Treatment of Sleep Apnea and Snoring through the use of Oral Appliances
Dr. James Kramer, a 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 the use of oral appliances.
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 because a narrowing of the airway causes an increase in the speed air travels through the airway and this causes vibration of the soft tissues which creates the snoring sound. Factors that affect snoring are larger soft tissue in the airway, increased resistance in the airway and an increase in the relaxation of these soft tissues.
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 of the airway to tighten up and unblock 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 are available. An in lab sleep study or an 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 events per hour or greater
Three important variables are used to determine a patient's severity:
- The AHI, discussed above
- The amount of time the patient is having an apnea or hypopnea event
- The drop in blood oxygen levels as a result of the event
Is Sleep Apnea a serious health risk?
Systemic health effects of sleep apnea can be life threatening: cardiovascular disease from a lack of oxygen in the blood, high blood pressure, stroke, depression/anxiety, type 2 diabetes and a risk of motor vehicle accidents.
How does an Oral Appliance prevent Snoring and Obstructive Sleep Apnea?
Oral appliances are custom made acrylic devices that cover the upper and lower teeth that position the lower jaw forward and open, which helps improve muscle tone and move the base of the tongue forward. This improves the size of the airway, allowing air to pass with less resistance. Oral appliances improve air flow that reduces or eliminates snoring and obstructive sleep apnea.
What do I do next if I think I would benefit from an oral appliance?
A medical evaluation and diagnosis is important to treating all illnesses, including sleep disordered breathing. A dentist is not licensed to diagnose Snoring or Obstructive Sleep Apnea. It is paramount to begin the process with a diagnosis made by a Board Certified Sleep Physician. Dr. Kramer works closely with patients' sleep physicians in a coordinated effort to give patients the best treatment possible.
What are the treatment options for Obstructive Sleep Apnea?
- Continuous Positive Airway Pressure (CPAP): This device is the standard of care in severe sleep apnea patients. It has a mask that fits tightly over the nose or the nose and the mouth which is attached to an air blower. This air blower administers an air pressure which prevents collapse of the airway.
- Oral Appliance Therapy.: Discussed above.
- Surgery of the tongue, throat or jaw. An Ear, Nose and Throat specialist may perform soft tissue surgeries of the throat or tongue to clear the airway of patients who cannot tolerate CPAP or oral appliances. An Oral Surgeon may perform jaw surgeries that advance the upper and lower jaw which bring the soft tissues out of the airway. These surgeries are quite invasive and should be considered when non-surgical therapies have failed.
- Weight loss: Excessive weight can be the main reason for someone's OSA. Weight loss is unique in that it can be an option to eliminate someone's OSA instead of just treating it with therapy.
- Positional Therapy: Sleeping on one's side can significantly improve a person's sleep apnea or snoring.
- Inspire. Implantable device that stimulates the base of the tongue to open the airway.
What is the best option for my condition?
There is no single best option. Many patients may benefit from a combination of the therapies listed above and this is the reason that a team approach is critical in deciding which therapy is best for the individual patient. Dr. Kramer has networked with area medical specialists in treating these patients. A patient is best served when all of the factors are considered before deciding on a course of treatment.
Indications for Oral Appliance Therapy
- Snoring
- Mild to moderate Obstructive Sleep Apnea
- Severe Obstructive Sleep Apnea patients who cannot tolerate CPAP therapy
- Combination therapy, where CPAP or surgery has not been completely effective
Contraindications for Oral Appliance Therapy
- Limited range of motion of lower jaw
- Active TMJ disorder
- Insufficient number of teeth (minimum 10 teeth on upper and lower)
- Active periodontal disease or excessive tooth mobility
Minor side effects of Oral Appliance therapy
- Excessive salivation
- Loosening of dental restorations
- Dry mouth
- Loosening of teeth
- Temporary discomfort of teeth
Significant side effects of Oral Appliance Therapy
- Jaw pain
- Permanent bite changes
- TMJ noise or pain
Oral Appliances used in our office
The FDA approved devices used in our office are made by ProSomnus Sleep Technologies. We have selected Prosomnus for their commitment to research, technology and customer service. Their fully digital workflow provides 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 scanning essentially eliminates distortion and is paramount to delivering a perfect fit every time. Dr Kramer fits and delivers every device personally and we fully warranty our devices for 1 year for any defects that may arise.
The Prosomnus PH is a fantastic device for most patients. Its dual arms move the mandible forward, allow excellent side to side range of motion and are adjustable to .1mm. The durability is excellent given the minimal thickness of the device. The digital workflow process allows for minimal coverage of the inside of the teeth which allows for maximum tongue space. The precise fit is also the main reason this device does not promote tooth movement- an unfortunate side effect of many devices. It also meets Medicare approval for reimbursement.
The Prosomnus EVO incorporates a combination of upper and lower advancement arches that advance the mandible in 1 mm increments. This metal free option is a choice for patients with metal allergies. The material is essentially unbreakable. This device has an excellent comfort rating by patients and is very easy to fit. The EVO is not a Medicare approved device because the arches are not hinged together.
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.
Oral Appliance Therapy is a covered benefit with most Medical Insurance policies. Our experienced and dedicated staff will help you in verifying benefits before treatment begins.