A dental orthotic for sleep apnea has been considered a useful therapeutic alternative over the last several years to continuous positive airway pressure (CPAP) therapy for some individuals and in certain situations.  As a sleep technologist, you most likely want to know more about sleep apnea or snoring mouthpieces, including what they are and when they are appropriate as a first line treatment or a second line treatment for sleep apnea.

What are Sleep Apnea Mouthpieces?

A snoring or sleep apnea mouthpiece is an effective and efficient anti-snoring device. And, as the popularity of this form of sleep apnea treatment continues to grow among the public, many sleep medicine professionals are beginning to recommend these oral appliances to their patients who suffer with obstructive sleep apnea (OSA). In fact, there are more than 100 various types of these oral appliances that the FDA approves for treating both snoring and OSA.

A few common sleep apnea mouthpieces include:

• Mandibular Advancing Devices (MAD)

• Tongue Stabilizing Devices (TSD)

• Jaw Advancing Devices (JAD)

A snoring mouthpiece is worn by your patients in their mouths similar to an orthodontic appliance or sports mouth guard while they are sleeping. The sleep apnea mouthpiece holds your patient's jaw forward so that their airway remains open and their upper airway muscles and tongue are kept from blocking and collapsing their airway.

To offer the most benefit, the dental orthotic for sleep apnea should be custom-fit to improve your patient's sleep, helping to revitalize their health and restore their alertness. You can assure your patients that a snoring mouthpiece is a non-invasive type of treatment that is effective and will fit into their lifestyle.

It’s important that your patients know the benefits of this type of oral therapy, including that they are:

• Easy to wear

• Comfortable

• Portable

• Quiet

• Easy to care for

• Convenient when traveling

A patient's oral appliance can be customized using physical or digital models and impressions of their teeth and sending them off to the dental lab to create the appliance.

Although your patients can easily purchase over-the-counter (OTC) appliances online or at a drug store, be sure they realize that the OTC appliances are not approved by the FDA for sleep apnea. The OTC appliances are not custom fit and when not fitted properly, they can result in unwanted side effects, like tooth movement, jaw problems, or can actually make their sleep apnea condition worse.

If you have a patient who believes they have sleep apnea, you should schedule them for a sleep study so you can determine if they do have the condition and if a sleep apnea mouthpiece is a good option for them.

Once their appliance is created, the patient needs to have a fitting in order to adjust their piece for maximum effectiveness and comfort.  At this point, the patient should be educated on how to properly clean their oral appliance and take care of it. You might wish to schedule a sleep study after you have fitted their piece to verify success of treatment.

How Does the Sleep Apnea Mouthpiece  Work?

There have been randomized controlled trials that have shown evidence that oral mouthpieces were an effective treatment for up to 50 percent of patients with OSA. This also included patients with more severe OSA. Sleep apnea mouthpieces also showed substantial improvements in symptoms like daytime sleepiness and snoring.

These oral dental appliances have been shown to achieve similar results to CPAP therapy by splinting open the upper airway while patients sleep and preventing any breathing obstructions.

Your patients wear them just like they would a mouth guard, except that you custom design them so that they reposition your patient's tongue and lower jaw pushing them forward. Your patient will put the dental orthotic for sleep apnea in their mouth and go to bed. When they wake up in the morning, they simply take the appliance out until it is time to go to bed again.

Advise your patients to clean the appliance by soaking it in a denture cleaning solution and using a toothbrush. You should also provide your patients with storage trays, spacers, dental rubber bands, keys and things of this nature.

When to Consider a Dental Orthotic for Sleep Apnea as a First-Line Treatment for Obstructive Sleep Apnea

It is recommended that sleep physicians consider prescription of oral appliances, rather than no treatment, for adult patients with obstructive sleep apnea who are intolerant of CPAP therapy or prefer alternate therapy.  Read more here.

The primary goal of this oral appliance is to keep your patient's airway open while they are sleeping, which will prevent it from collapsing and blocking their normal airflow while they breathe.

You can consider dental orthotic for sleep apnea as a first line of treatment for those with mild to moderate OSA if they:

1. Travel frequently.

2. If you plan on combining it with Continuous Positive Airway Pressure (CPAP) therapy or if you have a patient who absolutely needs CPAP therapy, but needs extremely high pressures for the therapy to be effective. If this is the case, your patient will wear the appliance along with their CPAP therapy.

3. If your patient requires a more cost-effective therapy than CPAP therapy. Most medical insurances (including Medicaid and Medicare) cover sleep apnea appliances.

When to Consider a Dental Orthotic for Sleep Apnea as a Second-Line Treatment for Obstructive Sleep Apnea

The AASM recommends dental orthotics as a second-line treatment in patients who are struggling with more severe cases of OSA and can't wear or tolerate CPAP devices. You may also recommend a dental orthotic as a second-line treatment along with CPAP therapy (wearing both together) in order to reduce the CPAP machine's pressure, which will make it more comfortable for your patient to use.

Snoring appliances should also be recommended to patients instead of no therapy or for snoring with or without OSA.

By treating your patients for their sleep apnea with a snoring mouthpiece, you can help them feel more alert and less fatigued.  You can reduce their symptoms and better their quality of life, which will likely improve their chances of committing to and continuing their oral appliance therapy. They will sleep better at night, feel sharper during the day and have more energy. Their partners will sleep better too.

You can feel good about improving your patient's sleep and their health. Chances are since you are among the many sleep medicine professionals, you have seen patients who are frustrated and have given up on CPAP therapy as a treatment option. You know their sleep apnea has to be treated for their health, and now, you can give them other options.

If you would like to learn more about dental orthotics and their role in treating sleep anpea, then be sure to attend our Missouri Sleep 2017. Thomas Gotsis, DDS, FAGD will be speaking on "Mandibular Advancement Devices: Calibration and Titration"