In people with mild to moderate cases of sleep apnea who cannot use continuous positive air pressure (CPAP) due to discomfort, an option would be to use an oral or dental sleep apnea device or appliance to relieve the patient’s symptoms and reduce the risks.
Sleep apnea can be obstructive (OSA) or central (CSA) or both. Oral appliances and CPAP are used in patients with OSA.
What happens in obstructive sleep apnea?
In obstructive sleep apnea, when you go to sleep, the soft tissues and muscles of the soft palate at the base of the tongue and the uvula become lax and collapse onto the airways. Even enlarged tonsils can obstruct the airway.
Such off and on occlusion of the airway causes cessations in your breathing throughout your night’s sleep. This interferes with your proper sleep, your sleep cycle, and with your requirement of deep sleep. You become sleep deprived and are exposed to the various health complications of sleeplessness. Taking professional help is, therefore, absolutely necessary.
The sleep specialist will have two options for you:
- Continuous positive air pressure (CPAP) machine therapy
- Oral and dental appliances
CPAP continues to be the first line of treatment for moderate to severe obstructive sleep apnea, but some patients find it inconvenient with the mask on the face and with some side effects to bear such as a blocked nose, dry throat, bloating, and irritation of the skin over the face due to the mask.
These oral appliances have become quite popular among sleep apnea patients because they are an effective choice of treatment for snoring and obstructive sleep apnea.
The American Academy of Sleep Medicine (AASM) has approved oral appliance therapy (OAT) as a first treatment of choice for mild to moderate OSA.
The AASM also recommends that patients with severe OSA who cannot tolerate CPAP therapy should be started with oral appliance therapy.
Treating sleep apnea is necessary because its dangers and effects can be very serious if left untreated.
Why people prefer oral appliance therapy (OAT)?
CPAP is more effective than OAT but an oral device has the advantage of being easier to use.
Oral appliance therapy is an effective, non-invasive treatment that fits easily into your lifestyle. Patients like this therapy because it is:
- Easy to wear
- Convenient for travel
- Easy to care for
Sleep Apnea Mouthpiece
Over 100 different oral appliances are approved by the FDA of the United States for use in OSA.
Your dentist or orthodontist works in coordination with your sleep specialist. He will do a complete clinical evaluation of your oral cavity and even take an x-ray of your mouth and jaw.
He will provide you with various designs and you will have to choose one that fits you the best.
You wear these appliances in your mouth before going to sleep. It is similar to a sports mouthguard or an orthodontic appliance.
The appliance holds your lower jaw forward and prevents the tongue and the soft tissues from collapsing and occluding the airway. This way the airway stays open and allows for proper breathing.
It adjusts the position of your lower jaw and tongue so that your airway cannot close and you breathe comfortably when sleeping.
It brings the lower jaw forward or it may move the position of the tongue and soft palate forward or it may do both. This helps to stop your snoring and keep the airway open to facilitate proper breathing.
Such oral or dental devices have shown better long-term control of sleep apnea.
There are many designs and makes available and the two most commonly used oral devices are:
- Mandibular repositioning device or mandibular advancement device (MAD) is the most commonly used device and resembles a sports mouthguard. It forces the lower jaw forward and downward slightly and this helps to keep the airway open.
- Tongue retaining device(TRD) is a custom-made oral device or splint. It holds the tongue in place and does not allow it to fall backward and obstruct the airway. This way it helps you to breathe normally. It takes a little longer time to get used to TRD and therefore, the MAD scores on this point
A periodic follow-up every six months with your dentist is necessary to ensure that the mouthpiece or device still fits well and to review the improvement of your symptoms and signs.
How do you use the oral appliance?
You simply insert the oral device into your mouth before going to sleep. You remove it when you wake up. The oral appliance is worn only during your sleeping hours.
Benefits of sleep apnea oral/dental devices
- Higher compliance than CPAP
- Significant reduction of apneas in mild to moderate cases resulting in improved sleep
- Reduction of snoring
- Risks associated with sleep apnea are considerably reduced.
Side effects of oral devices
Many people experience no discomfort but some common side effects include:
- Excessive salivation
- Dry mouth
- Tooth pain
- Temporomandibular joint pain
- Face pain.
If you experience any of these symptoms, do see your sleep specialist or the orthodontist who will advise you accordingly.