Oral Appliance Therapy for Snoring and Related Sleep Disorders
Obstructive Sleep Apnea
Obstructive sleep apnea (“OSA”) sufferers experience blockage of the upper airway while sleeping, usually due to the collapse of the tongue and soft tissues in the back of the throat. The muscles associated with breathing respond by trying harder to pull air into the lungs. Breathing eventually resumes, but often with a deep gasp or snort that awakens the sufferer. Most sufferers experience multiple episodes each night. Left untreated, in addition to sleep deprivation, OSA can reduce oxygen flow to the sufferer’s vital organs and has been associated with cardiac arrhythmia (erratic heart rhythms).
If you suffer from mild or moderate OSA, behavioral changes such as weight loss and better sleep hygiene alone may be enough. For those who don’t respond to these basic therapies alone, however, a number of additional and alternative treatment options are available. Patients who don’t respond to any combination of the more conservative options discussed below may elect to undergo surgery to eliminate tissue in the soft palate, uvula and tongue or reposition the anatomic structure of the mouth and facial bones.
Oral Appliance Therapy
Oral appliance (OA) therapy usually entails selection, personal fitting and use of a specially designed device that resembles a sports mouth guard or orthodontic retainer. The OA maintains an open, unhindered airway in the esophagus, thereby keeping the airway open during sleep. OAs are a front-line treatment for patients with mild to moderate OSA who are inappropriate candidates for (or prefer not to use) a continuous positive airway pressure (CPAP) device, or who have been unsuccessful with CPAP therapy. Oral appliances for snoring can be used by themselves, or in conjunction with other treatment options.
How Oral Appliances Work
- Repositioning of the soft palate ,lower jaw, uvula, and tongue
- Stabilizing the bottom tongue and jaw
- Increasing the muscle tone of the tongue
Who Can Benefit
- Although patients with moderate to severe OSA should have an initial trial of nasal CPAP, many find greater success with combined use of an OA and a CPAP device.
- Patients with moderate to severe OSA who are intolerant of or refuse treatment with nasal CPAP may also benefit from OA use alone.
- Oral appliances are also indicated for patients who refuse treatment, or are not candidates for tonsillectomy and adenoidectomy, craniofacial operations, or tracheostomy.
Advantages of Oral Appliance Therapy
- For most patients, oral appliances are comfortable and easy to wear. Most find that it only takes a couple of weeks to become acclimated to wearing the appliance.
- Oral appliances are small and very portable.
- OA treatment is reversible and non-invasive.
Types of Oral Appliances
While there are many different oral appliances available, most fall into one of two general categories: tongue retaining devices and mandibular repositioning devices.
Tongue retaining appliances hold the tongue in a forward position using a suction bulb. This serves to keep the back of the tongue from collapsing during sleep and obstructing the airway in the throat.
Mandibular repositioning appliances also indirectly pull the tongue forward by repositioning and maintaining the lower jaw in a protruded position. This stimulates activity of the muscles in the tongue, making it more rigid. These devices also hold the lower jaw and other structures in a stable position to prevent the mouth from opening.
Other OA Facts
- Custom-made oral appliances are more effective than over-the-counter devices. The latter are not recommended as either a screening tool or a therapeutic option.
- Dentists with training , such as those in our office, familiar with the various available designs of snoring appliances and will work with you to find the one that fits your condition. 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 preliminary assessment segment of our oral appliance therapy is done with care and caution, and often may take several weeks to complete. It includes assessment and examination of the patient, evaluation of the findings to determine what appliance works best, then the final fitting and maximizing adaptation to mold for comfort and efficiency..
- After our first phase, we also extend ongoing care services. With oral appliances checking the effectiveness in the short term, and over time is an essential step in treating snoring and OSA. Follow-up care serves to assess the effectiveness of treatment as well as the comfort and condition of and your physical reaction to your appliance.
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