Obstructive sleep apnea (OSA) is a surprisingly common condition in which the throat at the back of the mouth closes too much during sleep, causing an interruption in steady air flow to the lungs. These periods of blockage can last for just a few seconds to up to half a minute or more. During this time, the level of oxygen falls in the blood, the sleeper is slightly aroused, and sounds of snoring or even gasping for breath can be heard. Ironically, sufferers of OSA may be less aware of having the condition than are their significant others, who are all too familiar with their loud snoring.
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Officially receiving a diagnosis of OSA requires a sleep study at a hospital or clinic specializing in sleep medicine. A person will have a number of electrodes and sensors attached to them, to detect the stoppage of breathing and its length while they attempt to sleep as normally as possible. After such a test and diagnosis, the current ‘gold standard’ of OSA treatment uses a continuous positive airway pressure (CPAP) device. Slightly pressurized air from the device goes to the patient via an air tube and face mask, with the pressure just enough to keep the throat from collapsing during in-breaths.
Unfortunately, many people who would benefit from CPAP treatment have tried it and find it very bothersome. Many of them adapt well to the routine of wearing the face mask in their sleep, and they are fortunate. For those who have tried and failed at CPAP, another option for treatment of the condition is using special dental appliances to help keep the throat open. This is a valuable option, because ongoing, untreated sleep apnea raises one’s risk for developing quite a number of adverse health conditions. These include heart attack, stroke and diabetes, as well as more immediate risks of daytime sleepiness to the point of endangerment of self and others when working or driving.
Those seeking the dental alternative to CPAP must first receive an official diagnosis of OSA from a medical doctor with experience in sleep medicine. They should then speak with their own dentist to find out if s/he is familiar with such appliances. Not all dentists will be, as dental sleep therapy is a sub-specialty that not all dentists practice. However, they will likely be able to make a well-advised referral to another dentist with more expertise in the area.
Experience is necessary for several reasons. First, there are numerous different mouth devices to consider and choose between, even though they basically fall into two different categories (below). The dentist must be familiar with how such appliances are fitted, tested, and potentially modified so that the patient receives maximum benefit from their use. Although many of the devices superficially resemble sports mouth-guards or ‘retainers’ used after orthodontic treatment, there are in fact subtle differences between these and many oral sleep appliances.
In general, the oral devices are either ones which hold the tongue in a forward position – by means of a suction cup or other designs – or they bring the entire lower jaw (the mandible) slightly forward. These small changes are enough to allow more space for air at the back of the mouth and upper throat. The normal ‘bite’ pattern for people is one where the top teeth are in front of the lower teeth when the jaw is closed at rest. This is a small, normal amount of ‘over-bite.’ The mandible-moving devices align the bottom and top teeth just to the point of a slight ‘under-bite,’ with the lower teeth more forward than the upper ones.
People who have suffered from OSA and been helped by either CPAP or oral devices typically wonder how they tolerated the degree of daytime sleepiness they suddenly recognize when it is absent. Some people end up using both CPAP and oral appliances, but the oral alternatives are especially valuable for those who have tried and failed to tolerate the CPAP mask.
SleepDisorders.com is an informational portal assisting sleep apnea sufferers in finding more information about treatment options. Users may also locate sleep doctors in their area using the SleepDisorders.com Doctor Finder.
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