Medications are generally not effective in the treatment of sleep apnea. Oxygen administration may safely benefit certain patients, but does not eliminate sleep apnea or prevent daytime sleepiness; therefore, the role of oxygen in the treatment of sleep apnea is controversial and it is difficult to predict which patients will respond well. It is important that the effectiveness of the selected treatment be verified. This is usually accomplished by polysomnography.
At Sleep Apnea Dentists of New England, we specialize in the treatment of sleep apnea utilizing custom oral appliances.
Oral Appliance Therapy
Mandibular Advancement Device
Dental appliances that reposition the lower jaw and the tongue are very helpful to many patients with obstructive sleep apnea and also those whose only problem is disruptive snoring. These devices gently keep your jaw forward during sleep to open your airway. For the vast majority of patients, they are far more comfortable than PAP therapy. In fact, experience shows that 83% of patients that try oral appliance therapy comfortably sleep with for an average of almost 7 hours per night.
For a large majority of patients, when properly made and calibrated, these devices significantly or completely resolve patient’s symptoms and help create restful, restorative sleep. The success rate for returning breathing back to normal (AHI<5) is between 66-70%, when the jaw has been properly placed. However, over 83% of patients experience a significant decrease in their level of obstructive sleep apnea (50% decrease of AHI/number events per hour) and enjoy a great resolution of symptoms when the jaw position has been properly adjusted. This is why a specially trained dentist is the best provider to fit the patient with such a device.
Tongue Retaining Devices (TRD)
These devices simply hold the tongue and keep it forward during the night. They are not as effective as mandibular advancement devices, but they can be an option for those who cannot use a mandibular advancement device due to poor dental health (significant bone loss/advanced periodontal disease), or those with few or no teeth who cannot tolerate PAP therapy. There are over the counter TRDs available, but custom TRDs are generally more comfortable and are made to fit the size or your tongue.
Positive Airway Pressure (CPAP, APAP, BiPAP): PAP therapy, most commonly CPAP, is the only treatment for obstructive sleep apnea that opens the entire airway returning patients to normal breathing (AHI<5) 90-95% of the time. Physicians often recommend this therapy first because they are confident it will treat their sleep apnea optimally. Unfortunately, experience shows that only 50% of those who try CPAP therapy can actually sleep with it for over 4 hours per night. There certainly are those who love CPAP and find it very effective (Dr. Cohn’s father and mother both use CPAP therapy successfully) but for the other 50%, it leaves them still searching for a treatment answer.
Some of the barriers to comfortable CPAP therapy include a feeling of claustrophobia, air leakage from the mask, an ill fitting mask, an uncomfortable feeling of being tethered to a machine, abdominal bloating, sore eyes, difficulty sleeping with a large inflow of air creating more sleep fragmentation, facial tissue breakdown from the mask, difficulty traveling with the machine, inability to use the device if you are in an area without electricity and the feeling of embarrassment at bedtime, particularly if you are dating. For some, even if they can manage to sleep with it and it controls their sleep apnea, it does not resolve their symptoms. Sometimes continued efforts with the help of your CPAP provider result in changes that allow you to use the device comfortably. Sometimes treating chronic sinus problems or poor nasal air flow can help you sleep with CPAP therapy more comfortably.
This surgery removes soft tissue in the back of your mouth and at the back of your throat. Most times the tonsils and adenoids, if present, are removed. Recovery can be painful and the procedure itself yields mixed results. Unfortunately, it is not a very predictable way to treat sleep apnea and positive results are low. Some literature shows only a 13% success rate with this surgery.
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This surgery dissects and cuts the bones of your upper and lower jaws to move them forward. The objective is to increase the size of your airway. This is major surgery and should only be considered after careful consideration and failure of non-surgical treatments. For those patients with a very small lower jaw it may result in an aesthetic enhancement. The success rate for returning patients to normal breathing (AHI<5) is 39%. However, 3/4 of the patients who undergo this procedure can experience a decrease in the number of events per hour by up to 50%.
An illustration showing maxillomandibular advancement (MMA) surgery. Arrows show the upper and lower jaws move forward surgically and enlargement of the airway.
This surgery is a lot like a pacemaker for your tongue. The surgeon implants a device under your skin in your chest. A wire is then threaded up your neck and attached to your hypoglossal nerve. This nerve is responsible for your tongue movement. A wire is also attached to the muscles between your ribs. Once you have healed, the device is operated by a small remote control.The remote is synchronized with your breathing and at a point during every breath it tightens the muscles of the tongue and upper airway during sleep, opening the upper part of your airway to improve airflow and thereby reduce your sleep apnea. This is a newer form of treatment and is only used for selected patients that have moderate to severe obstructive sleep apnea whom are not morbidly obese. It is often required that you have failed non-surgical treatments before you are eligible for this surgical procedure. Studies show that 35% of patients return to normal breathing.
If you have severe obstructive sleep apnea, which can be life threatening, and all other treatments have failed, a tracheostomy may be recommended. In this procedure, a surgeon makes an opening in your neck and inserts a metal or plastic tube through which you can breathe. It simply bypasses your nighttime obstruction and lets you intake air below this area. This is usually used as a last resort.