Sleep Apnea Therapy

How does sleep apnea impact health?

Sleep apnea is associated with an increased risk of several other chronic health conditions, most notably the following:

• High blood pressure
• Heart disease
• Diabetes
• Strokes
• Obesity
• Mood disorders (depression, mania, dysthymia, and bipolar disorder)

Many people with sleep apnea also suffer from fatigue due to poor quality sleep, which can lead to more injuries from workplace accidents, driving accidents, and so on.

How can dentists help with sleep apnea treatment?

Because obstructive sleep apnea can occur due to the mechanics of the mouth and throat (a relaxed tongue/throat muscles, enlarged tonsils, or a small mouth/jaw), dentists can play an important role in treating it.

If you have been diagnosed with obstructive sleep apnea, an appointment with your dentist may reveal some treatment options that your doctor has not mentioned.

The most commonly recommended treatment for sleep apnea is CPAP (Continuous Positive Airway Pressure). However, these machines can be difficult for some patients to tolerate and some people simply prefer not to wear a mask when sleeping. Wearing a specially made oral appliance or mouth guard may be an alternative option to consider.

Oral devices made for sleep apnea sufferers may ease mild to moderate sleep apnea symptoms in patients who are not overweight.

Mandibular advancement devices (see below) are the most commonly used. Your dentist can assess your mouth and sleep problems and recommend whether you would be a good candidate for an oral appliance.

If you decide to proceed, you will need a checkup early on to see how well it is working. You should stay in regular contact with your dentist to monitor your sleep apnea symptoms and see if an adjustment or replacement is needed for your device.

The benefits of oral devices for sleep apnea treatment

Oral devices offer some important advantages over CPAP treatment (or surgical intervention) for sleep apnea:

• Cost: even the more expensive adjustable devices are more affordable than CPAP machines
• Comfort: devices may be uncomfortable at first but most users adjust within a few days
• Effectiveness: clinical trials have shown that oral devices are effective in preventing apneas for some patients
• Lack of side effects: these devices are custom-made and fit well to reduce possible side effects
• Frequency of use: people may use oral devices more regularly than machines because of their relative ease of use
• Long-term treatment: over time, oral appliances may improve the strength of the airway and reduce or eliminate apneas

A surgical procedure called uvulopalatopharyngoplasty (UPPP) is sometimes used as a last resort for sleep apnea. During this procedure, the surgeon removes soft tissue from the back of the throat. However, its long-term effectiveness is questionable.

Devices used for sleep apnea treatment

The most widely recommended and effective sleep apnea treatments are CPAP machines and dental appliances.

Your choice of treatment will depend on several factors, including the severity of your sleep apnea symptoms, the physical structure of your upper airway, your general medical condition, and your personal preferences.

CPAP (continuous positive airway pressure) machines

CPAP machines blow air with continuous pressure down your throat when you sleep, keeping your airways open. They can be effective in easing snoring, improving sleep quality, relieving drowsiness during the daytime, and lowering blood pressure.

CPAP machine consists of three parts:

• A mask that fits over your nose and mouth and is held in place with straps
• A motor that blows the air
• A large tube connecting the motor to the mask

These machines are relatively small, lightweight, and quiet. However, most people do find that they take some getting used to because of confinement feelings from wearing a mask that may need to fit over both the nose and mouth.

A few possible side effects include the following (some of which may be corrected by an adjustment to the mask):

• Sore mouth
• Dry mouth
• Excessive salivation
• Altered bite
• Nasal congestion, runny nose or sinusitis
• Nosebleeds
• Sores on the bridge of the nose
• Stomach bloating
• Chest muscle pain
• Arthritis of the temporal mandibular joint

Mouth devices for sleep apnea

Oral appliances that are worn at night or “dental sleep devices” may be effective for people of normal weight with mild to moderate sleep apnea symptoms and poor tolerance of CPAP treatment.

Mandibular advancement device (MAD)

A mandibular advancement device (MAD) is the most widely used oral device for sufferers of sleep apnea. It looks a little like a sports mouthguard, snapping over the upper and lower dental arches with adjustable metal hinges that ease the lower jaw forward.

By moving the jaw forward, the muscles that collapse during apneas tighten so that they will not fall down when sleeping.

To check whether or not you are a good candidate for a MAD, your dentist will assess your teeth, mouth, and jaw joints. If suitable, your dentist creates a model of your teeth and an oral appliance is tailor-made to precisely fit your mouth.

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