The most widespread sleep problem, sleep apnea (SA), is characterized by a decrease or interruption in airflow to the lungs when a person is asleep. ( Mustafa Habeeb Chyad, Sadik Kamel Gharghan, and Haider Qasim Hamood, 2020) Sleep Apnea and Obstructive Sleep Apnea pose a significant danger for heart attack, stroke, and other conditions. An increasing number of studies indicate that OSA encourages the onset of hypertension, stroke, myocardial infarction, and early mortality. (Jose M.Marin MD, Santiago J.Carrizo MD, 2007) The National Heart, Lung, and Blood Institute estimates that over million Americans suffer from sleep apnea and that the risk of getting it rises with advancing age. Even though using a CPAP machine is the most popular way to treat OSA, many users find the devices uncomfortable and do not use them as directed. According to the American Academy of Dental Sleep Medicine (AADSM), up to 50% of patients suffering from sleep apnea do not adhere to or endure CPAP. The intolerant or non-compliant CPAP users all opt to ignore their signs rather than treat their illnesses. And the vast majority of these patients are not informed that there is an alternative to CPAP.
What is an alternative device that may be useful for those who cannot tolerate a CPAP machine?
Oral appliance therapy might become able to assist individuals with mild to moderate OSA who cannot use a CPAP machine. According to a report, oral appliance therapy—the most popular alternative to CPAP—is preferred by 81% of patients. (Jennifer Q. Le, Jeff L. Rodgers, Kevin Postol, 2018) Therefore, it is essential that dentists examine their patients and promote oral appliance therapy as a CPAP substitute. Patients with mild to severe obstructive sleep apnea (OSA) and CPAP non-compliance have an efficient therapeutic solution in oral appliance therapy (OAT). Moreover, Oral appliances are preferred by patients because they are effective, non-invasive, and simple to use. (Tahere Hossein zadeh Nik, Fariba Esmaeilnia Shirvani, 2011)
People who do not respond positively to CPAP, who fail therapy with CPAP, or those who are not suitable for CPAP are likely to gain dental/oral appliance therapy. (Kushida C.A., Littner M.R., Hirshkowitz M., Morgenthaler T.I., Alessi C.A., Bailey D., Boehlecke B., Brown T.M., Coleman J., Friedman L., et al., 2006) Dental sleep appliances for non-compliant CPAP patients are undoubtedly playing a significant role for sleep apnea patients. Let’s delve into details.
Effective CPAP alternative for Sleep Apnea
Obstructive sleep apnea (OSA) can be successfully treated with oral appliance therapy (OAT), an effective alternative to CPAP. However, this treatment is only beneficial when it is truly utilized. (Reza Radmand, Harmeet Chiang, Massimiliano Di Giosia, M. T. Galang-Boquiren, Rosemarie Rohatgi, David Silk, Olivier M. Vanderveken, Michael Adame, 2021)
Types of oral appliances used for snoring and OSA
There are two main divisions into which dental appliances fall:
- Mandibular advancing devices:
The most popular form of OA for treating OSA is called a mandibular advancement appliance, which works by projecting the mandible and widening the upper airway.(ChanAndrew S.L., Lee Richard W.W., Cistulli Peter A., 2007) By boosting the muscle activity of the tongue and other airway muscles, mandibular advancing devices (MADs) help increase the strength and stiffness of the airway. - Tongue retaining devices:
These devices keep your tongue forward and outside your mouth all night long by wrapping a soft plastic splint over it. Patients with milder to moderate OSA benefit from oral appliances; however, patients with more severe OSA may also benefit from a TRD. (Naoki Higurashi, Makoto Kikuchi, Soichiro Miyazaki, Yoshiaki Itasaka, 2002) In certain circumstances, treatment problems associated with Tongue Retaining Devices (TRDs) are less than those associated with MADs, but TRDs might also be less comfortable.
- Mandibular advancing devices:
When used for OSA, the majority of insurance policies at least partially cover these devices; however, if used for basic snoring, they are not covered. If you have not received an official diagnosis of OSA, resist the temptation to use any. Even if you have OSA, your doctor will refer you to a dentist who makes these devices. Call your insurance provider to see how much is covered before having a device manufactured.
How do oral appliances treat Sleep Apnea?
Obstructive sleep apnea (OSA) is a growing problem that affects roughly 17% of adult women and 34% of males. (Paul E. Peppard, Terry Young, Jodi H. Barnet, Mari Palta, Erika W. Hagen, Khin Mae Hla, 2013) Apnea dental appliances perform three things to cure sleep apnea symptoms:
- You can hold the airway open by moving the lower jaw gently forward.
- Retain the tongue in a position that prevents it from falling backward and obstructing the airway while you sleep.
- Carrying out both of these things at once.
Pros of Sleep Apnea dental appliances
Up to 50% of individuals can successfully treat their OSA using oral appliance therapy. (Andrew Ng, H. Gotsopoulos, M. Ali, P. Cistulli, 2005) Many patients prefer these oral appliances because of the many benefits they gain. These advantages are as follows:
- Comfortable: Many patients complain that using a CPAP mask is uncomfortable, and several patients have trouble maintaining the mask when they sleep. Some claim that the air pump makes them bloat or is noisy. You will probably get undisturbed, noise-free sleep if you use oral devices because they are convenient to wear.
- Non-invasive: Oral appliance therapy is becoming more popular as a non-invasive therapeutic alternative for individuals with OSA.(Marijke Dieltjens and Olivier M. Vanderveken, 2019)
- Easy to wear: Dental sleep appliances are easy to use and wear and therefore preferred by many patients with sleep apnea.
- Noise-free and Quiet: Oral devices are beneficial compared to CPAP because they are noiseless.(Andrew Ng, H. Gotsopoulos, M. Ali, P. Cistulli, 2005)
- Portable: You can take these appliances with you anywhere you travel because they can be carried easily, hence portable.
- Cost-effective: Oral appliances are usually covered by health insurance, particularly Medicare and Medicaid, especially if you have previously undergone PAP therapy and were paid by your insurance. Hence they are less expensive.(Andrew Ng, H. Gotsopoulos, M. Ali, P. Cistulli, 2005)
- No need for electricity: These devices do not require any power source to function.(Andrew Ng, H. Gotsopoulos, M. Ali, P. Cistulli, 2005)
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