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Appliance therapy offers sleep apnea solution without a CPAP machine

December 05, 2018

The National Sleep Foundation estimates that more than 18 million Americans suffer from obstructive sleep apnea. If left untreated, severe sleep apnea can lead to a host of medical problems.

Most patients are prescribed a Continuous Positive Airway Pressure (CPAP) device, which is a proven, effective treatment for the sleep disorder. But for those who can’t take advantage of this common treatment option, sleep dentistry provides another solution.

For some, dryness of the throat, mouth, and nose caused by the device can lead to inflammation, runny nose, pain, and congestion. Ear pressure caused by the continuous positive air pressure can also occur, though this generally only happens if the user has some type of congestion from a cold or flu. Some patients also report an uncomfortable accumulation of stomach gas caused by air becoming trapped in the body when the head tilts forward during CPAP use. This typically can be alleviated by use of a wedge pillow to keep the head aligned with the body.

An alternative to the CPAP

For patients who experience difficulties with the CPAP, Kettering Health Network Sleep Centers have developed another program to provide sleep apnea relief: oral appliance therapy, also known as “sleep dentistry.”

“Sleep apnea can cause other medical issues, including serious cardiovascular problems like atrial fibrillation and acid reflux,” said Ron Dean, DMD, D.ABDSM, a dentist affiliated with Kettering Health Network, who specializes in the treatment of snoring and sleep apnea. “Most importantly, sleep apnea will make you feel tired, unproductive, and forgetful, and you are at increased risk of car accidents because you’re exhausted.”

Until recently, the only surgical treatment for the disorder was a procedure to open up the airway. But with oral appliance therapy, the airway is opened with a device worn at night like a retainer.

Worn only during sleep, the oral appliance works like a two-part sports mouth guard or orthodontic device. It is designed to hold the lower jaw slightly forward to open up the airway and improve breathing. Research has shown that the oral appliance therapy is an effective treatment option for sleep apnea and may cause less discomfort to patients than the use of a CPAP machine.

“The CPAP works--it’s a great device--but using it is clearly an issue for a lot of patients,” said Dr. Dean.

Finding the right treatment

Dental specialists like Dr. Dean work closely with physicians to determine the best options for the patient. As with any specialty therapy, a diagnosis needs to be made by the physician first. In this case, a thorough examination and sleep study must be performed either at home or in a sleep lab. Once the diagnosis for obstructive sleep apnea is confirmed, the doctor refers the patient to the dental specialist for fitting of the device.

The doctor and dentist will perform CT scans of the head and neck and look closely at the nose. Many people snore or have apnea because they cannot breathe through their nose, so the medical team ensures there is no nasal obstruction. They also check to be sure there is no TMJ (temporomandibular joint disorder); if TMJ is present, the medical team has to pursue a more comprehensive evaluation and referral to other medical specialties, such as an ear, nose, and throat specialist, if needed.

After these evaluations, the dentist will evaluate the patient to make sure he or she meets the requirements of using the dental appliance. For example, because of the way the device works, the patient must have enough teeth available, and in the right positions, to support it.

As with any kind of custom sports guard or other dental appliance, a mold is taken of the upper and lower teeth, and the patient is fitted for a specific device. Within a few weeks, the patient is enjoying better breathing and more comfortable sleep, without the noise, hoses, and masks of the CPAP machinery.  A follow up sleep study with the appliance in place will determine the efficacy of treatment or if additional adjustments are needed.

If you are looking for a solution to a better night’s sleep, contact the Kettering Health Network Sleep Center at 1-855-400-7533 or visit ketteringhealth.org/sleep