23 April 2015

JUST BREATHE: Go to the dentist to fix your apnea?

Many of us have an underbite that could be the culprit
behind our sleep breathing issues.
While Positive Airway Pressure (PAP) therapy maintains its position as the gold standard among sleep professionals for the treatment of obstructive sleep apnea (OSA), it may be getting some serious competition from dentists who have a different mechanical approach to treating sleep apnea.

Oral Appliance Therapy (OAT) can be used to treat mild to moderate cases of OSA (as determined by an overnight sleep study to measure severity and to confirm diagnosis of your sleep breathing disorder). However, rather than using PAP therapy, which forces air pressure into the airway to open it up, an oral appliance is used to reposition part of the mouth (tongue or jaw) by way of a specific mouthpiece which allows for a larger opening at the back of the throat where tissue may otherwise collapse during sleep. Sometimes OAT can even be combined with PAP, as well, to combat stubborn cases of OSA.

There are a host of OAT devices to choose from; the American Sleep Apnea Association lists as many as 80! The TAP and Herbst devices are currently the most commonly used. There are two main categories of OAT: Some use a suction device to manage tongue position and prevent it from blocking the airway (tongue retention). Others force the jaw slightly forward to open up space for breathing (mandibular positioning).

The TAP Device
The Herbst Device
The SUAD Device

Generally speaking, most OAT devices are comfortable and simple to wear. Most patients acclimate to them within a couple of weeks. They are great for people who travel a lot; they require very basic cleaning and, with good maintenance, should last several years. Though not all devices are covered by insurance, the nightly use of them over a period of years makes them cost effective for patients who are adherent.

(Curator's note: I use an OAT; mine--an SUAD--is five years old and still works great! I paid $1000 out of pocket, which over five years' usage is not expensive, and I still have years to go. This is just my story, but I know others who use OAT who have found it to be a worthwhile, cost-effective treatment as well.)

Patients who qualify for this kind of therapy to treat their sleep breathing problems include:

  • those who have mild to moderate sleep apnea or UARS or primary snoring
  • those who do not/did not respond well to PAP
  • those who are not overweight
  • those who do not qualify for surgical procedures like tonsillectomy to treat OSA
  • those for whom positional therapy is not an option

These devices resemble common mouthguards, but they are actually much more complex, as they include specific parts which help to move the lower jaw forward. They require special fitting and construction via a dentist specially trained and board certified in the field of sleep dentistry.

Make no mistake: these are handmade devices that are built to fit an individual and are not something you can pick up at the local drugstore, boil in some water and be done with. The Ohio Sleep Medicine Institute says it most clearly: "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." These devices require professional fitting and testing even after they have been trialed by the patient to ensure they work.

There is no LEGAL over-the-counter option for oral devices to treat OSA at this time. OAT requires a doctor's prescription and a clinical diagnosis. 

Once you received your custom-fitted device, you will have follow ups to ensure it is treating your sleep apnea effectively, to make sure it is still in working condition, and to check for both comfort and fit issues. Your primary care physician, your sleep specialist and your dentist should all be on board together to handle these follow ups.

As with any medical therapy, there are risks and disadvantages. Some patients who try OAT discover problems with TMJ, too much saliva, dry mouth or mouth discomfort. Long-term problems may include tooth misalignment or changes in bite (though some devices offer a realigning mouthpiece for the morning after to help reposition the jaw).

People interested in locating a dentist who can assist with creating, fitting and follow up on oral appliance therapy can click this link.


American Academy of Dental Sleep Medicine || Oral Appliances
American Sleep Apnea Association || Oral Appliances
Ohio Sleep Medicine Institute || Are you a candidate for dental sleep apnea treatment?