Snoring and Sleep Apnea appliances
Sleep related breathing disorders
(SRBD): its a spectrum.
SRBDs are considered a spectrum and include snoring, upper airway
resistance syndrome (UARS) and sleep apnea.
Dr Zacal became interested in this topic because of the destruction she
was often seeing in patient’s dentitions and also the destruction of some of
the treatment that was done to fix the initial broken teeth, acid reflux and
worn down teeth. These may all be related to having an undiagnosed
SRBD and getting to the root of the problem can go a long way to not only
increasing the longevity of the teeth AND the work that is done to fix the
teeth! (more in the publication)
Although it would seem obvious that sleep is important, along the way to
becoming a Diplomate of the American Academy of Dental Sleep
Medicine, she was surprised to learn of the very many health benefits of
quality sleep and proper sleep architecture. People’s lives can quite
literally be transformed when they are not grumpy or too fatigued to enjoy
doing things they love. More on this topic can be found at the youtube channel @DrCatherineZacal_DDS
Contrary to popular belief, your room mates cannot make the diagnosis of snoring for you!
Snoring without sleep apnea, or “primary snoring” can only be diagnosed
by a family doctor or sleep physician, according to the American Academy
of Sleep Medicine, which is what the Canadian Sleep Medicine community
also follows.
It is important to be know
which condition you have in order to
treat it with the right appliance.
SNORING APPLIANCE
Once you receive the go ahead to have a snoring appliance made, the
process can begin!
Custom impressions are taken and a jaw position is prescribed to allow for
minimal TMJ disturbance and tooth movement. The double appliance (a
piece for the top jaw, connected to a piece for the bottom jaw) holds the jaw
in a forward position to bring the tongue forward and out of the throat and
also has a somewhat tightening effect on the soft palate. This relieves the
vibrations associated with air passing through a narrow space once the
ideal position is established.
SLEEP APNEA: Oral Appliance Therapy, or OAT
The rough rule of thumb is as follows:
Severe sleep apnea: 30 events or more per hour
Means starting with a CPAP although the use of OAT can be initiated in
certain circumstances even for severe sleep apnea.
Moderate sleep apnea: 15-30 events per hour
Mild sleep apnea: 6-14 events per hour
Oral Appliance Therapy may be the first line of treatment for moderate to
mid sleep apnea, and for upper airway resistance syndrome.
Upper Airway Resistance Syndrome (UARS):
Oral Appliance Therapy may also be very helpful in treating UARS, a
condition where the sleep apnea severity barely registers (can be 6 events
per hour) but the symptoms of daytime sleepiness is severe in these
patients. There is less cardiac risk because the severity of the disease is
not high, however quality of life is lower due to fatigue and the risk of a
motor vehicle accident increases. UARS occurs when a very
sensitive airway causes a person to wake up many times during the
night when they encounter a minor airway resistance. Most people don’t
know they wake up due to the UARS, they assume they are waking up for
other reasons, including insomnia.
ORAL APPLIANCE THERAPY
Oral Appliance Therapy works on much of the same premise as making a
snore appliance, however there are some major differences:
An oral appliance for the treatment of sleep apnea requires a prescription
from a sleep physician who is in charge of the diagnosis and treatment
options of the sleep apnea for that particular patient.
The dentist acts as a “pharmacy” to fill the OAT prescription and then
works with the patient for approximately 3 months to establish the best
position of the jaw to alleviate any sleep apnea symptoms. The
effectiveness of the appliance then needs to be checked and verified by a
referral back to the sleep physician and potentially a follow up sleep study,
depending on the severity of the sleep apnea.
IMPORTANCE OF PRE-HAB OR MAINTENANCE.
OAT is not a “set it and forget it” type of therapy. It comes with some
very simple instructions to allow for best results. If any any side effects or
appliance comfort issues do come up, they addressed by the dentist who is
versed in addressing any OAT related concerns. TMJ dysfunction
screening, and sometimes some TMJ “pre-hab” may be needed prior to
having an appliance made. These are all important steps in fabrication of
the OAT process to minimize side effects.
DISCLAIMER: the information presented here is for educational and information purposes only. It is not intended to replace personalized medical advise from your primary care provider and is not intended to offer any diagnosis.