Sleep Apnea

We're concerned about the overall health of our patients, including their sleep health. Many people suffer needlessly from dangerous sleep disruptive disorders that keep them from getting enough oxygen at night. The risk of a heart attack is 23 times more likely than average with a sleep disorder, and 92% of stroke victims live unknowingly with sleep apnea before having a stroke. Our training allows us to offer you education and treatment surrounding sleep health most simply and cost-effectively possible.

Estimates suggest that more than twelve million Americans have obstructive sleep apnea (OSA). Most cases are still undiagnosed, contributing to diabetes, high blood pressure, hypertension, congestive heart failure, coronary artery disease, and traffic accidents related to drowsy driving. Dentistry serves a vital role in treating this silent epidemic. The American Academy of Sleep Medicine recommends oral appliances as primary therapy for the treatment of mild to moderate obstructive sleep apnea and for patients with severe sleep apnea who can't tolerate CPAP treatment.

What is OSA?

OSA is a breathing disorder characterized by brief interruptions of breathing during sleep due to a blockage in the airway. Obstructions occur when throat muscles, the tongue, tonsils, or the soft palate relax and cover the airway, preventing breathing. The obstruction results in a severe drop in blood oxygen levels throughout the night.

OSA is typically diagnosed using a sleep study. During a sleep study, a sleep physician monitors brain activity and body system functions while a patient rests overnight at a sleep lab. The specialist evaluates the data collected to diagnose sleep disorders and recommend treatment. If prescribed by the sleep doctor, a dentist trained in sleep medicine works with them to treat obstructive sleep apnea with oral appliance therapy. In some cases, a home sleep study may also be possible instead of reporting to a sleep lab.

How Is OSA Treated?

Treatment of snoring and obstructive sleep apnea may involve surgery, CPAP or BiPAP machines, or oral appliance therapy. Oral appliances provide the least invasive option and are often a good choice for treatment of mild to moderate OSA. A carefully calibrated appliance like a CPAP or BiPAP can comfortably help hold the jaw in a precise position throughout the night.

All treatment recommendations should be made in conjunction with your sleep physician. If appliance therapy is selected, it's essential the right positioning is used to maintain an open airway.

CPAP Intolerance

A gold standard for treatment of sleep apnea is CPAP. If you do not like your CPAP due to improper fit, leaks, claustrophobia, uncomfortable straps, allergies, or did not want to take it of and put it on during bathroom breaks you could get benefited from oral sleep appliance. If you are pregnant or if you travel a lot this could serve your purpose. Oral appliances are not cumbersome and are easy to maintain. It does not involve change of hoses or parts. keeping it hygienic is a breeze and you could get a check up with your routine dental visits.

The best part you don’t have to keep all your loved ones awake while you sleep so that your loved ones can sleep comfortable next to you. Compliance is good and you could keep it all night long rather than just 4 hrs as in with CPAP. You could get in and out of bed and into sleep easily.

Who Is A Good Candidate For Oral Appliance Therapy For OSA?

Many people try CPAP therapy when they’re first diagnosed with obstructive sleep apnea (OSA).  If they have trouble using the CPAP, then they become candidates for oral appliance therapy.   Until now, CPAP has been the first line of therapy for all patients, but a new study suggests that the underlying cause of OSA determines whether CPAP or oral appliances are a better treatment for the condition.

A group of Australian researchers published a study in Annals of the American Thoracic Society which discussed the common traits of patients who are good candidates for oral appliance therapy instead of CPAP as a first-line OSA treatment. This is important work since currently, most insurers will only fund CPAP as first-line therapy. Many patients must prove that CPAP doesn't work for them before their insurers will qualify them for an oral appliance.  This can result in treatment delays and long-term damage to their health if CPAP is not the best treatment for their condition.

Traits of an Oral Appliance Patient

The researchers looked at sleep studies for a group of patients, and found that the patients who did better on oral appliances than on CPAP had:

• Upper airway collapsibility outside of the ‘severe’ range
• Weak lower muscle compensation for apneas
• Lower loop gain
• A higher arousal threshold (So sounder sleepers)
• And a lower ventilatory response to apneas

Patients with these traits were found to be “highly responsive” to oral appliance therapy.   Severity of OSA and obesity were not factors in how well a patient responded to CPAP versus an oral appliance.

For the patients who had these markers, a custom oral appliance gave them a 73% reduction in AHI, and, after treatment, they averaged only 8 apneas per hour. That means the appliance took patients from moderate to severe OSA down to mild OSA. This is a huge improvement.