue is in a forward position, the back of the tongue does not collapse during sleep and obstruct the airway in the throat.
The tongue is held in the suction bulb that protrudes from between the teeth on this cast.
Mandibular Repositioning
Mandibular repositioning appliances are by far the most numerous type on the market. They all function to reposition and maintain the lower jaw (mandible) in a protruded position during sleep. It is felt that this serves to open the airway by indirectly pulling the tongue forward since the tongue is attached to the lower jaw, by stimulating activity of the muscles in the tongue and making it more rigid, and by holding the lower jaw and other structures in a stable position to prevent opening of the mouth.
Are Oral Appliances an approved therapy?
Oral appliances have been approved as a primary therapy and an alternative to CPAP.
"Oral appliances (OAs) are indicated for use in patients with mild to moderate OSA who prefer them to continuous positive airway pressure (CPAP) therapy, or who do not respond to, are not appropriate candidates for, or who fail treatment attempts with CPAP. Until there is higher quality evidence to suggest efficacy, CPAP is indicated whenever possible for patients with severe OSA before considering OAs. Oral appliances should be fitted by qualified dental personnel who are trained and experienced in the over- all care of oral health, the temporomandibular joint, dental occlusion and associated oral structures."
Practice Parameters for the Treatment of Snoring and Obstructive
Sleep Apnea with Oral Appliances: An Update for 2005
SLEEP, Vol. 29, No. 2, 2006
