What You Need to Know About Oral Sleep Appliances

Dr. Paul CaselleBlog0 Comments

As dentists we will occasionally have a patient ask if we can treat snoring or may have been told by their physician to inquire about an oral appliance. We know if snoring is due to sleep apnea it can result in an increased risk for a growing number of health problems such as: high blood pressure, stroke, irregular heart beat, heart attack, diabetes, depression, anxiety. Snoring and OSA can take a toll on a person’s quality of life since these problems can often cause excessive daytime sleepiness which can affect relationships and productivity.

OSA can affect children as well as adults however it more common in older people particularly men who are over weight. Symptoms of OSA include:
Falling asleep during the daytime
Loud snoring or snoring with intermittent pauses
Restless sleep
Poor memory and mental alertness
Irritability
Weight gain
Morning headaches

If any patient presents with any of these symptoms it is recommended they see their primary care physician or a sleep disorder physician for evaluation.
Diagnosis and proper treatment of sleep disorders can only be determined by a detailed sleep study.

 

What Exactly is Sleep Apnea?

It is disorder that occurs when a person’s breathing is interrupted during sleep. People with untreated sleep apnea stop breathing repeatedly during their sleep, sometimes hundreds of times. This means the brain — and the rest of the body — may not get enough oxygen.

In Obstructive Sleep Apnea (OSA) the tongue and soft tissues at the back your throat block or obstruct air from entering the lungs. If the amount of oxygen in your blood drops too low your brain alerts your body to unblock the airway by tightening the throat muscles. You partially awaken and the flow of air starts agin. This will happen throughout the night.

In Snoring the tongue and soft palate collapse partially blocking air from moving resulting in a vibration of your throat muscles creating a snoring sound.

How is OSA Treated

If your sleep apnea is due to an Obstructed airway there are severel treatments available:

Life Style Changes such as losing weight, avoiding alcohol, not smoking, and following good sleep habits as well as sleeping on your side.

CPAP Machine which is a machine that forces continuous Positive Airway Pressure (CPAP) into your nose and throat to keep the air passages open while you sleep. It is effective for moderate to severe OSA.

Oral Appliance Therapy  consists of  two types of devices.  A tongue retaining device holds 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 in the throat.  A mandibular repositioning  device moves your lower jaw slightly forward allowing you tongue and soft tissues from falling back in your throat. These appliances treat snoring and mild to moderate OSA. There are several different types of mandibular repositioning appliances from simple to more complex.  The EMA appliance is one of the simplest to use both for patient and dentist. The appliance consists of straps of different rigidity and lengths that are attached to buttons that are located on an upper and lower mouthguards. These straps are of different lengths which will protrude the mandible to open the airway. The patient will use a series of lengths until they reach a point where snoring is eliminated. Once this  length is determined a sleep study should be done to confirm results. Other more advanced appliances will have set screws that will advance the upper and lower mouthguard to achieve the desired results. Patient jaw movements tend to more restricted with the more advanced appliances.

Finally, surgery can be performed to remove excess tissue such as tonsils or adenoids in a patient’s throat to allow air to move more freely.

It is important to note that occasional snoring may not be serious however if patients are a heavy snorer and have several symptoms of sleep apnea you should refer them to their physician to rule out anything more serious.

I have included the following links to learn more about oral appliances for the treatment of sleep apnea & snoring.

http://www.aasmnet.org/

http://www.kellerlab.com/video-library.php

http://somnomed.com/dentists/dental-education/

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