Reclaim a Full Night’s Rest With Sleep Apnea Treatment
What Causes Snoring?
Snoring occurs when the soft tissue structures of the upper airway collapse onto themselves and vibrate against each other as we attempt to move air through them. This produces the sound we know as snoring. Large tonsils, a long soft palate, a large tongue, the uvula, and excess fat deposits in the throat all contribute to airway narrowing and snoring. Usually, the more narrow the airway space, the louder or more habitual the snoring.
Obstructive Sleep Apnea
Obstructive Sleep Apnea (OSA) occurs when the tongue and soft palate collapse onto the back of the throat. This blocks the upper airway, causing airflow to stop. When the oxygen level drops low enough, the brain moves out of deep sleep and the individual partially awakens. The airway then contracts and opens, causing the obstruction in the throat to clear. The flow of air starts again, usually with a loud gasp. When the airflow starts again, you then move back into a deep sleep. The airway muscles collapse, as you awaken with a gasp. The airway clears once again as the process repeats itself. This scenario may occur many times during the night.
The combination of low oxygen levels and fragmented sleep are the major contributors to most of the ill effects that the sleep apnea patient suffers. In addition to excessive daytime sleepiness, studies show that sleep apnea patients are much more likely to suffer from heart problems (heart attack, congestive heart failure, hypertension), strokes, as well as having a higher incidence of work-related and driving-related accidents.
Diagnosis of Obstructive Sleep Apnea
Since OSA is a serious medical condition, it must be diagnosed by a physician. Diagnosis is based on the results of an overnight sleep study, called a Polysomnogram (PSG). Other factors of determining OSA are patient evaluation and history.
Good sleep hygiene, weight loss, and exercise are some helpful OSA treatments a patient can practice on their own. However, medical and dental treatments include Continuous Positive Airway Pressure, Oral Appliance Therapy, and surgery.
Continuous Positive Airway Pressure (CPAP)
Continuous Positive Airway Pressure (CPAP) is pressurized air generated from a bedside machine. The air is delivered through a tube, connected to a mask, covering the nose. The force of the pressurized air splints the airway open. The CPAP opens the airway like air into a balloon; when air is blown into the balloon, it opens and gets wider. This is exactly how CPAP clears the airway.
Oral Appliance Therapy
Oral appliances are worn in the mouth to treat snoring and OSA. These devices are similar to orthodontic retainers or sports mouth guards. Oral Appliance Therapy involves the selection, design, fitting and use of a custom-designed oral appliance that is worn during sleep. This appliance then attempts to maintain an opened, unobstructed airway in the throat. There are many different oral appliances available. Approximately 40 appliances have been approved through the FDA for treatment of snoring and/or Sleep Apnea. Oral appliances may be used alone or in combination with other means of treating OSA. These means include general health, weight management, surgery, or CPAP. Oral appliances work in several ways:
- Repositioning the lower jaw, tongue, soft palate and uvula
- Stabilizing the lower jaw and tongue
- Increasing the muscle tone of the tongue
Dentists with training in Oral Appliance Therapy are familiar with the various designs of appliances. They can determine which one is best suited for your specific needs. The dentist will work with your physician as part of the medical team in your diagnosis, treatment, and on-going care. Determination of proper therapy can only be made by joint consultation of your dentist and physician. The initiation of oral appliance therapy can take from several weeks to several months to complete. Your dentist will continue to monitor your treatment and evaluate the response of your teeth and jaws.
In addition to Oral Appliance Therapy, dentists who are oral and maxillofacial surgeons may consider a variety of methods to evaluate, diagnose and treat upper airway obstruction. These dental specialists treat upper airway obstructive disorders by utilizing both minimally invasive procedures as well as more complex surgery, including jaw advancement. Additionally, an ENT specialist may evaluate you for other types of surgery, mainly the removal of the excess tissues in the throat. It may be necessary to remove tonsils and adenoids (especially in children), the uvula, or even parts of the soft palate and the throat.
Frequently Asked Questions
My husband snores — where can I find an oral appliance?
Oral appliance therapy to treat snoring and obstructive sleep apnea should be provided by an experienced dentist. A list of dentists who are members of the American Academy of Dental Sleep Medicine can be found at this web site by clicking on Find-A-Dentist. However, prior to beginning treatment, an overnight sleep study (polysomnogram) should be performed by a medical doctor to objectively identify the problem and its severity. Following this, the dentist can work closely with the physician to treat the problem in the most effective way. An overnight polysomnogram can be arranged through the family doctor.
Are oral appliances effective?
Oral appliances were first utilized in the 1930s to help people breathe properly during sleep. By the 1980s, physicians and dentists began to seriously study the effectiveness of oral appliances to treat snoring and obstructive sleep apnea and found them to be effective in many, but not all cases. Recent studies show oral appliances to be most effective in treating snoring and mild to moderate obstructive sleep apnea. However, some appliances have been shown to effectively treat severe apnea in some cases. While oral appliances are often effective, it is important to know that they are not adequate for everyone and to date, it is not possible to predict the successes from the failures prior to treatment.
What does RDI stand for?
The term RDI stands for Respiratory Disturbance Index and is one very important measure of the severity of the sleep disorder. The RDI is a number that represents how many times per hour breathing stops or becomes very shallow. This index is important because it is often associated with disruption of sleep and dangerous drops in blood oxygen levels. Most physicians agree that an RDI below 10 is normal while an RDI over 40 may indicate severe disease.
What’s the difference between snoring and obstructive sleep apnea?
The term Sleep Disordered Breathing describes a number of sleep breathing disorders that include snoring, upper airway resistance syndrome and obstructive sleep apnea. Sleep Disordered Breathing is viewed as a continuum where simple snoring represents a mild disorder during which breathing during sleep is very loud due to the near-collapse of the upper airway. When the snoring becomes worse due to further airway collapse (to the point where sleep is interrupted) the term upper airway resistance syndrome is used. Most serious, is the complete collapse of the airway that is termed obstructive sleep apnea. During an apnea, breathing cannot occur and the sleeper is forced to awaken to resume normal breathing.
How does oral appliance therapy compare with CPAP? Are there studies that explain this?
When it became apparent that Oral Appliance Therapy was legitimate and desirable part of the treatment mix, questions naturally arose regarding its comparative effectiveness with positive airway pressure modalities. Recently, four studies have focused on Oral Appliance Therapy going head to head with nasal CPAP. Three of them used a cross-over design and the fourth a parallel-group design. All of the investigations were randomized, controlled treatment trials. Each of the studies focused on effectiveness as a product of the treatment efficacy in combination with acceptance and adherence to treatment. Treatment efficacy was similar in all the trials and did not deviate significantly from past investigations.
It was shown that Oral Appliance Therapy often, but not always decreased the apnea-hypopnea index whereas CPAP nearly always resolved sleep disordered breathing entirely. Acceptance and adherence to treatment with CPAP was limited while that of Oral Appliance Therapy was less so resulting in the proportion of successfully treated patients being about the same in each study. In all three cross-over trials where patients were asked to choose a preferred treatment, the majority chose oral appliance therapy.
Will my appliance be covered by medical insurance? Will Medicare cover my appliance?
Oral appliances are sometimes covered by insurance. They are often not covered by commercial insurance carriers, HMO’s and Medicare for a variety of reasons including: lack of knowledge and understanding by insurance companies of the recent advances in oral appliance therapy in the treatment of sleep apnea; snoring (only) is not a recognized medical condition by the medical field; and lack of CPT or medical reimbursement code for oral appliance therapy.