How Dentists Can Help With Sleep Apnea and Snoring
While Positive Airway Pressure (PAP) therapy (CPAP, BiPAP, and AutoPAP) represent the gold standard for treating obstructive sleep apnea (OSA), some have tried it, only to discover they couldn’t tolerate it.
Fortunately, this tried-and-true approach, while hit-and-miss with many, isn’t the only OSA treatment option. Your dentist, in fact, can provide another kind of mechanical treatment: oral appliance therapy (OAT).
What’s dental sleep medicine and OAT? Why might you consider this therapy for OSA?
Dental sleep medicine basics
A sleep medicine-accredited dentist has undergone specialized education through the American Academy of Dental Sleep Medicine (AADSM). 1
Sleep medicine dentists are specifically trained to identify potential cases of sleep-disordered breathing based on:
- The structural features of a person’s face and jaw
- Specific kinds of wear and tear in the mouth indicating the presence of OSA
Sleep medicine dentists are also highly skilled in the craft of building OAT (sometimes called oral devices).
These specialists work in concert with local sleep medicine physicians to manufacture, fit, and test oral devices. They assist in conducting OAT therapy follow-ups to ensure the treatment reduces apneas and remains comfortable to the user. Insurance payers also require them to confirm compliant use of OAT.
Why oral appliance therapy?
This therapy works by repositioning part of the mouth (tongue or jaw) using a customized mouthpiece. This provides a larger opening at the back of the throat where tissues — tonsils, the tongue, or the uvula — may otherwise collapse during sleep.
These handmade devices aren’t something you pick up at a drugstore, boil in water, and wear. OAT requires special fitting, construction, and testing by a sleep medicine dentist.
People most likely to qualify for OAT include those who:
- Have mild to moderate sleep apnea, upper airway resistance (UARS), or primary snoring
- Respond poorly to PAP
- Aren’t overweight
- Don’t elect to have surgical procedures like tonsillectomy
- Can’t treat their OSA or primary snoring through side sleeping
Oral appliance therapy facts
OAT devices are designed for comfort and portability. Most people who use them acclimate within a couple of weeks. The device comes bundled with a custom “morning-after” realignment tray the user wears shortly upon awakening to quickly adjust their bite to its normal position.
Like PAP therapy, OAT is covered by insurance. Usage is traced through built-in compliance chips. This is important for people who work at jobs that require proof they’re using their OSA therapy, such as truck drivers and pilots.
OAT is also adjustable, sometimes by the user, sometimes with the help of a sleep medicine professional.
Which is better, OAT or PAP therapy?
Advantages to using OAT versus PAP therapy include:3
- Ease in packing for travel
- Simple cleaning and maintenance
- Functionality in locations with frequent power outages, while camping, or in remote areas without electricity
- Cost-effectiveness (no need to continue buying supplies)
- Effectiveness in people of healthy weight and who side sleep
No therapy is perfect. OAT also its own risks and disadvantages. The AADSM lists the following as more common problems:4
- Temporomandibular joint (TMJ) pain
- Increases or decreases in saliva
- Gum, soft tissue, and tongue irritation
- General mouth discomfort
- Potential tooth misalignment or bite changes
Also, OAT may be ineffective in treating severe OSA, or it may improve OSA severity—lowering the apnea-hypopnea index (AHI) — while still not controlling it. In this case, another option — combination therapy, which uses PAP with OAT together — may be more effective.3,5,6
People with certain kinds of deficiencies in their facial structures (chiefly, the jawbone) may not qualify due to fit issues. OAT must fit like a glove for the upper and lower jaw in order to work.7
Types of oral appliance therapy
There are two categories of OAT. One is a suction device that retains tongue position and prevents it from blocking the airway. These devices are far less common than mandibular advancement devices (MAD), which force the jaw slightly forward to open up space for breathing.
What to expect if you use OAT
Once you receive your custom-fitted device, you should expect one or more sessions to perfect the fit as well as follow-ups with both your sleep specialist and dentist to make sure it’s working and to address any persistent side effects.
People interested in finding a sleep medicine dentist can use the sleep medicine dentist locator tool found at the AADSM website.
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