Sleep apnea is a condition where breathing repeatedly stops and starts during sleep, disrupting rest and potentially impacting overall health. Oral appliances, sometimes referred to as night guards, are a treatment option for this condition. These custom-fitted devices are worn in the mouth during sleep to help maintain an open airway.
Understanding Sleep Apnea
Sleep apnea involves recurrent pauses in breathing or periods of shallow breathing while sleeping, leading to poor ventilation and fragmented sleep. The most common form is obstructive sleep apnea (OSA), where the upper airway becomes partially or completely blocked during sleep, despite efforts to breathe. This blockage often occurs when throat muscles relax, causing surrounding tissues to collapse and obstruct the airway. A less common type, central sleep apnea (CSA), occurs when the brain fails to send proper signals to the muscles that control breathing.
Untreated sleep apnea can lead to serious health issues because of reduced oxygen levels and interrupted sleep. These complications include excessive daytime sleepiness, which increases the risk of accidents, as well as high blood pressure, heart problems like irregular heartbeats, stroke, and an increased risk of type 2 diabetes.
How Oral Appliances Work
Oral appliances are custom-fitted dental devices worn during sleep to keep the airway open. They differ from over-the-counter mouthguards, which are not typically customized or effective for sleep apnea. These devices function by repositioning structures in the mouth and throat to prevent airway collapse.
There are two main types of oral appliances: mandibular advancement devices (MADs) and tongue-retaining devices (TRDs). MADs, the most common, hold the lower jaw slightly forward and downward. This repositions the tongue, increasing space in the throat and stabilizing the jaw to prevent airway blockage. TRDs, or tongue-stabilizing devices, use suction to hold the tongue forward, preventing obstruction. While MADs are preferred, TRDs can be an option for individuals unable to use MADs.
Candidacy and Effectiveness
Oral appliances are recommended for individuals with mild to moderate obstructive sleep apnea. They are also an option for those with severe OSA who cannot tolerate or prefer not to use a CPAP (continuous positive airway pressure) machine. Oral appliances are not effective for central sleep apnea, as this condition involves brain signals, not a physical airway blockage.
The effectiveness of oral appliances varies, but they can reduce the severity of OSA. For instance, MAD therapy can reduce OSA severity by more than half for about 70% of people. Studies show oral appliances can achieve a 50% or greater reduction in the Apnea-Hypopnea Index (AHI)—a measure of breathing interruptions—in approximately 50% of patients.
While CPAP leads to a greater AHI reduction, oral appliances show similar improvements in symptoms like daytime sleepiness and quality of life. Patient adherence to oral appliance therapy is high, sometimes exceeding 90%, compared to CPAP. However, oral appliances may not be suitable for individuals with significant tooth loss, certain jaw conditions like severe temporomandibular joint disorder, or active orthodontic treatment.
Obtaining and Maintaining an Oral Appliance
Obtaining an oral appliance begins with an obstructive sleep apnea diagnosis, usually through a sleep study. After diagnosis, a sleep specialist may refer the patient to a dentist specializing in dental sleep medicine. The dentist will take impressions of the teeth and a bite relationship to create a custom-fitted device.
The custom appliance is made in a lab to ensure comfortable and effective fit. Follow-up appointments with the dentist and sleep specialist are necessary for adjustments and to monitor effectiveness, potentially including a repeat sleep study. Proper cleaning and care ensure the appliance’s longevity and oral hygiene. Clean the appliance daily after removal using mild soap and a soft-bristled brush, avoiding abrasive toothpaste or hot water that can cause damage. Store the appliance in a protective case, often submerged in water, to prevent drying and bacterial growth.