ORAL APPLIANCES FOR SNORING & SLEEP APNEA

Over 40 million American snore, 45% of all adults, 25% habitually.  Men outnumber women by five to one and as their partners will tell you, snoring is not a laughing matter.  Four percent of men and two percent of women suffer from sleep apnea.

What is Snoring?

What causes all this noise?  Snoring is caused when a person’s airway is constricted forcing air to be inhaled at increased velocity and pressure.  Various obstructions, such as a relaxed tongue, soft palate, uvula and pharyngeal tissue, tend to collapse against each other during sleep, creating vibrations.  As a person ages and perhaps gains a little weight the problem intensifies.

What is Sleep Apnea?

Occasionally the airway closes completely and there will be an interruption of breathing during sleep.  This is called obstructive sleep apnea and may occur dozens of times per hour, lasting as long as 30 seconds.  It is characterized by sudden loud gasps, chronic daytime drowsiness, cardio-pulmonary effects, and yes, snoring.  Not everyone who snores suffers from sleep apnea, but the majority of persons with sleep apnea snore.

Other Symptoms Include:

•  High Blood Pressure
•  Stroke
•  Cancer and other stress related diseases
• Drowsy Driving
• Memory Loss
• Weight Gain

How is it Diagnosed?

Severe snoring and suspected obstructive sleep apnea should be evaluated at a sleep disorder center, such as the sleep labs at Good Samaritan and Nyack Hospitals, where I am on active staff.

At these centers, sleep patterns and their physiologic affect on you are monitored.  Pulmonologists, neurologists or other physicians with specialty training in sleep disorders may be involved in making a definitive diagnosis and in initiating treatment. Diagnosis of sleep apnea is not simple, as there can be many different reasons for disturbed sleep.  Several tests are available for evaluating a person for sleep apnea.

Polysomnography is a test that records a variety of body functions during sleep, such as the electrical activity of the brain, eye movement, muscle activity, heart rate, respiratory effort, air flow and blood oxygen levels.  These tests are used both to diagnose sleep apnea and to determine its severity.  The key indicator is called The Apnea/Hypopnea Index (AHI) which measures the number of events per hour.

Diagnostic tests usually are performed in a sleep center, but new technology may allow some sleep studies to be conducted in the patient’s home.

Treatment Options

Behavioral Therapy – Behavioral changes are an important part of the treatment program and in mild cases behavioral therapy may be all that is needed.  The individual should avoid the use of sleeping pills which makes the airway more likely to collapse during sleep and prolong the periods of disrupted breathing.  Overweight people can benefit from losing weight.  Even a 10% reduction in body weight can cut the AHI in half.  Breathing pauses for some patients with mild sleep apnea only when they sleep on their backs.  In such cases, using pillows and other devices that help them sleep on their sides is often helpful.  We carry two types of strap on back cushions in our office.

Continuous Positive Airway Pressure (CPAP) – CPAP is the most effective treatment for sleep apnea.  In this procedure, the patient wears a mask over the nose during sleep and pressure from an air blower forces air through the nasal passages.  The air pressure is adjusted so that it is just enough to prevent the throat from collapsing during sleep.  The pressure is constant and continuous, and apnea episodes return when CPAP is stopped or used improperly.  Unfortunately only 30% of patients are able or willing to use this treatment modality and these patients only tend to use CPAP for ½ the night.  Variations of the (CPAP) device attempt to minimize side effects that sometimes occur, such as nasal irritation and drying, facial skin irritation, abdominal bloating, mask leaks, sore eyes, headaches and claustrophobia.  Some versions of CPAP vary the pressure to coincide with the person’s breathing pattern, and others start with low pressure slowly increasing it to allow the person to fall asleep before the full prescribed pressure is applied.

Surgery – Some patients with sleep apnea may need surgery.  Although, several surgical procedures are used to increase the size of the airway, none of the m is completely successful or without risks.  More than one procedure may need to be tried before the patient realizes any benefits.  Often the benefits are temporary and the resulting anatomic change can make future CPAP treatment more difficult.

Oral Appliance Therapy – The mild to moderate snorer, and/or apneic person, however, can be helped by new and revolutionary oral appliances that have been well researched and  proven  medically to be effective.  They are worn at night and fit over the upper teeth similar to an athletic mouth guard, while the bottom part engages the lower teeth and holds the jaw in a forward position, the first step done in CPR to open the airway.  They can be simple appliances, constructed in one sitting in the office using thermoplastics, or more complex appliances requiring impressions and laboratory construction.  These more sophisticated devices can actually be titrated and adjusted to find the most beneficial positions.  It usually only takes 2-3 nights to become comfortable with them and you can sleep in any position.  95% of patients fitted with these appliances have had considerable success using them, reporting an average of 70% reduction in snoring and sometimes complete elimination.  There is usually significant reduction in sleep apnea as well.

There are many different oral appliances available.  Approximately 50 appliances have been approved through the FDA for treatment of snoring and/or Obstructive Sleep Apnea in this country.  Oral appliances may be used alone or in combination with other means of treating OSA.  This includes general health, weight management, surgery, or CPAP.  Dr. Chernick has advanced training in Oral Appliance Therapy and is familiar with all the various designs of appliances.  He can determine which one is best suited for your specific needs.  We 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 dental specialist and physician.  Initiation of oral appliance therapy can take from several weeks to several months to complete.  We will continue to monitor your treatment, help you titrate the appliance and evaluate the response.  You will be followed by our office for the life of the appliance.