Sleep Q and A

What exactly is Oral Appliance Therapy (OAT)? 

An oral appliance is a small device, similar to an orthodontic retainer or an athletic mouthguard. It is worn in the mouth during sleep to prevent the soft throat tissues from collapsing and obstructing the airway. Some appliances hold the lower jaw forward during sleep while others have direct effect on tongue position. Oral appliances relieve snoring and may treat OSA by realigning the jaw and/or tongue in relation to the head. Although oral appliances do not work on everybody, a well-made, well-fitted appliance may reduce or eliminate snoring, and may significantly relieve symptoms of OSA.

 

What is the role of my physician in this treatment? 

Obstructive sleep apnea is a serious medical disease. It can only be diagnosed by your physician after having an overnight sleep study. We will work with your physician and keep him or her informed regarding our progress.

 

How do I care for my appliance?

Oral appliances are easy to care for but they do have to be cleaned regularly.

Each morning, simply brush it with a toothbrush and toothpaste. Rinse it well and allow it to sit in its case all day with the top open. Be sure it is up, out of the way, where no curious dogs can chew on it! Also avoid extremes of temperature, especially heat, since the appliance may distort. Do not leave the appliance in direct sunlight.

Two times each week, the appliance should be soaked for 15 minutes in an ultrasonic cleaning container designed for orthodontic appliances, using the cleanser tablets. This will disinfect and keep the appliance looking its best.

Examine your appliance frequently and call the office if you observe any broken areas.

Most of the side effects encountered during appliance use are minor and temporary. They include tenderness to teeth, muscles and joint. Dry mouth and increased salivation is also noticed frequently. In addition, teeth will not meet properly for 10 to 20 minutes after first removing the appliance after a nights use. The office will work with you to manage these occurrences and minimize any problems.

It should be noted that in some patients, a permanent bite change will occur over the years due to a small, permanent change in jaw joint position and/or minor tooth movements due to the pressures placed by the appliance each night.

It is critically important to keep up with twice yearly evaluation visits allowing the doctor to monitor any possible changes in your bite. They are most easily managed if discovered in the early stages.

 

Is there anything we can do to prevent potential side effects?

Very often patients find that they are unable to close their teeth completely in the morning immediately after removing the appliance. This is normal and is due to a temporary jaw joint change. This will generally resolve within 10 or 20 minutes on its own as the joint drifts back into its normal position.

After 20 minutes, jaw exercises are helpful to re-establish joint position and good tooth contact. This can be accomplished by clenching the teeth together and holding for several seconds and then releasing and then repeating the clench/release for a minute or so. Or, you may clench/release on the soft plastic exercise tabs that were provided to you.

Another method is to chew gum while taking a hot shower. Chew and shower for about 10 minutes or until teeth close properly and comfortably.

 

What are the advantages of using an oral appliance?

Oral appliances offer relief from the effects of sleep apnea while avoiding the more expensive and invasive option of surgery. Some patients find that the right oral appliance works as the perfect solution for nighttime peace and freedom from interrupted sleep. Oral appliances may target snoring or the interrupted breathing of sleep apnea, or both. With the right appliance, patients can improve the quality and duration of sleep, reduce daytime sleepiness, improve airflow, reduce the volume or frequency of snoring, and reduce or eliminate apneic events (paused breathing). Oral appliances are also more portable, smaller, and easier to use than the CPAP option.

 

How long will my oral appliance last?

 

Depending on which appliance you choose, they can last years. Most appliances are generally constructed to withstand normal wear and tear well, and Dr. Fabey can repair or reinforce your appliance periodically to increase its functionality. Tooth grinding and other excess wear and tear may shorten the lifespan of your appliance.

 

What are the different types of sleep apnea?

The most common type of sleep apnea is Obstructive Sleep Apnea. Obstructive sleep apnea is caused by a blockage of the airway. The upper airway may become obstructed by excess tissue in the airway. The obstruction may be located in the nasal passages, or the structure of the jaw and airway may be the cause of sleep apnea.

Central sleep apnea is much less common. With obstructive sleep apnea, air cannot flow into or out of the person's nose or mouth although efforts to breathe continue. With central sleep apnea, the brain fails to send the appropriate signals to the breathing muscles to initiate respirations. A person may also experience Mixed Apnea, which is a combination of Obstructive and Central Apnea. 

 

Am I at risk for sleep apnea?

 

Virtually anyone can develop sleep apnea. It is estimated that over 15 million Americans have sleep apnea. However, sleep apnea is more often found in men than women. Individuals who snore loudly, are overweight, or have high blood pressure are at the highest risk. Some studies suggest that sleep apnea may also be hereditary.

 

If I snore, does that mean I have sleep apnea?

 

Snoring occurs when your throat muscles relax to the point where the airway is narrowed and partially obstructed. As the air passes through the obstruction, the structures in the throat vibrate and produce snoring. Although snoring is a strong indication of sleep apnea, the two are not necessarily synonymous. If you snore, you may want to contact an experienced sleep apnea dentist.

 

How is normal breathing restored during sleep?

 

During an apneic event, your body experiences an increased amount of carbon dioxide and a decrease in oxygen. This alerts the brain to open the airways. This alert is usually accompanied by a snort or gasp. These arousals can prevent you from getting a good night's sleep. Many patients awake 40-60 times an hour due to apnea but are unaware of this upon awakening in the morning.

 

Why should I seek treatment for sleep apnea?

 

The lack of quality sleep can take a huge toll on one's life. Sleep apnea patients complain of a lack of energy, muddied concentration, decreased productivity, slowed metabolism, and general loss of quality of life. In addition to the obvious disadvantages of lost sleep, sleep apnea can lead to high blood pressure, heart attacks, strokes, and even sudden death.

 

How do I know if I have sleep apnea?

 

Many patients come to us because their partners or family members observed their apneic events or heavy snoring.

If you are not aware of a nighttime breathing problem, ask yourselves these questions:

• Do you snore on a regular basis, or wake others in your household up?
• Do you awaken frequently at night gasping for air?
• Are you excessively tired during the day?
• Do you fall asleep at unusual times during your day?
• Do you have morning headaches or frequent sore throat or dry mouth?

If you answered yes to any of these questions, you should consider getting a thorough sleep evaluation.

 

How is sleep apnea diagnosed?

You will need to participate in a diagnostic sleep study. A diagnosis must be made by a board certified sleep physician. A series of tests are utilized to reach a diagnosis of obstructive, central, or mixed sleep apnea. A polysomnography test records body functions during sleep. A Multiple Sleep Latency Test measures how long it takes for the patient to fall asleep and is helpful for pinpointing daytime sleepiness.