What is Sleep Apnea?
Sleep apnea is a common sleeping disorder marked by shallow breathing, pauses in breath and labored breathing punctuated by gasping or snoring sounds. Pauses of breath can last from several seconds up to minutes and can happen from five to thirty times or more per hour. A pause may be followed by a choking or snorting sound as the sleeper involuntarily gasps for breath.
The two main causes of sleep apnea are a blockage of the airway and poor signals from the part of the brain responsible for directing the muscles that control breathing. These two causes may occur together, however sleep apnea caused by a collapsed or blocked airway, known as obstructive sleep apnea, is the most common reason sleep apnea is experienced.
As oxygen is restricted to the lungs, blood and brain, the sleeper is less likely to fall into deep, restorative cycles of sleep. A person suffering from sleep apnea finds himself or herself tired during the day as the disorder inhibits restful sleep. A lack of quality sleep can lead to accidents or poor job performance. Serious health concerns including heart disease, high blood pressure, stroke, diabetes and depression can also result from untreated sleep apnea.
The condition is a highly manageable one as there are a number of treatment options that can relieve the symptoms of sleep apnea. Treatment options range from lifestyle changes such as weight loss and smoking cessation, to devices that keep the breathing passage open through pressurized air or by altering the position of the lower jaw and connected airways, to surgery. An individual with sleep apnea should monitor their condition regularly to ensure symptoms and negative health affects are minimized.
Types of Sleep Apnea and Snoring Appliances
For patients that cannot tolerate a CPAP machine or for those patients that do not have sleep apnea but who do snore, we can make a dental appliance to hold the jaw forward. The technical term is a mandibular advancement device or MAD. The goal is to move the tongue off the back of the throat, which has the effect of opening the airway. The airway can also be opened vertically, which is a fancy way of increasing the space between the upper and lower teeth. The most effective sleep apnea appliances need to be custom made. The process is started by taking impressions and then pouring up a model. That model is then sent to a lab that makes the custom dental appliance on the models, which are an exact duplication of your teeth. There are several different appliances and each has its unique advantages and disadvantages but they all have the same effect, which is to open the airway, and they all must connect the upper appliance to the lower appliance, which is how the lower jaw is moved forward to open the airway. We use the following sleep apnea appliances, which are presented in alphabetical order.
EMA is an acronym for elastic mandibular advancement. This appliance is one of the thinnest and least obtrusive of the various mandibular advancement appliances. A good comparison would be to compare it to a clear removable orthodontic aligner. This appliance contains no metal so there is no concern of any type of metal allergies, and there is plenty of room for the tongue. There are plastic buttons, which are bonded to the appliance. Acrylic straps are used to attach the upper appliance to the lower appliance. There are different straps, some of which are elastic to allow more movement and less forward tension, and others which are more rigid to allow less movement and more forward tension. We usually start with the more elastic straps and then titrate the appliance forward by using more rigid bands. Titrate is a fancy word that means adjusting and modifying. Titration is necessary to be able to adjust the appliance if we need to more the lower jaw forward to to increase the vertical height, which is also an option for opening the airway.
We use a telescoping Herbst appliance to treat snoring and sleep apnea. This is a custom made dental appliance made using a hard acrylic, which has the adjustment hardware that connects the upper and lower appliance. It is named "telescoping" because there is a piston on the lower appliance that fits inside a rod on the upper appliance, which is how the two appliances stay connected. We can add spacers to the piston, which have the effect of moving the lower jaw forward, which is how this appliance is titrated. This is a very rugged appliance that is good for people who do a lot of grinding, or what dentists refer to as bruxism. There is metal in this appliance so please let us know if you have any metal allergies.
SomnoMed MAS™ is a another option to treat sleep apnea and snoring. MAS is an acronym for mandibular advanement splint. mandibular advancement appliance, which is custom made in two pieces. There is a top appliance contains the hardware and the lower appliance contains a fin. This appliance is titrated by turning a screw in the upper appliance, which has the effect of moving the fin forward. This moves the lower jaw forward, which increases the opening at the back of the throat and pulls the tongue forward and opens the airway.
TAP 3 Elite
The TAP 3 Elite is a sleep apnea and snoring appliance that is made of acrylic. The upper appliance has a hook in the front, and the lower appliance has a bar. The hook engages the bar, which is how these two appliances stay connected. There is a screw in the front of the top appliance that can be used to move the hook further back, which has the effect of moving the lower jaw forward. This results in opening up the airway and is the method of how this appliance is titrated. The appliance allows side to side movement of the jaw and is a good choice for people who grind their teeth at night. This device is comfortable on the teeth and allows good freedom of movement of the jaw. Therefore it is used frequently for patients who tend to grind their teeth heavily.