It is normal for the throat muscles to relax during sleep, narrowing the airways. In sleep apnea patients, a full or partial blockage of the airway occurs. Frequent loud snoring may be a sign of sleep apnea and can be a serious medical condition and can lead to hypertension, heart attack, stroke, depression, muscle pain, fibromyalgia, morning headaches, impotence, irritability, frequent nighttime urination, and memory and concentration difficulties. When left untreated, sleep apnea can be deadly.
Oral Sleep Appliances are the most commonly accepted method for treating sleep apnea and can be an alternative to Continuous Positive Airway Pressure (CPAP). Typically, you will be referred to a physician for a sleep study and proper diagnosis, then Dr. Massa will work to create the right appliance to help your condition. Those who have attempted CPAP but were unsuccessful will also benefit from Oral Appliance Therapy. Oral appliances are designed to keep the airway open at night, eliminating snoring and interruption. Many CPAP users frustrated with the face mask attached to a motor are happy to substitute Dr. Massa’s simple dental appliance. Dr. Massa serves patients in Naples, FL and surrounding areas, and has had advanced training in sleep breathing disorders, receiving a fellowship at The Las Vegas Institute for Advanced Dental Studies, and is a member of the International College of Craniomandibular Orthopedics.
What are the pros and cons of treating sleep apnea with oral appliances?
Many patients find that they have serious problems with CPAP systems, and they end up not using them, which defeats the whole purpose of treating their sleep apnea. Dr. Massa can create a custom-fit oral appliance for these patients. This oral therapy can be effective for patients with mild, moderate or severe sleep apnea. The goal with these appliances is to move the lower jaw to a more physiologic and relaxed muscle position, usually resulting in the jaw more forward and open and thus relaxing the airway. This position and the appliance will also keep the tongue from sagging backwards and blocking the airway. The appliances can also be used in tandem with your CPAP machine.
Here are some pros and cons of using oral appliances:
Pros of Oral Appliances
- For patients who can’t tolerate CPAP, oral appliances are much more comfortable.
- CPAP patients often complain of dry, itchy noses from the air pressure drying out their sinuses. Oral devices do not have this problem.
- Oral appliances are great for people who travel a lot and can’t take a CPAP system with them.
- Oral appliances can be used in conjunction with CPAP in patients who require very high pressures in their CPAP systems, as the appliance can keep the jaw from falling backwards during sleep so a lower pressure can be used.
- Oral appliances are more cost effective.
Cons of Oral Appliances
- May cause jaw pain, soreness, or tension if made improperly.
- Mouthpieces can lead to sore teeth and/or gums.
- May cause problems with the temporomandibular joint if made incorrectly.
- May cause excess saliva production or even dry mouth.
- May loosen existing dental restorations such as bridges.
How is sleep apnea usually treated?
Continuous positive airway pressure (CPAP) therapy is the most recommended treatment for patients with obstructive sleep apnea. CPAP involves the patient wearing a mask over their nose and mouth that creates higher pressure in their respiratory system than the outside room pressure. By creating a pressure difference, this keeps the tongue and the tissues at the back of the throat from sliding back and blocking the airflow. There are different CPAP devices, but all require some sort of mask along with equipment that sits bedside.
Oral appliances are the other typical treatment for sleep apnea. Worn at night, these help keep the jaw and tongue in the proper position.
How can oral appliances treat sleep apnea?
There are generally two types of oral appliances for sleep apnea that Dr. Massa custom fits — mandibular (lower jaw) relaxing devices and tongue-retaining devices.
Mandibular advancing devices (MADs) look very similar to sports mouthguards, except there is an upper and a lower arch that is custom milled to the position diagnosed by Dr. Massa.
Tongue-retaining mouthpieces are similar to MADs, but they have a small compartment that fits around the tongue. Using suction, this compartment keeps the tongue forward, preventing it from collapsing back into the airway. Contact Dr. Massa in Naples, FL today for more information.
How do I know if I have sleep apnea?
Sleep apnea has two sets of symptoms: those that occur at night and those that occur the following day. You may not have any idea that you are having problems at night with your sleeping, but the daytime symptoms can provide a clue. These are the common symptoms of sleep apnea:
- Awakening with shortness of breath
- Episodes of breathing cessation witnessed by another person
- Loud snoring
- Abrupt awakenings from sleep, often with snorting sounds
- Waking up with a headache in the morning
- Excessive daytime sleepiness
- Waking up with a dry mouth or sore throat
- Difficulty staying asleep
- Attention problems
A first step toward finding if you have sleep apnea is to take the Epworth Sleepiness Evaluation you’ll find on this page.
How can Dr. Massa diagnose my sleep apnea?
Training and experience are crucial to the proper diagnosis of sleep apnea. Dr. Massa weighs a combination of symptoms such as fatigue or waking up with a dry mouth and throat, along with input from your partner as to whether he or she often hears loud snoring or choking noises while you sleep. He’ll weigh your responses to the Epworth Sleepiness Evaluation, and from there, he may recommend either a home sleep apnea test or an in-lab overnight sleep test.
How does Dr. Massa fit me for a sleep apnea oral device?
Dr. Massa has extensive experience creating oral appliances for his sleep apnea patients. There are more than 80 different oral devices that have been approved by the FDA, and each is customized to the patient. The process starts with Dr. Massa utilizing a tens unit and K-7 to achieve a physiologic bite position then followed up with an Itero scan and/or impressions to create a 3D rendering of the teeth. The 3D rendering is then sent to the lab to create a custom fit appliance.
Once you’ve worn your oral appliance for some time, it’s good to bring it back for Dr. Massa to check the fit. This, of course, is especially important if the appliance is causing you any pain.
How Long does it take to have the device fitted and then to start using it?
Once the Itero scan has been recorded or impressions have been taken and the position diagnosed, it takes approximately three weeks for the appliance to be delivered.
Take The Epworth Sleepiness Evaluation
The Epworth Sleepiness Scale measures a person’s general level of daytime sleepiness. It is a simple questionnaire based on retrospective reports of the likelihood of dozing off or falling asleep in a variety of different situations. When you finish the test, add up the values of your responses. The scale estimated whether you are experiencing excessive sleepiness that possibly requires medical attention.
How likely are you to doze off or fall asleep in the following situation? You should rate your chances of dozing off, not just feeling tired. For each situation, decide whether or not your would have:
- No chance of dozing -0
- Slight chance of dozing -1
- Moderate chance of dozing -2
- High chance of dozing -3
Write down the number corresponding to your choice and then total your score.
Situation Chance of Dozing
|Siting and Reading|
|Sitting inactive in a public place (i.e. theater or a meeting)|
|As a passenger in a car for an hour without a break|
|Lying down to rest in the afternoon when circumstances permit|
|Siting and talking to someone|
|Sitting quietly after lunch without alcohol|
|In a car, while stopped for a few minutes in traffic|
Total Score: _________________
A score of 10 or more indicates a possible sleep disorder. Talk to one our Doctors about your results.
Copyright ESS @ MW Johns 1990-1997. Used under License.
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