Sleep apnea is a common condition characterized by repeated interruptions in breathing or shallow breathing during sleep. This can lead to fragmented sleep, affecting overall well-being and potentially reducing oxygen to the body’s organs. Oral appliances offer a non-invasive option to manage this condition. This article explores how these devices work and for whom they are recommended.
How Oral Appliances Address Sleep Apnea
Obstructive Sleep Apnea (OSA) occurs when the upper airway becomes partially or completely blocked during sleep. This blockage often results from the relaxation of muscles in the throat, including the tongue and soft palate, which can fall back and obstruct airflow. Oral appliances function by mechanically repositioning the jaw and/or tongue to create additional space in the back of the throat. Maintaining an open airway is important for continuous breathing and to prevent the cycles of restricted airflow and brief awakenings that define sleep apnea.
Mandibular Advancement Devices (MADs) are the most widely used type of oral appliance. These devices gently hold the lower jaw in a slightly forward position. This forward movement helps to pull the tongue and other soft tissues away from the back of the throat, preventing them from collapsing and blocking the airway. The resulting increase in the pharyngeal area allows for improved airflow, which can reduce snoring and the frequency of apneic events.
Tongue Retaining Devices (TRDs) operate through a different mechanism, using suction to hold the tongue in a forward position. This prevents the tongue from falling backward and obstructing the airway. TRDs can be suitable for individuals with certain dental conditions that make MADs less appropriate. Both MADs and TRDs aim to mechanically keep the upper airway open, thereby facilitating better breathing throughout the night.
Types of Oral Appliances and Professional Fitting
Oral appliances for sleep apnea primarily fall into two categories: Mandibular Advancement Devices (MADs) and Tongue Retaining Devices (TRDs). MADs are typically constructed as two custom-fitted pieces, one for the upper teeth and one for the lower, connected by hinges or screws. This design allows for the controlled and adjustable forward positioning of the lower jaw.
TRDs feature a mouthpiece that covers the dental arches and incorporates a small compartment designed to hold the tongue forward using suction. While MADs are widely used, TRDs offer an alternative for individuals with specific oral anatomy or dental circumstances.
Professional diagnosis and custom fitting are necessary for oral appliances. Custom-made devices are fabricated from precise dental impressions of an individual’s mouth, ensuring an optimal fit, enhanced comfort, and improved effectiveness. Over-the-counter or “boil and bite” devices are not recommended because they often provide an imprecise fit, lack the necessary adjustability, and may not effectively treat sleep apnea. A qualified dentist or orthodontist, collaborating with a sleep specialist, is responsible for the proper calibration and fitting of these custom devices.
Who Can Benefit from Oral Appliances
Oral appliances are a treatment option for individuals diagnosed with obstructive sleep apnea (OSA). They are commonly recommended for people experiencing mild to moderate forms of OSA. For some individuals with severe OSA who are unable to tolerate or prefer not to use a CPAP machine, oral appliances may also offer a viable alternative. These devices provide a portable and quiet option compared to CPAP therapy.
The suitability of an oral appliance depends on various factors specific to the individual. Patients typically need a sufficient number of healthy teeth to anchor the device securely, with at least eight teeth on each arch often recommended for MADs. Certain dental conditions, such as severe tooth decay, loose teeth, or active periodontal disease, may make oral appliances less appropriate. While temporomandibular joint (TMJ) disorders can be a consideration, mild to moderate cases do not always prevent the use of an oral appliance.
Oral appliances are not effective for central sleep apnea, which stems from a different neurological cause rather than a physical airway obstruction. They are also not recommended for children with breathing issues, as their treatment approaches often differ. A thorough evaluation by a healthcare provider is important to determine if an oral appliance is a safe and appropriate treatment choice based on a person’s specific condition and overall health.
Living with an Oral Appliance
Adjusting to an oral appliance often involves some initial changes for the user. Many individuals may notice an increase in saliva production, particularly during the first few weeks of wearing the device. Temporary jaw soreness, tooth discomfort, or mild pain in the temporomandibular joint (TMJ) can also occur, though these issues frequently resolve as the user adapts. A temporary change in bite upon waking is common, but this sensation typically returns to normal shortly after removing the device.
With continued use, some individuals may experience more lasting changes in their bite or slight tooth movement. For this reason, regular follow-up appointments with the dental professional who prescribed the appliance are important. These visits allow for monitoring of any potential dental changes and ensure the ongoing effectiveness of the device through necessary adjustments. Maintaining proper hygiene of the oral appliance is also essential, typically involving daily cleaning with a toothbrush and mild soap or specialized cleaning solutions to ensure its longevity and cleanliness.