Most sleep apnea patients use an air-blowing mask to help them breathe while they sleep but a special dental appliance might be another solution.
Diane Greenwald thought a poster in a doctor’s office was made for her.
“Do you wake up in the morning tired? Do you have trouble concentrating? Can you fall asleep after lunch? Has anyone in your life told you that you snore?”
A sleep study confirmed sleep apnea, a disorder that causes patients to stop breathing at night. To treat it, Diane used a CPAP system, short for continuous positive airway pressure.
Diane says, "I certainly did feel better using it, but it was very cumbersome.”
After three years, Diane wanted an alternative and she got one from a dentist.
Dr. Kenneth Hilsen says, "One of the techniques for treating the most common sleep disorder, which is sleep apnea, is the use of an oral appliance.”
Though it looks like a sports mouth-guard, the top and bottom are joined together. The device holds the bottom jaw forward, preventing the tongue from relaxing into the airway during sleep.
Dr. Hilsen says, "If we just move the jaw forward, the tongue moves with it and the airway just becomes more open.”
The process to make the appliance is similar to other orthodontic work.
“We take impressions. We take special bites too so we know where the jaw should be placed, and we send that off to the laboratory.”
And since it's less bulky, patients are more apt to use it.
“Compliance is very high," Dr. Hilsen says. "People wear them for years.”
It's working for Diane.
“Now I get up and after I stretch a little bit I can move around and I feel invigorated from the sleep,” she says.
The American Academy of Sleep Medicine has published guidelines on the use of oral appliances for sleep apnea. The sleep specialists say that the devices are appropriate for mild to moderate sleep obstructive sleep apnea patients, and can even be used in patients with more serious cases if they aren’t using their CPAP machine.
Fast facts:About 45 percent of Americans snore occasionally and 25 percent snore frequently.
About 18 million adults are believed to have sleep apnea.
The standard treatment is a breathing mask that delivers pressurized air during sleep, called CPAP.
Another treatment for some patients with sleep apnea is a dental appliance that fits into the mouth during sleep to keep the airway open.
Snoring and Obstructive Sleep Apnea
Snoring is the noisy sound that occurs when airflow through the back of the nose or mouth is obstructed during sleep. The American Academy of Otolaryngology – Head and Neck Surgery estimates 45 percent of American adults snore occasionally. About 25 percent snore frequently. The condition is more common in men and in people who are overweight.
Snoring can be a sign of a condition called obstructive sleep apnea. People with sleep apnea experience brief periods when they stop breathing during sleep. In obstructive sleep apnea, the breathing cessation is caused by a collapse of the soft tissues in the back of the throat. A condition called central sleep apnea is caused when the brain fails to properly signal the respiratory muscles to breath. When oxygen levels drop below a critical level, the body is partially aroused. This causes the airways to re-open and re-establishes normal breathing.
According to the National Sleep Foundation, more than 18 million adults in the U.S. have sleep apnea. Many people are unaware of problem because they don’t fully awake during the brief periods when they stop breathing. Instead, the bed partner often complains of loud snoring followed by gasping for breath.
Obstructive sleep apnea is more than a noisy problem for the weary bed partner. Sleep disruptions and periodic lack of oxygen can interfere with a good night’s rest and lead to daytime sleepiness, an increased risk for accidents, and mood and memory problems. Some research also suggests obstructive sleep apnea may increase the risk of developing high blood pressure, heart disease, stroke, congestive heart failure and heart rhythm abnormalities.
Treating Obstructive Sleep Apnea
There are some lifestyle changes that sometimes help alleviate symptoms of obstructive sleep apnea. Patients may be advised to lose weight, avoid alcohol and stop smoking.
The preferred method of treatment is a continuous positive airway pressure (CPAP) device. CPAP uses a mask that fits tightly over the nose during sleep. When the machine is turned on, a stream of fresh air is blown through the mask. The pressurized air keeps the throat open during sleep and eases the symptoms of sleep apnea.
Some people have difficulty adjusting to the use of a breathing mask during sleep. CPAP can also cause a dry or stuffy nose, headaches and skin irritation (where the mask touches the face). When CPAP doesn’t work, or a patient can’t tolerate the treatment, doctors may recommend surgery. There are several different kinds of surgical options to open the airways.
Oral Appliances for Obstructed Sleep Apnea
There is another option for some people with obstructive sleep apnea – an oral appliance. There are more than 40 different types of oral appliances available. They can generally be classified into one of two categories. Tongue retaining appliances contain a suction bulb that pulls the tongue forward and prevents it from falling back and obstructing the air passageway in the throat. Mandibular repositioning devices reposition the lower jaw, holding it in a forward position during sleep. Since the tongue is attached to the lower jaw, it also pulls the tongue forward to keep the airway open.
Kenneth Hilsen, D.D.S., uses a mandibular repositioning device for patients in his practice. Each is custom-made for the patient. First, the dentist takes impressions of the patient’s bite. This allows the dentist to determine how far forward the lower jaw needs to be positioned. The mold is then sent to a dental lab. In about three weeks, the custom-made oral appliance is sent back to the dentist’s office. Fitting is confirmed and the patient is shown how to place the appliance in the mouth during sleep.
Hilsen says the molded appliance is soft enough to be worn comfortably at night. Since it’s continually taken in and out of the mouth, patients need to be meticulous about cleaning the appliance in a special antibacterial solution every day. If the appliance is properly cared for, it will last for many years. Cost of a custom appliance and fitting ranges from several hundred to several thousand dollars and is often covered by insurance.
The Academy of Dental Sleep Medicine says oral appliances work best for patients who snore and in those with mild to moderate symptoms of obstructive sleep apnea. The devices don’t work for everyone. A small number of patients who use oral appliance therapy experience changes in occlusion and temporomandibular symptoms.
A recent Cochrane review of oral appliances found that while patients using them report better quality sleep and improvement in daytime sleepiness, CPAP is generally a more effective treatment. Thus, when possible, CPAP is still the preferred method of treatment for obstructive sleep apnea.
NOTE: Kenneth Hilsen, D.D.S. owns the patent for the dental appliance he uses in his practice.
Web ResourcesAmerican Academy of Otolaryngology – head and neck surgery, Web site
For information on snoring and sleep apnea:
American Sleep Apnea Association Web site
National Heart, Lung and Blood Institute Web site
National Sleep Foundation Web site
For information on oral appliances for sleep apnea:Academy of Dental Sleep Medicine Web site
Dental Organization for Sleep Apnea Web site