Could an oral device for sleep apnea be more effective than your CPAP?

man yawning

Partnering with a dental sleep medicine doctor could improve your sleep quality and overall health. At Amber Dental in Wheaton, IL. Dr. Michael Koehne is part of a growing trend that incorporates dental sleep medicine for his patients suffering from chronic snoring or sleep apnea. By working with a patient’s physician and data from a patient’s qualifying sleep study, Dr. Koehne constructs a custom oral appliance that stabilizes the jaw to increase the airway and reduce the likelihood of blockage. A CPAP machine is the gold standard for some treatments of sleep apnea, but for Dr. Koehne’s patients that have trouble tolerating a CPAP machine, a custom oral appliance can be an effective method of getting back to a restorative night’s sleep.

What is Sleep Apnea?

Sleep apnea is the interruption of regular patterns of breathing during sleep. There are varying degrees of severity, ranging from loud breathing and snoring to full airway obstruction, keeping your body from getting the air it needs. 

Everyone is familiar with snoring and how disruptive it is, both for the snorer and their bed partner. It’s a common problem that increases with age–about half of men and women over the age of 65 snore regularly.1 Although snoring doesn’t necessarily mean a full airway collapse while sleeping, snoring does cause sleep disturbance which can be severe. A sleep study should be considered for chronic snorers since it can be an important early symptom of obstructive sleep apnea (OSA).2

According to the American Academy of Dental Sleep Medicine, obstructive sleep apnea is a sleep-related breathing disorder that affects millions of people worldwide. It is estimated that one in five adults experiences at least mild OSA. Untreated OSA is associated with several behavioral, social, and medical issues including daytime sleepiness or excessive fatigue during the day, hypertension, high blood pressure, cardiovascular disease including heart failure, stroke, insulin resistance, depression, reduced libido, anxiety, and impaired cognitive function.3

Obstructive sleep apnea is caused by an obstruction of the upper airway during sleep and is diagnosed through a sleep study by a physician who is a  sleep medicine specialist. While sleeping, the muscle tone of the upper airway decreases, and the airway trembles or collapses. A partial collapse (hypopnea) or full collapse (apnea) interrupts breathing resulting in snoring, waking up during the night, oxygen desaturation, or gasping for air.4

There are a variety of treatment methods for OSA, ranging from diet and lifestyle changes, the use of a continuous positive airway pressure (CPAP) machine, oral appliance therapy (OAT), or upper airway surgery.

CPAP as a first line of defense

CPAP machines work to reduce apnea during sleep by maintaining pressure on the soft tissues in the airways to keep them from collapsing. The patient wears a mask that provides continuous airflow through a tube that pushes against any blockage. This positive pressure acts as a splint, keeping the airway open and allowing for continuous uninterrupted breathing during sleep. 

Several different types of masks work with different CPAP units, from a small nose pillow to a full-face mask. The type you wear depends on the type of sleep apnea you have, and the style that fits you the best. A doctor who is a sleep medicine specialist can help you find a combination that is just right for you.

Although the use of a CPAP machine is the commonly prescribed treatment for OSA and is highly effective in reducing the number of apneas and hypopneas per hour of sleep, consistent nightly use of a CPAP machine is low among users, especially those with moderate to mild OSA.5 Reasons can range from a poorly fitting mask, to dry mouth, or even claustrophobia, causing patients to look for other treatment options for their OSA.

Oral Appliance Therapy as an alternative to CPAP

For patients that primarily snore or have mild or moderate OSA, or those who are unable or unwilling to use CPAP, oral appliance therapy (OAT) can be a useful alternative. An oral appliance is a device worn in the mouth at night that repositions the lower jaw forward, gently moving soft tissues and increasing available airway volume, reduce the collapse of the upper airways. Although CPAP treatment is functionally more effective than OAT in reducing apnea, several studies have shown that patients are more likely to use OAT consistently over time, and prefer OAT over CPAP when given the choice.6 

According to the American Academy of Dental Sleep Medicine,

Oral appliances are an accepted first-line treatment for those who have mild and moderate sleep apnea, and an alternative for those patients who have severe sleep apnea and cannot tolerate or refuse CPAP therapy. Studies have found the overall success rate, the ability of oral appliances to reduce [apnea and/or hypopnea] to fewer than 10 events per hour, to be 54% and a reduction in snoring of 42%.7

Partner With a Dental Sleep Medicine Doctor

Dental Sleep Medicine is the study of the oral and maxillofacial causes and consequences of sleep-related problems. Your regular dentist can screen for signs and symptoms of apnea, but for treatment, it’s recommended to partner with a qualified dental sleep medicine doctor. The American Academy of Dental Sleep Medicine states that:

Dental Sleep Medicine, an offshoot of Dentistry and more specifically of Oral Medicine, is highly multidisciplinary and requires a lot of specialist medical knowledge on the part of those working in it, including on-ear, nose, and throat medicine, neurology, lung disease, and internal medicine. This challenging discipline is practiced mainly by maxillofacial surgeons, orthodontists, and dentists specialized in oral medicine, dental sleep medicine, or orofacial pain and dysfunction.8

Your dental sleep medicine doctor will work in tandem with your physician to help you understand the most effective ways to treat your OSA and work with you to make your treatment as comfortable and easy to use as possible. Be sure to bring up any concerns you have before, during, or after treatment. The more your doctor understands your needs and concerns and can help find solutions, the more successful your treatment plan for OSA can be.9

Let Amber Dental Help With Your Dental Sleep Medicine Needs

Ultimately, the best solution is one that you will use consistently to get the most effectiveness. You, your physician, and your dental sleep medicine doctor can work together to find the solution that best suits your needs. Dr. Michael Koehne, Diplomate of the American Academy of Dental Sleep Medicine, and the team at Amber Dental can be a partner in managing your obstructive sleep apnea and getting you back to quality sleep.




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