It is estimated that as much as 50% of the population experience some degree of either snoring or sleep apnea symptoms. Many suffer for years with chronic poor sleep patterns or leave their spouses or significant others struggling with the same. Many sleep apnea patients dissatisfied with their current CPAP treatment are looking for alternatives to solve their sleep and snoring problems. Many turn to a dental solution in hopes of finding a less invasive and more comfortable treatment.
Today, dentists are equipped with diagnostic technologies that can help accurately diagnose the severity of the symptoms. For patients who are diagnosed with moderate to severe sleep apnea, referrals to a certified sleep medicine specialist are made. Severe cases of sleep apnea are life-threatening conditions and often go unnoticed until a major event occurs. In our office, we utilize an easy and accurate overnight sleep study program to determine whether oral appliance therapy is indicated.
Oral appliances are indicated only for mild to moderate sleep apnea and snoring caused by a repetitive obstruction to the airway. Airway obstruction occurs because of an anatomical limitation such as a large or floppy tongue, excess tissue in the throat, obesity, nasal obstruction, or an enlarged uvula or tonsils. Sleep apnea severity is defined among other variables by the number of breathing pauses per hour of sleep, which may lead to low blood oxygen levels and may or may not involve snoring. Sleep apnea treatment options should be carefully weighed as this disorder can lead to serious and sometimes debilitating consequences, including, among others, high blood pressure, stroke, congestive heart failure, or diabetes.
In our office, the overnight sleep study allows us to determine not only the severity of the problem, but also provide a baseline to measure any future treatment effectiveness. The results of every home study we do are analyzed by a Board Certified sleep specialist. Most medical insurances cover the initial consultation and the overnight sleep study. Depending upon the insurance carrier, patients may need a referral from their dentist or primary care provider for a sleep evaluation. Oral appliances are usually covered by the medical insurance, rather than dental insurance.
As enticing as they might be for some patients, dental solutions for sleep apnea also have disadvantages. Devices can sometimes be uncomfortable. Intolerance or improper use can lead to discomfort or temporomandibular joint (TMJ) pain, as well as excessive salivation or dry mouth. In the long term, they can also lead to dental misalignment, bite changes, and space opening between the teeth.
In addition, oral appliances can be expensive. Most devices cost as much as $2,000 and many insurance plans cover only a fraction of the cost, leaving the bulk of the charges for the patient. Also, the severity of obstructive sleep apnea tends to worsen over time and a dental device may no longer be adequate several years in the future.
Patients experiencing nocturnal bruxism (teeth grinding) may also have to replace the oral appliance within a couple of years as it may deteriorate, and some insurance plans may not cover a second or third device. In comparison, CPAP is generally half the cost of a dental device and requires smaller co-pays with a smaller up front cost.
Patients should be aware that other forms of treatment are available, such as upper airway surgery (including tonsillectomy and adenoidectomy, or maxillofacial surgery), and have the potential to be more effective in treating sleep apnea than oral devices. Patients with dental appliances should try to stay off their back while sleeping given that obstructive breathing is generally worse when supine (laying down). Finally, oral appliances and CPAP are not mutually exclusive; some patients may use both depending on the circumstances: CPAP at home for most nights and an oral appliance when traveling or in the presence of an occasional bed partner.
Whatever sleep apnea solutions you decide upon to stop snoring, remember that any alternative to CPAP treatment should be done in collaboration with your general health practitioner, sleep physician, and dentist.
Snoring is a problem that affects 67% of adults. It is conservatively estimated over 120 million people in the United States snore every night. Snoring can cause disrupted sleep for both snorers and their sleeping partners, and it can lead to major health problems.
Snoring is the harsh sound that occurs when the tissue at the back of the roof of the mouth vibrates against the back of the throat. During sleep, throat tissues, the tongue, and the muscles that line the airway all relax, narrowing the airway. Air passing through the narrower airway cause the tissues to vibrate against each other and create the snoring sound that can grow louder during sleep. Snoring may also be an indication of a bigger health problem: sleep apnea.
Obstructive sleep apnea is a condition in which the soft tissues at the back of the throat completely close off the airway so that air cannot flow into the lungs. This airway blockage can reduce the amount of oxygen reaching the brain and body. When that happens, the brain alerts the muscles in the airway to tighten up and unblock the air passage. This leads to a cycle of blocking and unblocking the airway and causes significant disruption of sleep.
Obstructive sleep apnea (OSA), the most common, is usually caused when the soft tissue in the rear of the throat collapses and closes completely during sleep.
Central sleep apnea is not caused by a blocked airway, but rather the brain's failure to signal the muscles to breathe.
Mixed apnea is a combination of the two.
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