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739 N. Fairfax Ave.
Los Angeles, CA 90046
Tel. (323) 655-3933



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Snoring & Obstructive Sleep Apnea PDF Print E-mail

We are very proud of our services to manage obstructive sleep apnea (or OSA) and snoring by utilizing dental devices.

If you snore or have a breathing related sleep disorder, Wexley Headache Clinic can help to determine your diagnosis and will help to select the most appropriate treatment.

A variety of oral airway appliances are available and will be recommended to you, depending on your anatomy and diagnosis. The oral appliance prevents collapse of the airway behind the tongue, palate, pharynx, and lateral pharyngeal walls. Oral appliances have been found to be effective for the treatment of snoring, apnea, and high upper airway resistance syndrome.

Explore these topics on sleep disorders, and call us to schedule your consultation because you deserve a good night’s rest – every night!

About Snoring and Sleep Apnea

Sleep ApneaSnoring and sleep apnea are caused by the partial blockage of the airway during sleep, and this causes tissues in the throat to vibrate when the patient breathes. (See illustration of partial blockage.) Sleep apnea is a total blockage of the airway during sleep, causing the patient to stop breathing for 10 seconds or longer.

The Oral Appliance is used at night to prevent the collapse of the tongue soft palate and lateral pharyngeal walls. Sleeping disorders can cause stress and affect the health of those who suffer from it. A common misconception is that snoring is merely an annoyance, not a health issue. The truth is that snoring can affect the health of the snorer and the health of their sleep partner. Snoring disrupts the sleep of the snorer, as well as the sleep of those within earshot to the detriment of all. The snorer and family members disrupted by snoring experience broken sleep patterns that can adversely impact their quality of life, as well as their health.

Everyone knows a good night’s sleep can make or break his or her day. What most people don’t know is that sleep disorders, such as sleep apnea or TMJ, frequently disrupt healthy sleep and can adversely affect a person’s life.

Snoring and Sleep ApneaPeople who suffer from sleep disorders frequently don’t even know it is happening to them. They wake up in the morning without feeling rested or have head and earaches and don’t know why. Studies commissioned by Congress and carried out by the National Center on Sleep Disorders Research have found that 63 percent of the American public is sleep deprived and 30 percent of Americans have a sleeping disorder.

Lack of sleep, or fragmented sleep, has been linked to hypertension (high blood pressure), heart disease, memory lapses, and auto accidents. Cures and preventive measures range from the psychological (antidepressants), to the extreme (laser surgery to remove soft tissue).

Obstructive Apnea  oral devices like Modified Herbst, SomnaMed or any of the similar appliances are very effective in managing mild or moderate sleep apnea and all most people need.


Appliances:

Thornton Adjustable PositionerThe TAP 3

The Thornton Adjustable Positioner 3 (TAP 3) alleviates snoring and sleep apnea by holding the mandible forward during sleep to prevent the tongue and soft tissue of the throat from collapsing into the airway. The TAP is based on the same principle as cardio-pulmonary resuscitation (CPR). The airway must be opened to allow air to pass through the throat.The TAP III is a custom-made two-piece appliance that snaps firmly over the upper and lower teeth with a patented titanium newly designed hinge. Seeamisleep.com/tapproducts.html andamisleep.com/snoring_sleepapnea.html for more information.

Snoring and Sleep Apnea




SomnoMed

The SomnoMed MASTM is a highly effective solution, for the majority of patients, to the problem of loud snoring and mild to moderate OSA.

Advantage of SomnoMed MASTM

The device is comfortable and easy to wear, and most people find that it only takes one or two nights to get used to wearing it. The SomnoMed MASTM is small enough to fit in the palm of your hand, making it easy to carry when traveling. Visit the SomnoMed website.

Durability

The SomnoMed MASTM is made from premium grade materials to ensure the durability of the device. Each device is hand-made to the doctor’s specifications providing a comfortable fit.

SomnoMedSomnoMed MASTM:

  • Successful treatment of snoring and mild to moderate OSA
  • Unrivaled patient acceptance and compliance
  • Clinically validated for the treatment of snoring
  • One year warranty




Treatment Options

There are three main methods of management of OSA ( obstructive sleep apnea) in patients who have been diagnosed using an overnight sleep study.  These are:

  • Nasal Continuous Positive Airway Pressure (n CPAP)
  • Oral Airway Dilator Appliances
  • Surgery

When a patient has had an overnight sleep study and does not have apnea, the treatment for the snoring is often an oral appliance or surgery.  Other options for managing OSA are weight loss, smoking cessation, decreased alcohol use, more exercise, and an attempt to better regulate the sleep/wake time.

CPAP

Illustration of continuous positive airway pressure (CPAP) maskCPAP has, and continues to be, the gold standard treatment for sleep apnea.  It is hardly ever used for snoring.  The treatment is carried out by placing a mask over the nose, mouth, or both, and securing it tightly with straps to prevent air leaks.  A  small generator forces air through a tube attached to the mask and pneumatically opens the airway with air pressure.  Many patients cannot tolerate the mask, the restriction in their sleep, and the closed-in feeling they may have.  In addition, the bed partner now has to trade off the sound of the generator for the snoring. Despite its problems, when CPAP is used on a routine basis  through out the night the results are quite good.

Oral Appliances for management of Obstructive Sleep Apnea

Oral appliances (OA) is a form of therapy that can best be delivered by the dentist.  Over the last ten or so years the acceptance of OA as an effective alternative to CPAP and surgery has been well documented.  Numerous clinical studies have described the usefulness as well as the compliance of this treatment.  Oral Appliances has two distinct and well-defined types:

TSDs or Tongue Stabilizing Device are made out of a soft, flexible material that does not fit over teeth.  The front of this device is a bulb or concave part, into which the patient sticks their tongue.  This holds the tongue forward while sleeping.  These devices were developed in the early 1980's, and were based on the theory that the tongue would fall back into the airway, and therefore, was the sole culprit in the presence of airway narrowing  causing the snoring and apnea.  At this time, these devices are used infrequently and do not make up the bulk of the devices used today.  In the opinion of the author, these devices are reserved almost exclusively for patients who are edentulous and/or have confirmed macroglossia.

Mandibular Repositioning Appliance or MRD comprise a wide variety of devices and appliances, most of which are two-piece and fit both the top and bottom teeth.  They are constructed and connected in a manner that allows both vertical opening and anterior repositioning, as necessary, to effectively dilate or open the airway.  In the last few years it has become apparent that vertical opening with minimal anterior repositioning offers the most optimum result in many patients. Research has shown that these appliances can open the airway by placing a pull on the musculature that supports the airway and is related to the mandible.

As demonstrated on the drawings below, when the appliance is in place, the airway is opened and demonstrates a more normal configuration.

In addition, imaging studies have shown that the lateral dimension of the airway is more critical than the anterior-posterior dimension in terms of managing the OSA, which is what the OA has been shown to effect.

Many of the MRDs on the market today are custom-fabricated.  This requires a set of impressions, a jaw registration at the desired vertical, along with the desired anterior position of the mandible as the starting point for treatment.  It is then sent for laboratory fabrication.  A new generation of appliance is becoming available boil and fit.  It maintains the upper and lower configuration and it can be fabricated in the dental office as an immediate device.  This type of appliance fits the teeth in a custom manner like the laboratory-fabricated devices without the need for a laboratory step.

Most experts in the use and delivery of MRD' indicate there are five criteria that offer the most optimum result, and should be taken into consideration when deciding on which oral appliance to use for the patient.

These are:

  • Adjustability: The appliance should be able to be adjusted in cases where dental work is done or the fit is not exactly correct.
  • Titrateable:  If a given or initial jaw position is not causing the desired result, then the appliance should be easily modified to create the optimum result.
  • Posterior Support:  The appliance should have support in the posterior to prevent TMJ dysfunction or symptoms.
  • Full Tooth Coverage:  All of the teeth should be covered to prevent undesired tooth movement.
  • Jaw Mobility:  The mandible should be able to move during the night.  Being locked into a restricted position may cause pain in the  jaw muscles.

 


Surgery

Surgical treatment of the airway OSA has historically been thought to be the second-line treatment for snoring and sleep apnea when the patient fails CPAP.  At this time, surgery does not have the same success that CPAP, and does not have the success rate that can now be expected from oral appliances.

1.  The first surgical option is mostly soft tissue in nature, and is done so as to revise soft-tissue relationships or to reduce excess or unwanted tissue.  Most surgery of the uvula, soft palate and tongue is less than 50% successful overall.  In addition, many of these surgeries are quite painful with a lengthy healing period and sometimes need to be repeated.  The most common soft-tissue surgery is the Laser Assisted Uvulopalatoplasty (LAUP), the Uvulopalatal Pharyngoplasty (UPPP), and the Hyoid advancement.

2. Orthognathic jaw surgery is an option on more extreme situation where jaws are more retruded.

 
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