Sleep Apnea and Snoring

Snoring is often the first sign of Obstructive Sleep Apnea (OSA), a deadly medical condition defined by periods during the night when the sufferer literally stops breathing for more than ten seconds at a time. Aside from causing a rest-less sleep for both you and your sleep partner, this period of suffocation initiates alarm systems that stress the body leading to a host of problems in organ systems throughout the body. Sleep apnea affects more than 20 million Americans and can lead to cardiovascular disease, diabetes, and daytime sleepiness contributing to increased risk for motor vehicle and workplace accidents. It has been estimated that even mild sleep apnea can decrease life expectancy by 10 years. OSA is a medical condition that must be diagnosed by a physician via a sleep study (polysomnograph). Following diagnosis, your physician will likely recommend treatment with Continuous Positive Airway Pressure (CPAP). This is the gold standard for treating OSA, but many people are unable to sleep with the cumbersome CPAP device strapped to their face. In these cases, patients are referred to our office for oral appliance therapy. We are specially trained to evaluate people who suffer from OSA for treatment with a mandibular advancement splint (MAS). This appliance holds the lower jaw forward, opening the airway by pulling the tongue away from the back of the throat. Most patients find the appliance to be very comfortable, and it is effective in 85% cases of mild to moderate OSA. If you snore, or if you suspect that you or someone you know suffers from sleep apnea, please ask Dr. Forgosh for more information.

What is Sleep Apnea

Obstructive Sleep Apnea (OSA) is a deadly medical condition defined by periods during the night when the sufferer literally stops breathing for more than ten seconds at a time. Aside from causing a rest-less sleep, this period of suffocation initiates alarm systems that stress the body leading to a host of problems in organ systems throughout the body. Sleep apnea affects more than 20 million Americans and can lead to cardiovascular disease, diabetes, and daytime sleepiness contributing to increased risk for motor vehicle and workplace accidents. It has been estimated that even mild sleep apnea decreases life expectancy by 10 years.

Diagnosis

OSA is diagnosed by a sleep physician through a sleep study, or polysomnograph. This study measures the frequency and degree of apnea throughout a night’s sleep. Using the data collected, your physician will classify the severity of OSA, and recommend treatment.

Treatment of Obstructive Sleep Apnea (OSA)

The first step in treating mild OSA is altering sleep habits and risk factors. Often weight loss and side sleeping (versus sleeping on your back) will be effective in diminishing OSA. It is also a good idea to avoid alcohol before bedtime and many sleep aids as they decrease the muscle tone in the soft tissue and actually increase the risk of OSA. If these steps do not work, medical intervention is necessary. The gold standard for treating OSA is Continuous Positive Airway Pressure (CPAP). This device utilizes a face mask connected by air lines to blow a stream of room air into your nose or mouth throughout the night. The flow of air holds the upper airway open, preventing the tongue and soft tissue from blocking the back of your throat. Unfortunately, many patients are not able to tolerate CPAP due to discomfort caused by the face mask, or they find it difficult to sleep tethered to an air compressor. CPAP can also cause dry mouth, skin irritations, and recurrent upper respiratory infections if the machine is not well maintained. People with busy travel schedules also find the added equipment cumbersome. The best way to treat patients with OSA who are unable to tolerate CPAP is with an oral appliance fabricated by a dentist with special training to treat OSA. The appliance is comfortable, adjustable, and effective. It works by holding the lower jaw forward, pulling the tongue away from the back of your throat. This position opens the upper airway and gives you the freedom to breath.

How does oral appliance therapy work?

If you have ever taken a course in CPR, you remember that the A in ABC stands for Airway. When performing rescue breathing the first step is to pull the lower jaw forward to open the airway. The oral appliance uses the same jaw position to allow you to breath at night. There are two parts to the Mandibular Advancement Splint (MAS), and upper and a lower component. With the two pieces in place, the “fins” on the lower splint hit and slide on the adjustable guides on the upper, pulling your jaw forward and your airway open. It is a simple and elegant design that is custom made for you and fully adjustable to you needs.

Are there any other options for treatment?

Some other treatment options require surgery. Uvulopalatopharyngoplasty, or UPPP is a procedure that removes the Uvula and part of the soft palate and soft tissue of the throat. The efficacy of this procedure is unpredictable and the recovery from surgery is understandably painful. Another surgical option is orthagnathic mandibular advancement. While this treatment is quite effective, it requires an oral surgeon to fracture your jaw in at least two places and wire it shut for 4-6 weeks. These cases also demand extensive orthodontic treatment to establish acceptable dental function and esthetics following surgery. The mechanism of relieving the airway obstruction, much like oral appliance therapy, it to reposition the lower jaw forward, pulling the tongue away from the back of your throat to open the airway. The most severe, life threatening cases of OSA can require tracheotomy.

Why would I see a dentist for a medical condition?

Without surgical intervention Obstructive Sleep Apnea is a life-threatening, life-long condition. If you have Obstructive Sleep Apnea and are unable to tolerate CPAP, the best option for treatment is a dental appliance which holds the lower jaw forward and the airway open. While very effective and safe, these appliances can only be fabricated by a dentist who is specially trained to screen, treat, and monitor people who are good candidates for oral appliance therapy. If not carefully monitored by an experienced dentist, ill-fitting or poorly titrated appliances can cause changes in your bite, orthodontic tooth movement, and potentially cause problems with temporo-mandibular joints (TMJ). While your physician is responsible for the diagnosis and prescription of treatment, he/she simply does not have the equipment or training to make and monitor these devices.

Medical Coverage

We collect payment for treatment from you when we initiate treatment, and if you are eligible for insurance coverage, you will be reimbursed by the insurance company directly.