Sleep apnea patients dissatisfied with their current CPAP treatment are looking for alternatives to solve their sleep and snoring problems. Many turn to a dental solution in hopes of finding a less invasive and more comfortable treatment. As a comprehensive, coordinated sleep care center, Ohio Sleep Medicine Institute works in collaboration with dentists across Central Ohio to provide patients who are potential candidates for oral therapy with the most appropriate options taking into account their health concerns and comfort issues. Although oral appliances may be an excellent choice for some patients, below are a few facts you should know before considering oral appliance therapy.
When is oral appliance therapy indicated?
Oral appliances are indicated ONLY for mild to moderate sleep apnea and snoring, caused by a repetitive obstruction to the airway. Airway obstruction occurs because of an anatomical limitation such as a large or floppy tongue, excess tissue in the throat, obesity, nasal obstruction, or an enlarged uvula or tonsils. Sleep apnea severity is defined among other variables by the number of breathing pauses per hour of sleep, which may lead to low blood oxygen levels and may or may not involve snoring. Sleep apnea treatment options should be carefully weighed as this disorder can lead to serious and sometimes debilitating consequences, including among others, high blood pressure, stroke, congestive heart failure or diabetes.
Prior to electing any form of treatment, patients should undergo an initial evaluation with a board certified sleep specialist practicing in an accredited sleep disorders center. An overnight sleep study may be recommended which will determine not only the severity of the problem, but also provide a baseline to measure any future treatment effectiveness. Most medical insurances cover the initial consultation and the overnight sleep study. Depending upon the insurance carrier, patients may need a referral from their dentist or primary care provider for a sleep evaluation. Oral appliances are usually covered by the medical insurance, rather than dental insurance.
Sleep apnea severity generally dictates the most appropriate therapy.
Patients with high moderate or severe sleep apnea are generally not good candidates for oral appliances as it will not help adequately resolve their apnea. Continuous Positive Airway Pressure (CPAP) therapy remains the standard of care for those patients. However, if you do not respond to or are not a candidate for CPAP, you may re-evaluate your options by consulting your sleep physician.
Patients with mild sleep apnea may consider a dental sleep solution. Oral appliances come in many different styles or brands. From the one size-fits-all mouthguard such as a night guard or bite guard designed to treat only snoring, to custom mouth pieces such as the Thornton Adjustable Posistioner (TAP) device or Herbst device used to improve upper airway patency, there are many devices to choose from. Custom dental appliances are designed to enlarge the airway and prevent upper airway collapsibility. These mandibular advancement devices typically cover the upper and lower teeth and reposition or hold the lower jaw in an advanced position. The tongue is attached to the front of the lower jaw or mandible. Moving the mandible forward pulls the tongue forward and opens up the airway space behind the tongue.
Which sleep apnea dentist to turn to?
Only qualified and trained personnel should fit oral appliances and practitioners overseeing dental management should have an EXTENSIVE knowledge of sleep-related breathing disorders. Misdiagnosis can lead patients with moderate to severe sleep apnea to be fitted with a dental device that will not adequately improve breathing in sleep. Additionally, oral appliances do not work for all patients. Therefore it is essential to monitor treatment effectiveness with a follow up sleep laboratory evaluation for patients with sleep apnea.
A few facts to consider…
As enticing as they might be for some patients, dental solutions for sleep apnea also have disadvantages. Devices can sometimes be uncomfortable. Intolerance or improper use can lead to discomfort or temporomandibular joint (TMJ) pain, as well as excessive salivation or dry mouth. In the long term, they can also lead to dental misalignment, bite changes, and space opening between the teeth. In addition, oral appliances can be expensive. Most devices cost over $2,000 and many insurance plans cover only a fraction of the cost, leaving the bulk of the charges for the patient. Also, the severity of obstructive sleep apnea tends to worsen over time and a dental device may no longer be adequate several years in the future. Patients experiencing nocturnal bruxism (teeth grinding) may also have to replace the oral appliance within a couple of years as it may deteriorate, and some insurance plans may not cover a second or third device. In comparison, CPAP is generally half the cost as a dental device and requires smaller co-pays with a smaller up front cost.
Patients should be aware that other forms of treatment are available, such as upper airway surgery (including tonsillectomy and adenoidectomy, or maxillofacial surgery), and have the potential to be more effective in treating sleep apnea than oral devices. Patients with dental appliances should try to stay off their back while sleeping given that obstructive breathing is generally worse when supine. Finally, oral appliances and CPAP are not mutually exclusive; some patients may use both depending on the circumstances: CPAP at home for most nights, and an oral appliance when traveling or in the presence of an occasional bed partner.
Whatever sleep apnea solutions you decide upon to stop snoring, remember that any alternative to CPAP treatment should be done in collaboration with your general health practitioner, sleep physician and dentist.