Treatment of Sleep Apnea and Snoring with the use of an Oral Appliance
Dr. James Kramer, Diplomate of The American Board of Dental Sleep Medicine, works with referring physicians to evaluate and treat sleep disordered breathing, such as snoring and obstructive sleep apnea, with use of an oral appliance.
Diplomates of the American Board of Dental Sleep Medicine (ABDSM) have received the highest credential a dentist can earn in dental sleep medicine. To earn this qualification, dentists are required to demonstrate competency in dental sleep medicine and must pass a rigorous written examination. It signifies a professional commitment to education, knowledge and experience in dental sleep medicine.
Why do people snore?
Snoring occurs due to a narrowing of the airway. This narrowing causes an increase in the air resistance that travels through the airway, which then causes vibration of the soft tissues and creates a snoring sound.
What are the consequences of untreated snoring?
Disrupted sleep of the affected individual and bed partner can occur. This can lead to daytime fatigue, drowsiness and marital discord.
What are some factors that affect snoring?
- Obesity
- Sleeping on your back
- Nasal obstruction
- Enlarged soft tissues in the throat
What is obstructive sleep apnea?
Obstructive sleep apnea is a condition where the soft tissues in the throat completely close off the airway so that air cannot flow to the lungs. This can lead to a decrease in oxygen in the blood, which the brain senses and alerts the muscles to open the airway. As the breathing process begins again, a disruption of sleep occurs that can lead to a decrease in the body reaching the deep stages of sleep. This sleep disruption causes daytime sleepiness and fatigue that can have serious consequences on an individual's quality of life.
How is obstructive sleep apnea diagnosed?
Two sleep test options: "in-lab" sleep study or "at-home" sleep test. Your sleep provider will help you decide which test is best for you. In-lab sleep studies gather more data, but at-home studies capture a better snapshot of the patients sleep environment. Both tests will provide a diagnosis of apneas (airway closure) and hypopneas (airway narrowing). Patients are then given a diagnosis based on the number of events per hour of apneas and hypopneas. This is called the Apnea-Hypopnea Index or AHI.
- Mild: 5-15 events per hour
- Moderate:15-30 events per hour
- Severe: 30 or more events per hour
Three important variables used to determine severity of sleep apnea:
- Apnea-Hypopnea Index
- Duration of the apnea or hypopnea event
- Blood oxygen level
Is sleep apnea a serious health risk?
Systemic health risks of sleep apnea can be life threatening. Examples of risks: cardiovascular disease, high blood pressure, stroke, depression/anxiety, type 2 diabetes, risk of motor vehicle accidents
How does an oral appliance treat snoring and obstructive sleep apnea?
Oral appliances are made of acrylic and are custom made devices that cover both upper and lower teeth. The oral appliance positions the lower jaw forward, which helps improve muscle tone and moves the base of the tongue forward. This increases the size of the airway which allows air to pass with less resistance. This improvement of air flow reduces or eliminates snoring and obstructive sleep apnea.
What if I think I would benefit from an oral appliance?
A medical evaluation and diagnosis are essential to treating all illnesses, including sleep disordered breathing. It is important to begin the process with a diagnosis made by a board-certified sleep physician. A dentist is not licensed to diagnose snoring or obstructive sleep apnea. Dr. Kramer works closely with the treating physician in a coordinated effort to recommend the best treatment option for each individual patient.
What are the treatment options for obstructive sleep apnea?
1. Continuous Positive Airway Pressure (CPAP): CPAP is a machine that uses air pressure to keep breathing airways open while you sleep. While CPAP is highly effective, long-term compliance is less than 50%. This device is the standard of care for patients with severe sleep apnea.
2. Oral Appliance Therapy
3. Surgery of the tongue, throat or jaw: An Ear, Nose and Throat (ENT)specialist may perform soft tissue surgeries of the throat or tongue to open the airway for patients who cannot tolerate CPAP or an oral appliance. An oral surgeon may perform jaw surgery that will advance the upper and lower jaws to open the airway. Surgical options are invasive and should only be considered when non-surgical options have failed.
4.Weight loss: Excessive weight can be a factor for obstructive sleep apnea. Weight loss is beneficial because it could reduce or eliminate obstructive sleep apnea in some patients.
5.Positional Therapy: Side sleeping can significantly improve a person's snoring or sleep apnea.
6. Inspire: Implantable device that stimulates the base of the tongue to open the airway.
What is the best option for my condition?
There may not be a "single" option for treatment. Many patients may benefit from a combination of therapies, and this is why a team approach is critical in determining which therapy is best. Dr. Kramer, along with local medical specialists, work as a team to consider all factors before choosing the best treatment option for each individual patient.
Indications for Oral Appliance Therapy
- Snoring
- Mild to moderate obstructive sleep apnea
- Severe obstructive sleep apnea with CPAP failure
- Combination therapy (when CPAP therapy or surgery is only partially effective)
Contraindications for Oral Appliance Therapy
- Limited range of motion of the lower jaw
- Active TMJ disorder
- Insufficient number of teeth (need a minimum of 10 teeth per arch)
- Active periodontal disease or excessive tooth mobility
Minor side effects of Oral Appliance therapy
- Excessive salivation
- Dislodging of dental restorations
- Dry mouth
- Temporary discomfort of teeth
Significant side effects of Oral Appliance Therapy
- Jaw pain
- Permanent bite changes
- TMJ noise or pain
Oral Appliances chosen by Dr Kramer
The FDA approved oral appliances provided in our office are fabricated by ProSomnus Sleep Technologies. Dr Kramer has selected Prosomnus for their commitment to research, technology and customer service. The fully digital workflow provides an appliance with superior fit, comfort and durability. Our process begins with an intraoral scan of the patient’s dentition, preventing the need for traditional dental impressions. The intraoral scan decreases distortion and is essential for delivering an accurate fit. Dr Kramer fits all oral appliance himself and offers a one-year warranty for any defects that may arise.
The Prosomnus PH is the ideal appliance for most patients. This appliance has dual arms that position the mandible forward and allows side to side movement of the lower jaw. The Prosomnus PH is adjustable in 0.1mm increments and the durability is excellent given the minimal thickness. The appliance also allows for maximum tongue space due to minimal coverage of the teeth. The precise fit decreases tooth movement, which is an unfortunate side effect of many other oral appliances. The Prosomnus PH meets Medicare approval for reimbursement.
The Prosomnus EVO incorporates a combination of upper and lower advancement arches that move the lower jaw forward in 1.0 mm increments. This metal free option is a great choice for patients with metal allergies. The material is extremely durable and has an excellent comfort rating by patients. The Prosomnus EVO does not meet Medicare approval for reimbursement because the arches are not hinged.
Are you and your spouse sleeping in separate bedrooms because of snoring? Are you suffering from cardiovascular disease? Are you lacking energy? Are you driving drowsy? Try an oral appliance; it could change your life! Call (920) 725-2533 option 3 for help.
