Sleep apnea can be treated in many ways, but not everyone knows that. Isn’t there another way to treat sleep apnea? Often in our practice, we hear our patients saw they don’t want to do a home sleep test because they don’t want to use a CPAP. A CPAP is a breathing machine strapped to the head to treat sleep apnea. CPAP stands for continuous positive airway pressure. There are a variety of breathing machines and more commonly people are getting BiPAP or APAPs. However, CPAP is the common vernacular, so for our purposes we will refer to all types as CPAP. Medical doctors diagnose if someone has obstructive sleep apnea (OSA) and write prescriptions for CPAPs. These devices have come a long way, and have been known in healthcare as the gold standard. While they are very effective when used correctly and faithfully, compliance is a major problem. If you have a PAP machine and you love it, or at the very least, tolerate it well, continue on! However, many of obstructive sleep apnea adults are prescribed a CPAP, but cannot tolerate it. Some common problems are a poor seal, claustrophobia, dry mouth, gassiness, skin irritation from the mask, acid reflux, grinding teeth, and sleep disturbances.
An alternative therapy is called a mandibular advancement device (MAD) or oral appliance therapy (OAT). Those terms can be used, but MAD is more commonly used. A MAD is a custom made appliance with an piece that fits over the upper teeth and another piece that fits over the lower teeth. These two would look like a double mouth guard to lay people. The upper and lower work together to posture the lower jaw forward. This opens the airway and moves the base of the tongue and jaw forward. Adjustable, the appliance can be changed to posture the lower jaw forward incrementally to gain maximum effect. Jaw comfort is always taken into consideration with determining a therapeutic position. The appliance is prescribed by an MD, just like a CPAP is. A sleep dentistry trained dentist will evaluate if you are a good candidate. Often times they can be done instead of a CPAP, but some medical insurance companies will require a trial of CPAP, and “failing” before they will cover a MAD. Insurance coverage however needn’t dictate treatment options, in our opinion. Dr. Geisler works with a company that is in network with a number of major insurers. For those who do not have coverage, we have a bundle to save you money.
Some users can tolerate the CPAP, but to bring their numbers of apneas and hypopnea index (AHI) down, complimentary therapies are used. A person can have both a CPAP and MAD and use at the same time, if designed correctly. Other combinations can include weight loss, with our without surgery or medication. We gain ,and lose, fat in our tongues as well as our throat and neck just like the rest of our body. Surgeries for nasal obstruction, enlarged tissues in throat, or narrow palates are also options. An implantable device which stimulates a tongue muscle to move forward, thereby opening the airway is also an option, once more conservative approached have not proven to be effective. Supplemental oxygen can be helpful for those with a MAD that is not getting full relief of obstructive events.
The medical community is less aware of a therapy commonly known as myofunctional therapy. Think of it basically as physical therapy for your tongue and airway, coached by specially trained individuals. Research looked at ten research papers and found that on average, an adult can reduce their apnea hypopnea index (AHI) by 50%! AHI Is the scoring system used most basically to diagnose. We recommend myofunctional therapy to all our patients with OSA. It is also helpful for people with a milder form of breathing issue during sleep, named upper airway resistance syndrome (UARS). We have had good success with therapists in our area and online and would be happy to connect you.
The process of having a MAD made involves first having a sleep test ordered by a physician. The sleep test, either done at home or in a lab, is then read. Aa diagnosis of OSA is determined by a medical doctor. They can then write an order for a CPAP or MAD, along with suggesting other therapies such as weight loss. The treating dentist does an exam and history, determining if the person is a good candidate. We talk about the pros and cons of MAD therapy. When moving forward, digital scans of the mouth and teeth, along with photos are taken. Vitals are taken, along with an evaluation of teeth. At our office, it is common to also take a CBCT. A CBCT is a 3D x-ray that shows inside your nose, mouth and airway. Once everything is clear, we send in the digital scans along with a prescription to a dental laboratory. Your appliance is fabricated, typically taking a few weeks. At delivery, we have you try it in and make sure it’s a perfect fit. Home care is reviewed, orally and in written form. We follow up at a week, within a month and at 6 months. We retest with a simple device worn at home to verify effectiveness. The physician referring stays in the loop with communication from us. Follow-ups are yearly afterward. An appliance will not last your whole life, and will need to be replaced as parts will likely wear out. Changes in your teeth, weight, or health can be factors in needing a change as well.
