ORAL APPLIANCE THERAPY
A CPAP alternative that’s 95% effective for snoring!
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How It Works
The oral appliance is an upper and lower mouth piece, similar to an athletic mouth guard. The upper and lower pieces are connected by a hinge that functions to hold the lower jaw in a more forward position. This position is customized based on the individual’s ability to move their jaw forward.
Placing the jaw in a more forward position pulls the tongue and related soft tissue out of the back of the throat, keeping it from impinging on the airway.
Dr. Wittbold and Dr. Kulaga have extensive training in oral appliance therapy, are familiar with the various designs of appliances and can help determine which is best suited for your specific needs.
Once impressions are taken of the dental arches, delivery of the appliance will be in 2-3 weeks. Over the next several weeks, the patient will gradually advance the appliance to the ideal, most effective setting.
A follow-up sleep study with the oral appliance in place will measure the effectiveness of the appliance.
Frequently Asked Questions
What is Sleep Apnea?
Apnea literally means “cessation of breath.”There are three types of sleep apnea:
Central – occurs when the brain fails to send the appropriate signals to the muscles to initiate breathing. Central sleep apnea is less common than obstructive sleep apnea.
Obstructive – occurs when air cannot flow into or out of the person’s nose or mouth although efforts to breathe continue. Oral appliance therapy only treats the obstructive sleep apnea.
Mixed– a combination of central and obstructive.
Eighty-four percent of the sleep apnea cases are obstructive sleep apnea (OSA). It is a serious medical condition that occurs when a person stops breathing or has restricted breathing while they are sleeping. The tongue and soft palate collapse onto the back of the throat while sleeping, causing air flow to restrict or stop completely. This naturally causes the blood oxygen levels to decrease. Once the blood oxygen level drops low enough, the body goes into a fight-or-flight response—blood pressure rises, the heart races and stress hormones surge. The individual partially awakens, and the airway reopens. This scenario may occur over and over throughout the night.
Regardless of type, an individual with sleep apnea is rarely aware of having difficulty breathing, even upon awakening. Sleep apnea is recognized as a problem by others witnessing the individual during episodes or is suspected because of its effects on the body. Symptoms may be present for years (or even decades) without identification, during which time the sufferer may become conditioned to the daytime sleepiness and fatigue associated with significant levels of sleep disturbance.
What are the symptoms of Obstructive Sleep Apnea?
Often the person with obstructive sleep apnea is not the first to recognize the signs. OSA is often first noticed by the bed partner or a person who observes the patient at rest. Many people who have OSA have no sleep complaints.
The most common obstructive sleep apnea symptoms include:
Daytime sleepiness or fatigue
Dry mouth or sore throat upon awakening
Headaches in the morning
Trouble concentrating, forgetfulness, depression, or irritability
Restlessness during sleep
Sudden awakenings with a sensation of gasping or choking
Difficulty getting up in the mornings
Who is at risk of having Obstructive Sleep Apnea?
Loud snoring and obesity are most predictive of the probability of having sleep apnea.
However, you don’t have to be overweight to have sleep apnea. Small airways, restricted nasal passages, narrow dental arches, high palates and deep overbites all contribute to airway restrictions that don’t provide enough room for the tongue. Many times, the upper dental arch and sinuses are underdeveloped a result of mouth breathing and thumb sucking as a child.
Enlarged tonsils can cause obstruction. Most often in adults, the obstruction is caused by too much tissue at the back of the throat — the uvula and soft palate — that hangs down and blocks the windpipe.
Children have sleep apnea too. The obstruction is usually due to large tonsils and adenoids.
Sleep apnea is more common in men, because testosterone contributes to snoring and apnea. However, once women enter menopause, and have a reduction in estrogen, they are at equal risk. (If a man is taking testosterone supplements, he should watch for an increase in sleep apnea)
An estimated 20 million Americans suffer from OSA. Less that 15 % are diagnosed, and even fewer are receiving ongoing treatment.
How severe is my OSA?
The severity of OSA is measured by an hourly average of how many times a person stops breathing for 10 seconds or more and/or how many times their blood oxygen drops due to restricted breathing.
Mild: 5-15 events /hour
Severe: 30 and greater
Someone with moderate OSA has an index of 15-30 events per hour. That means they have an event (stop breathing for 10 seconds or more or their blood oxygen drops by 3%) 15-30 times per hour. That’s every 2-4 minutes! For severe apnea, it can be more than once a minute. Every time one of these events occurs, the person moves out of the deep sleep to a lighter stage of sleep. They don’t necessarily awake to consciousness, but it is the deeper levels of sleep that are restorative for the mind and body.
In addition to excessive daytime sleepiness, sleep apnea can cause memory loss, morning headaches, irritability, depression, decreased sex drive and impaired concentration. Sleep apnea patients have a much higher risk of stroke and heart problems, such as heart attack, congestive heart failure and hypertension. Sleep apnea patients are also more likely to be involved in an accident at the workplace or while driving.
Can children develop Obstructive Sleep Apnea?
Yes. Symptoms of OSA in children may not be as obvious. They include:
Choking or drooling
Excessive sweating at night
Inward movement of the ribcage when inhaling
Learning and behavioral disorders
Poor school performance
Sluggishness or sleepiness (often misinterpreted as laziness in the classroom)
Restlessness in bed
Pauses or absence of breathing
Unusual sleeping positions, such as sleeping on the hands and knees, or with the neck hyperextended
Is Oral Appliance Therapy Right for You?
Oral appliances are indicated for use in patients with mild to moderate sleep apnea who prefer oral appliances to CPAP or who fail treatment attempts with CPAP.
Patients with severe sleep apnea should have an initial trial of CPAP because greater effectiveness has been shown with this intervention than with the use of oral appliances.
It is recognized that CPAP is the “gold standard” for treatment of sleep apnea however; it is also recognized that many people have trouble using the CPAP.
Oral appliances are much easier to use and the compliance rate is much higher.
The effective rate for patients with mild to moderate sleep apnea is 85%, but is less effective for patients with severe sleep apnea. In my practice I have found that several severe patients have benefitted from the appliance.