The "gold standard" for moderate to severe obstructive sleep apnea (OSA) is the continuous positive airway pressure (CPAP) therapy. The problem a lot of patients have is the amount of air pressure blasting through their nose and mouth and some patients cannot adapt and are termed CPAP intolerant. Oral appliance therapy (OAT) can be just the right treatment to help correct OSA and many patients prefer OAT to CPAP.
An oral appliance is basically a small device, think of a football mouthguard or a nightguard, that is custom made to fit securely over the upper and lower teeth. OAT appliances are designed to prevent the collapse of the tongue and other tissues in the back of the throat which will keep the airway open during sleep. Oral appliances can be used alone or in combination with other therapies to give the patient maximum benefit.
Who Can Use an Appliance
- 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 such as sleeping on your side rather then on your back.
- 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.
A board certified sleep medicine physician must first provide a diagnosis and recommend the most effective treatment approach and then Dr. Coates can 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
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 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
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 in the throat.
Mandibular Repositioning Appliances
Mandibular repositioning appliances reposition 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.
Other Treatment Options
There are three primary ways to treat snoring and sleep apnea, in addition to lifestyle changes such as good sleep hygiene, exercise and weight loss. The most common treatment is Continuous Positive Air Pressure. CPAP keeps your airway open by providing a steady stream of air through a tube connected to a mask that you wear as you sleep. Another option is surgery performed by an AADSM member trained as an oral and maxillofacial surgeon. A surgeon can prevent airway collapses by eliminating tissue in the soft palate, uvula and tongue. More complex surgical procedures can reposition the anatomic structure of your mouth and facial bones.