Sleep Apnea & Snoring

Oral Appliances

Oral appliances for the treatment of sleep apnea continue to increase in popularity as awareness grows amongst the public that oral appliances are an effective first line treatment for many sleep apnea sufferers. Over 100 different oral appliances are FDA approved for the treatment of snoring and obstructive sleep apnea. These appliances are worn in the mouth, just like a sports mouth guard or an orthodontic appliance, while you sleep. Oral appliances hold the lower jaw forward just enough to keep the airway open and prevent the tongue and muscles in the upper airway from collapsing and blocking the airway.

The American Academy of Sleep Medicine (AASM) has approved oral appliance therapy (OAT) as a first-line treatment for patients diagnosed with mild to moderate OSA. The AASM also recommends oral appliances for patients with severe OSA, who are unable to tolerate or cannot wear CPAP devices. Another option for people with severe OSA is combination therapy (wearing CPAP and an oral appliance together) to help reduce the pressure on a CPAP machine, making it more comfortable to use.

Aloha Dental Group is AASM certified to encourage the ongoing conversation about sleep disorders research, diagnosis, treatment, and management, the AASM brings together a vast network of sleep medicine professionals of all backgrounds and career paths.

Advantages of Oral Appliance Therapy

Oral appliance therapy is an effective, non-invasive treatment that fits easily into your lifestyle. Patients like oral appliance therapy because it is:

  • Comfortable
  • Easy to wear
  • Quiet
  • Portable
  • Convenient for travel
  • Easy to care for

Custom Made Oral Appliance vs. Boil and Bites

Although there are a few over-the-counter appliances you can purchase at drug stores or even online, remember that these oral appliances are not FDA approved for sleep apnea. When not fitted properly over-the-counter appliances can cause unwanted side effects, such as jaw problems or tooth movement or can even have the opposite effect and inadvertently worsen sleep apnea.

If you snore or believe you have sleep apnea, contact your primary care physician (PCP) to help schedule a sleep study to determine if you do have OSA. If it’s determined that an oral appliance is an option for you, it should be fitted by a dentist specially trained in Dental Sleep Medicine.

Adjusting to Oral Appliance Therapy

Since custom-made oral appliances are adjustable, your dentist will work with you to maintain your jaw position by continuously monitoring your progress. It is important to maintain a prescribed follow-up schedule with your dentist to ensure the device is working, fitting properly and that you see an improvement in your symptoms. It usually takes only a few days to adjust to wearing the oral appliance all night while sleeping. Your dentist will review the details with you as well as the best way to maintain your oral appliance at home.


Medical Insurance for Oral Appliance Therapy

Although a dentist will be placing your custom oral appliance, the great news is that oral appliances are generally covered under your health insurance plan, not your dental plan. Prior to treatment, you or your dentist may want to contact your health insurance, directly, for an estimate of insurance coverage. Due to variations in medical insurance plans, coverages do vary.

Medicare provides reimbursement for oral appliances for those 65 or older under the durable medical equipment (DME) benefit. In order to help Medicare patients with a portion of the reimbursement for oral appliances, many dentists around the country have enrolled as Medicare DME Suppliers for oral appliance therapy for obstructive sleep apnea.

Upper Airway Stimulation (UAS) Therapy

Some people with obstructive sleep apnea, or OSA, are unable to use continuous positive airway pressure (CPAP) therapy, the most commonly prescribed OSA treatment, despite best efforts.  Now there’s a new, clinically proven therapy for some people with moderate to severe OSA who are unable to use CPAP.

 This is a new therapy that works inside your body, and with your natural breathing process, to treat moderate to severe sleep apnea. This therapy might be right for you if:

  • You have been diagnosed with obstructive sleep apnea
  • You can’t use or don’t get relief from CPAP

The system consists of three components: a small generator, a breathing sensor lead, and a stimulation lead—all controlled by the small handheld Inspire sleep remote. Simply turn the therapy on at night before bed, and off in the morning when you wake up. When activated, Inspire therapy continuously monitors your breathing patterns during sleep and delivers mild stimulation to key airway muscles, which keeps the airway open. Your UAS therapy doctor will also evaluate your airway anatomy and overall health status to determine if Inspire therapy is right for you.

Weight Loss

About 70 percent of people with obstructive sleep apnea are overweight or obese. Their health care professionals usually encourage them to lose weight.

Surprisingly, there have been few formal studies of how effectively weight loss leads to lesser, lighter snoring and diminished incidents of apnea and hypopnea during sleep. Despite this, anecdotally practitioners report striking improvements in both OSA and snoring among patients who lose weight.

In some situations a physician may wish to prescribe weight loss medications to an overweight or obese patient with OSA.1

Nasal Decongestant

Nasal decongestants are more likely to be effective in cases of snoring or mild sleep apnea. In some cases, surgery is an effective way to improve airflow through the nose.

Positional Therapy

Some people snore or have sleep apnea only when sleeping on their back. Such people can eliminate or reduce airway blockage simply by learning to sleep on their side.

The traditional technique to induce side-sleeping is dropping a tennis ball in a sock and then pinning the sock to the back of the pajama top. There are also a couple of companies that make a products designed to discourage supine sleeping. 

Positional therapy generally works only in mild cases of OSA. In more severe cases, the airway collapses no matter what position the patient assumes. 

The purpose of an oral appliance is to treat OSA, primary snoring, and associated symptoms. Oral appliances are intended to decrease the frequency and/or duration of apneas, hypopneas, respiratory effort related arousals (RERAs) and/or snoring events. Oral appliances have been demonstrated to improve nocturnal oxygenation as well as the adverse health and social consequences of OSA and snoring. Oral appliances are indicated for patients with mild to moderate OSA and primary snoring. Oral appliances are accepted therapy for patients with severe OSA who do not respond to or are unable or unwilling to tolerate PAP therapies. Although oral appliances are typically used as a stand-alone therapy, they can serve as an adjunct to PAP therapy and/or other treatment modalities for the management of OSA. For this definition oral appliances refer to mandibular advancement devices because they are the most effective and widely used in clinical practice. Accordingly the function of an oral appliance is to protrude and help stabilize the mandible in order to maintain a patent upper airway during sleep. An oral appliance is custom fabricated using digital or physical impressions and models of an individual patient’s oral structures. As such, it is not a primarily prefabricated item that is trimmed, bent, relined or otherwise modified. It is made of biocompatible materials and engages both the maxillary and mandibular arches. The oral appliance has a mechanism that allows the mandible to be advanced in increments of 1 mm or less with a protrusive adjustment range of at least 5 mm. In addition, reversal of the advancement must be possible. The protrusive setting must be verifiable. The appliance is suitable for placement and removal by the patient or caregiver. It maintains a stable retentive relationship to the teeth, implants or edentulous ridge and retains the prescribed setting during use. An oral appliance maintains its structural integrity over a minimum of 3 years. This definition includes the key design features of effective oral appliances, is evidence-based or, in the absence of evidence, is agreed upon using a modified RAND Appropriateness Method process. Its intent is not to replace clinical judgment but instead represents a compilation of the best currently available appliance design features.

Oral appliances are an alternative to the traditional CPAP mask, used for sleep apnea treatment. Custom oral sleep apnea devices are worn in the mouth during sleep to prevent the collapse of the tongue and soft tissues in the back of the throat during sleep. This enables an individual to sleep restfully through the night without snoring or experiencing an obstructed airway.

Appliances may be used alone to treat excessive snoring and mild cases of sleep apnea. They may also be prescribed in combination with other sleep apnea treatments. There are many types of oral appliances that a sleep specialist may prescribe. The most common sleep apnea oral devices are:

  • Tongue-retaining appliances, which reposition the tongue during sleep to prevent airway blockage
  • Mandibular advancement devices, which reposition the lower jaw and tongue, preventing airway collapse

Oral appliance CPAP alternatives can be used to treat:

  • Severe snoring
  • Mild sleep apnea
  • Airway obstruction
  • Low oxygen levels

Oral appliances are custom-made for each patient. The devices control snoring and sleep apnea by positioning the tongue and jaw, keeping the airway open during sleep. This promotes higher oxygen intake and reduces snoring and obstructed airway during sleep.

The appliances are similar in appearance to mouth guards or retainers and are worn only during sleep. When the new oral appliance is introduced to a patient, eos sleep doctors use acoustic reflection technology, called pharyngometry, to monitor changes in the airway and to ensure optimal positioning of the device.

Benefits of using sleep apnea oral appliances include:

  • Non-invasive
  • Devices are comfortable and easy to wear
  • May be suitable for patients who are CPAP intolerant
  • Adjustment period with new device is short
  • Devices are small and easy to carry when traveling
  • Significantly improve symptoms including: increased oxygen saturation at night and decreased daytime sleepiness when used consistently
  • Compliance rates are considerably higher than CPAP
  • Significant improvements in snoring
  • Corrects mild sleep apnea symptoms

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