FEATURE — Do you snore when you sleep? Do you wake up gasping for air? Do you get morning headaches or daytime sleepiness? If so, you may be suffering from sleep apnea, a condition in which you stop breathing during the night.
Left untreated, this condition can cause serious associated medical problems like stroke, heart attack, diabetes, weight gain or even death.
Proper diagnosis for sleep apnea is made by a physician and often treated with a C-PAP machine. The machine works to keep the airway open while a person sleeps by delivering room air via a mask to the nose or face under various amounts of pressure. Even though great advances have been made, most people find C-PAP use very trying and often stop using it.
The reasons people resist use of C-PAP machines include claustrophobia, feeling of air in the stomach, noise of the machine or mask, pain or deformity from mask, annoyance of transporting device, dry nose or mouth and irritation to ears because of air pressure.
Still, for most severe sleep apnea sufferers, C-PAP is the treatment of choice.
For the past 10 years, sleep physicians have become more accepting of oral appliances for the treatment of sleep apnea. In fact, treatment guidelines now support a prescription of oral appliances as a first-line treatment choice for mild to moderate sleep apnea.
What is an oral sleep appliance?
Oral sleep appliances are devices that are worn in the mouth. Most patients are able to sleep with their mouth closed while wearing an oral appliance, and they generally do not have any attaching lines or electrical components.
Although C-PAP therapy can be more therapeutic than an oral appliance if a person religiously uses their C-PAP machine, studies show that oral appliance wearers are more compliant more of the time, thus rendering it more effective.
How does an oral appliance work?
By use of the special attachments between the upper and lower parts of the oral appliance, the lower jaw can be moved forward and held in position while the patient sleeps, keeping the airway open.
Many dentists use their expertise to determine a therapeutic position of the lower jaw that will keep the airway open at night and not cause pain in the jaw joint or its associated muscles.
The tongue muscle is one of the major offenders in obstructing the airway. By holding the jaw forward, the back of the tongue is brought partly out of the airway. The slight tension this causes on the associated muscles in and around the airway helps to improve or lessen the severity of the patient’s apnea.
Am I a good candidate for an oral sleep appliance?
If you have your natural teeth or a good-fitting denture with at least the lower denture being retained by implants, you may be a good candidate. If you have jaw or temporomandibular joint disorder, or TMJ, issues, the majority of the time your dentist can incorporate the treatment of your sleep apnea and your jaw joint problems in the fabrication of your oral appliance.
The severity of your apnea may make oral appliances less effective than a C-PAP.
With this noted, combination treatment, meaning wearing a C-PAP device and an oral appliance simultaneously, can lower the C-PAP pressures, making C-PAP compliance more tolerable. Of course, if C-PAP has not worked for you, oral appliance treatment may be an alternative for you, even though the treatment results are less than optimal.
How can I obtain a sleep appliance?
You can request a referral from your physician to see a dentist who has received special training to treat patients with sleep apnea. They will fit you for an oral sleep appliance and adjust it to ensure comfort, working closely with your physician to maximize its effectiveness.
Ed. note: Surgical remedies for snoring and sleep apnea are beyond the scope of this article and may be appropriate for some people. Readers are advised to consult with their own medical professionals for diagnosis and treatment options.
Written by Phillip Hall for St. George Health and Wellness magazine and St. George News.
Dr. Phillip Hall has been a practicing general dentist in St. George for 20 years. After receiving his degree at BYU, he graduated from Northwestern Dental School in Chicago. He has been a delegate representative of Washington County to the Utah Dental Association. As past president and current member of the St. George Rotary Club he is active in community service.
Hall has unique educational training and credentialing to provide dental-oriented treatment for Sleep Apnea and TMJ problems.
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