Overview:
According to the Mayo Clinic, Obstructive Sleep Apnea (OSA) is one of the most commonly diagnosed sleep disordered breathing conditions. This condition affects an estimated 22 million Americans1. With seemingly “normal” symptoms like: daytime fatigue, frequent morning headaches, snoring, irritability, and difficulty focusing, it’s no wonder that 75-80% of adults remain undiagnosed1. OSA is defined as the relaxation of the soft tissue of throat and tongue which then fall into the airway causing a blockage preventing normal breathing while asleep. This cycle of breathing, blocked airway sleep arousal, and oxygen deprivation repeats throughout the night.
Sleep apnea is diagnosed through the use of a sleep study which monitors sleep quality and blood oxygen saturation. It’s characterized as mild, moderate, or severe and has many treatment options ranging from very invasive such as surgery, to non-invasive like a dental device worn during sleep. With the rising prevalence of obstructive sleep apnea, a number of treatments are available, including a new device! A sleep physician or dental sleep provider are invaluable resources to help choose which treatment is best for you.
Treatments:
Continuous Positive Airway Pressure (CPAP)
Continuous Positive Airway Pressure uses a machine to send pressurized air down a tube, through a mask, and into a patient’s airway. The pressure of the machine can be turned up until the air is able to by-pass the obstruction. The CPAP is the most common treatment prescribed and is usually covered by most insurances.
Downsides tend to be noise, patient discomfort, and difficulty when traveling, as the entire machine system must be packed. CPAP does not do anything to make the underlying situation better, and patients get help ONLY when they wear the device.
Mandibular Advancement Device (MAD)
Because most of the tissues that constrict the airway are connected to the lower jaw bones, simply moving the lower jaw forward can positively improve symptoms of snoring and obstructive sleep apnea. It is considered more comfortable and convenient than an CPAP by some patients. A MAD will have little to no effect if the constriction occurs in the nasal area, as these tissues are not moved when the lower jaw is advanced.
Downsides to a MAD appliance include possible TMJ / muscle soreness and bite changes. Like the CPAP, the MAD does not address the underlying condition, and is therefore effective ONLY when worn. The patient will receive no benefits in any night’s sleep when they are NOT using the appliance.
Uvulopalatopharyngoplasty Surgery (UPPP)
Uvulopalatopharynyoplasty, or UPPP, is a surgical technique where, like tonsil removal, soft tissue form the soft palate and throat are removed. Once removed, there is less tissue to obstruct airflow and breathing is improved.
The downside to this treatment is the surgical procedure that a patient must endure and the recovery afterwards. This is considered to be very invasive and usually offered after other less invasive treatments have failed.
Maxillomandibular Advancement Surgery (MMA)
Maxillomandibular Advancement Surgery is the surgical repositioning of both the upper and lower jaw through surgery to relieve airway constriction. Often soft tissue is also repositioned similarly to the UPPP surgery.
This is considered to be the most invasive form of treatment and usually performed after an attempted UPPP was not enough. The downside to this treatment is the downtime and pain following, what is considered by most to be, a major surgery.
NEW!: Biomimetic Oral Appliance Therapy (BOAT)
A new oral appliance from Vivos Therapeutics, Inc can grow and correct underdeveloped upper and lower jaws without surgery. This device uses the body’s own system to stimulate growth and increase functional airway space creating permanent change. The device is worn like a retainer and is adapted to the patient.
Potential downside is cost and finding a dental sleep provider that offers this relatively new treatment.
Sources: 1 https://cpapsupplies.com/blog/sleep-apnea-statistics 2https://www.mayoclinic.org/diseases-conditions/obstructive-sleep-apnea/symptoms-causes/syc-20352090 3https://www.mayoclinic.org/medical-professionals/pulmonary-medicine/news/maxillomandibular-advancement-surgery-a-classic-procedure-refined/mac-20430404 4https://vivoslife.com/better-sleep/the-vivos-system/