ORAL APPLIANCES FOR SNORING & SLEEP APNEA
DOWNTOWN CHICAGO
SAFE, COMFORTABLE, EFFECTIVE - READ MORE TO SEE IF THIS IS THE PROPER CHOICE FOR YOU
SLEEP APNEA IS VERY SERIOUS
SLEEP APNEA CAN KILL!
What is Sleep Apnea?
Apnea is a cessation of breathing during sleep. Central apnea originates from the brain, which fails to send breathing signals to the respiratory muscles. Much more common is obstructive sleep apnea which results from intermittent mechanical obstruction of the airway. The tongue and soft palate normally relax during sleep, but too much relaxation causes a collapse that blocks airflow. Large tonsils, large tongue, small mouth, large uvula, nasal obstruction, recessed chin and aging are contributory factors to sleep apnea, hypopnea and snoring.
Sleep apnea is defined as an 80-100% reduction in airflow. An apnea event may be identified by apparent stoppage of breathing for at least 10 seconds, a gasp or a choking, and it is terminated by a microarousal from sleep.
Hypopnea is defined as a 50-80% obstruction in the airflow for at least 10 seconds. It is often characterized by snoring.
Snoring is obstructive sleep breathing accompanied by harsh vibratory sounds, usually occurring on inhalation. Snoring results from partial collapse of the pharyngeal airway during sleep. Snoring is a unique phenomenon because it can cause sleep arousals, not only in the snorer but in the sleep partner of the snorer. Sleep arousals cause sleep fragmentation, less restorative sleep and result in excessive daytime sleepiness. Snoring and hypopneas usually accompany sleep apnea, but most snorers do not have obstructive sleep apnea.
Hazards of Sleep Apnea
In an apnea event the breathing effort continues but the airflow stops for a time period of 10 seconds or much longer. With each apnea event the oxygen in the blood stream falls and the heart must work harder to circulate the blood.
Sleep apnea is associated with higher risks for:
· HIGH BLOOD PRESSURE
· HEART ATTACK
· STROKE
· DROWSY DRIVING
· MOTOR VEHICLE CRASHES
· JOB IMPAIRMENT
· EXCESSIVE DAYTIME SLEEPINESS
· MORNING HEADACHES
· SEXUAL DYSFUNCTION
· COGNITIVE / MEMORY PROBLEMS
· DEPRESSION AND ANXIETY
· HYPERACTIVITY IN CHILDREN
· WEIGHT GAIN
· GASTRIC REFLUX
· TYPE II DIABETES
Causes of Sleep Apnea
The human throat or oropharynx is a conduit for three distinct and important functions, swallowing, breathing and speech. Speech is one very distinguishing characteristic of humans from other animals. A compliant, collapsible airway is a requisite of speech articulation. In the throat airway patency is maintained by the tongue, palatal muscles, pharyngeal dilator muscles, and postural muscles of the head and neck.
During sleep all muscles relax, but too much relaxation, especially of the tongue, can collapse the airway. Allergies and nasal obstruction also make breathing difficult. In people with nasally obstructed breathing, deep inhalation can summon more air than the nose can deliver. The negative pressure created also contributes to airway collapse.
Human beings are designed to be primarily nose breathers. When nose function is sufficiently poor, the mouth is recruited as a back-up breathing organ. In mouth breathers the tongue is repositioned further back in the throat to aid in warming and humidification of inspired air. This repositioning of the tongue in mouth breathers also facilitates to airway collapse.
Diagnosis of Sleep Apnea
Obstructive sleep apnea is only one of many sleep disorders. An accurate diagnosis and the appropriate treatment plan is best made by a properly trained and certified sleep physician. Polysomnography is the gold standard for the measurements relative to sleep disorders. A study is usually done at a sleep center but in some cases is performed at home. Usually between 12 and 16 sensors are attached to the body, and video monitoring may also be done. Body functions such as brain activity, eye movement, jaw muscle activity, heart rate, respiratory effort, air flow, blood oxygen, limb movement, body position, snoring, and tooth grinding are monitored and recorded for later analysis.
Treatment of Sleep Apnea
With successful treatment of apnea, sleep breathing becomes easier and more regular. Snoring stops. Blood oxygen levels become normal and fluctuations are diminished. Quality of sleep and life are improved. Risk for high blood pressure, heart attack, diabetes, stroke, and vehicular work accidents are reduced.
There are four primary treatment options for apnea and snoring. All patients can benefit from life style changes which include weight loss, regular exercise, avoidance of alcohol within 4 hours of bedtime, good sleep hygiene habits, and avoidance of caffeine and sedatives or hypnotic drugs that make the airway more prone to collapsibility during sleep.
Surgical procedures, such as removal of tonsils and adenoids, correction of nasal obstructions, tongue reduction, jaw advancement, palatae reshaping and palate stabilizers are commonly recommended. Surgery generally has low success rates, risk of post operative complications, painful recovery period and is irreversible.
CPAP refers to an air pump delivering positive air pressure through a face mask or nasal tubes. The pump unit is placed next to the bed and operates on house current. The force of the pressurized air is adjusted to a level that splints the airway open and prevents collapse, much like blowing air into a balloon causes it to open and keeps it open. It is the most common treatment for apnea and usually successful. Side effects of CPAP include nasal irritation, dry nose and mouth, abdominal bloating and annoying air leaks in the eyes. Patient compliance is low. Wearing a CPAP is a lifetime commitment and the unit must be worn whenever one sleeps or naps. They are quite cumbersome to take with when traveling.
Oral Appliance Therapy
Oral appliances reposition the lower jaw in a more forward position and alter the relationship of the tongue and soft palate. They can increase the muscle tone of the tongue and keep the throat open by enlarging the cross-sectional area of the oropharynx. Oral appliances are comfortable and patient compliance is high. Many oral appliances are fully adjustable. They have been shown in controlled studies to be particularly effective in cases of mild to moderate sleep apnea. They are small, durable and easy to pack for travel. Dentists trained and certified in the emerging field of oral sleep appliance therapy can design, construct, fit and evaluate the effectiveness of the device prescribed to meet their patient’s unique needs.
APNEA, CLOSED THROAT OPEN THROAT
DR MOSES’ APPLIANCE
The “Moses” appliance is properly categorized as a mandibular advancement device (MAD). A “Moses” is an acrylic appliance that is worn in the mouth at night to treat obstructive sleep apnea, hypopnea, upper airway resistance and snoring. It is custom-fitted and laboratory fabricated.
The MAD works in the following ways:
- Supports the lower jaw in a forward position of low muscle activity and it prevents collapse of the tongue on the pharynx
- Increases volume of space for the tongue in the mouth
- Dilates pharyngeal muscles, lifts the drooping soft palate
- Raises the position of the hyoid bone relative to cranial base
- Lowers elevator muscle activity, reduces clenching, decreases or prevents bruxism
Additional, advantages of the “Moses” appliance:
- Open anterior facilitates a forward tongue position against the lips
- Elevates tongue to hard palate and increases nasal air flow
- Allows lip seal
- Corrects dysphagia
- Comfortable and adjustable
The fee includes impressions, bite registration, appliance fabrication, delivery, maintenance, adjustments, pre and post delivery objective measurements of the physiological functions necessary to determine treatment outcome. The fee does not include the necessary six month periodic examination.
MEASURING OUTCOME
The Medibyte screener is an FDA approved Class III polysomnographic recorder. It is a compact ambulatory device designed to aid in the detection of sleep disorders such as apnea, snoring and upper airway resistance in adult patients. Data collection occurs in the patient’s natural surroundings instead of the somewhat stressful environment of a sleep laboratory. Patients are given verbal instructions in the office, and then connect the device to themselves at night with the aid of a diagram.
The Medibyte records up to eight channels of information at one time. The patient however, typically connects six sensors that record all eight channels of data:
- Nasal/oral cannula – airflow, airflow resistance (snoring via a pressure transducer)
- Chest belt – respiratory effort
- Abdominal belt – respiratory effort
- Body position monitor – supine, right, left, prone or standing
- Finger monitor – pulse rate, blood oxygen
- Microphone – snoring loudness
The Microphone is connected into the auxiliary channel. Alternate sensors that can be used in the auxiliary channel are electromyography for measurement of bruxism or clenching, electrocardiogram, or sensors for periodic limb movement.
At the initial visit, the patient is given complete instructions on how to set up the Medibyte and then they take the device home for a night to establish baseline measurements of the physiological parameters mentioned. After each oral appliance adjustment the patient again sleeps with the Medibyte to establish consistent data on the effect of the adjustment and the effect of the appliance. Between adjustment and testing there is typically a two week adjustment period.
The standards strived for with oral appliance therapy are those recommended as being apnea-free by the American Academy of Sleep Medicine. The use of the Medibyte, disposable supplies, downloading of the data and interpretation by the clinician are included in the fee for the oral appliance during the initial adjustment phase of treatment. Regular six month recall visits are recommended for all patients using a Moses Appliance. The cost of the Medibyte re-evaluation at recall exams is not included in the initial fee quoted for the Moses Appliance.
