The rise of sleep apnea appliances
As more people are aware of sleep apnea, more are seeking a solution to sleepless nights (and yes, is someone who suffers from sleep apnea has a partner, they invariably suffer as well from their snoring). While traditionally the alleviation of sleep apnea has come from Continuous Positive Airway Pressure (CPAP) machines, digital dental labs have enabled the proliferation of oral appliances for those which less severe cases.
While some oral sleep apnea appliances can be found in online marketplaces their are supreme benefits of patients working with their dentists rather than going the DIY route. Firstly, there are different types of oral appliances depending on causation of a patient’s sleep apnea that the patient is wholly unaware of. Then there is the fit. By a patient working with a digital dentist they can ensure that the mouthpiece sits properly (Dandy creates custom-fit appliances with 3D printing) and can determine if adjustments are needed. A poor fit can not only not solves the problem, or cause abandonment of the treatment, it can harm a patient’s bite and jaw.
According to the AMA, 30 million people in the US suffer from sleep apnea, now with digital dentistry we can work together with our patients to bring that number down.
What is sleep apnea and CPAP?
Explaining sleep apnea to your patients: Sleep apnea disorder is characterized by a repeated interruption in breathing during sleep, which can last for several seconds to more than a minute and can occur so many times per night.
Sleep apnea can cause several symptoms, such as
- Headaches
- Difficulty in concentration
- Mood changes
- Some may experience daytime sleepiness and loud snoring.
Traditional treatment for sleep apnea may include lifestyle changes such as weight loss, quitting smoking, diet changes, and the use of CPAP machines. This machine fits over the mouth or nose and delivers an extra constant flow of air pressure to keep the airway open during sleep.
However, this method of treatment can uncomfortable and difficult to use consistently. There is also, unfortunately, a stigma associated with using the facemask, that causes many of those who are actively dating to abandon the treatment.
Sleep apnea has been linked to various health problems, such as high blood pressure, heart disease, stroke, and diabetes. As more people become aware of the risks associated with sleep apnea, they seek effective treatments, which, depending on the severity can be aided by sleep apnea appliances. This has led to the rise of several custom-made appliances that fit an individual’s mouth and works by repositioning the jaw to keep the airway open during sleep.
The benefits of sleep apnea appliances
Please tell your patients about the following benefits that sleep apnea appliances offer:
- Increase sleep quality: The intraoral device for sleep apnea improves sleep quality by eliminating snoring and interruption in breathing during sleep. This can lead to a more restful and rejuvenating sleep.
- They promote better daytime functioning.
- Sleep apnea appliances are easy to use. They are simply worn in the mouth at night, making them a convenient and hassle-free treatment option.
- The oral appliance therapy for sleep apnea can also reduce or eliminate snoring, offering another option for people who cannot tolerate CPAP.
- Some can correct the underlying problems that cause sleep-disordered breathing. An example is the dental treatment for sleep apnea, which can be used to straighten and develop the arches and teeth into a healthy alignment to open the airway and even treat some disorders such as TMJ disorder. With this, once the needed results are achieved, there won’t be a need to wear an appliance at night anymore.
Oral appliances vs. CPAP therapy for sleep apnea
Oral appliances are one of the treatment options for sleep apnea, particularly for individuals with mild to moderate obstructive sleep apnea or those who cannot tolerate CPAP therapy. They are worn in the mouth during sleep and work by repositioning the tongue and/or jaw to keep the airway open and prevent obstructions.
There are several types of oral sleep apnea appliances, but the most common is the Mandibular Advancement Device (MAD), which fits over the upper and lower teeth. It works by holding the lower jaw in a forward position, which helps to open the airway, and the Tongue-Retaining Device (TRD), designed to hold the tongue in a forward position to keep it from blocking the airway.
Some advantages of oral appliances include;
- Non-surgical: Oral appliances don’t cause any physical changes or pain because they are non-invasive. They’re ready to use, easy to wear, and don’t require much effort to get used to.
- It is convenient.
On the other hand, CPAP therapy involves using a CPAP machine, a small air compressor with adjustable tubing, and a mask. These machines are the size of a tissue box and lightweight, but noisy. Using a CPAP machine helps to prevent serious health problems linked to sleep apnea, such as stroke and heart disease.
Using a CPAP machine, the air pressure keeps the airway open, preventing it from collapsing or becoming blocked during sleep. This allows the person to breathe normally and prevents interruptions in breathing that can cause sleep apnea symptoms such as snoring, and gasping.
CPAP therapy can effectively treat sleep apnea, although adjusting to wearing the mask and using the machine during sleep may take time.
In comparison, 30%-50% of CPAP wearers find the mask uncomfortable or the machine too loud. Compliance with wearing the CPAP machine (about 50%) is generally lower than compliance with wearing a smaller and quieter oral device. Most patients prefer an oral device worn inside the mouth without anything else attached to their face.
Approaching the conversation with your patient
Dentists can absolutely play a role in sleep apnea treatment, learn about how dentists can play a role in diagnosing sleep apnea here!
Approaching the conversation about sleep apnea appliances with a patient requires sensitivity, empathy, and a clear understanding of the patient’s needs, concerns, and preferences. It is important to approach the patient in a non-judgemental manner, focusing on the patient’s needs and preferences. Overall you are seeking the best-treatment option which takes patient education, the right treatment option, and an understanding that they will continue to use the CPAP or appliance.
Here are some easy steps you can take to approach the conversation effectively.
- Establish a positive relationship with the patient.
- Educate the patient: Provide the patient with clear and accurate information about sleep apnea, its symptoms, and the benefits and risks of different treatment options, including oral appliances. You can highlight any other health challenges (if any), letting the patient know what to expect at any given time.
- Discuss the patient’s preference as regards lifestyle and a suitable device.
- Demonstrate the device by showing the patient the different types of appliances and how to use them.
- Always follow up and provide support.
- Be ready to walk patients through the process (as some may still be cranky from not getting enough rest). It is important you understand the situation for them—remember you are treating the person as much as the condition.
Discussing the different types of sleep apnea appliances
Sleep apnea appliances come in different types, each with unique features, designs, and functions. Not all sleep apnea appliances are suitable for everyone. With the help of a qualified sleep specialist, you can determine which type of appliance is most appropriate for a patient’s specific needs.
Some of the most common types are as follows:
Mandibular Advancement Devices (MADs)
These are the most widely used sleep apnea appliances. They are designed to hold the lower jaw and tongue forward, which helps to keep the airway open during sleep. MADs are usually custom-made. The most common types are the Herbst and Dorsal sleep apnea appliances.
The Herbst appliance is worn in the mouth and consists of two metal arms that attach to the upper and lower teeth. It is adjustable, allowing it to be fine-tuned and adjusted for maximum effectiveness.
The Dorsal appliance is similar to the Herbst appliance but slightly different in design. The Dorsal appliance comprises two separate pieces that fit over the upper and lower teeth. The lower piece can be adjusted forward to help keep the airway open during sleep.
However, both appliances effectively reduce snoring and improve sleep apnea symptoms. They have some potential side effects, such as soreness in the jaw and teeth, and may not be suitable for all patients.
Continuous Open Airway Therapy (COAT)
COAT consists of a small plastic mouthpiece worn in the mouth. The mouthpiece is designed to keep the airway open by using a vacuum to pull the soft palate forward.
Tongue Retaining Devices (TRDs)
TRDs use a suction cup or similar mechanism to hold the tongue forward. This prevents the tongue from falling back and blocking the airway during sleep.
Nasal Dilators
This device is inserted into the nostrils to help keep them open during sleep. They are often used by people with nasal congestion or other issues that make breathing through the nose difficult.
Cost Considerations and insurance coverage
There are several types of sleep apnea appliances and sleep apnea appliances, and the cost of these appliances can vary. Most sleep apnea appliances are expensive, while some are not, so we have highlighted some factors to consider, including their associated cost.
- Type of sleep apnea appliance. When choosing a sleep apnea appliance for a patient, consider what type bests suits the patients
- Consider maintenance and replacement cost. Which sleep apnea appliances require regular maintenance? How often would the patient need to clean or replace some parts? What are the ongoing costs when choosing these appliances?
- How much does the patients’ insurance cover? For some, insurance may cover some or all of the cost of a sleep apnea appliance.
Choosing the right sleep apnea appliances
There are several factors to consider while choosing an oral sleep apnea appliance, including the severity of the patient’s sleep apnea, personal preferences, and any underlying medical conditions.
Here are some factors to consider when choosing a sleep apnea appliance;
- The type of sleep apnea
- The comfort of the device
- Medical history of the patient
- Pros and cons; When choosing a sleep appliance, consider both the advantages and disadvantages, bearing the patient’s needs in mind.
- Cost, insurance, and warranties; The cost of sleep apnea appliances can vary widely depending on the type and brand of the device and the patient’s insurance coverage. Part of your journey as a dentist who adds sleep apnea to their practice will be insurance education.
Tips for using and maintaining the appliance
In order to ensure that the appliance is doing more good than harm, explain care of the device to your patients. Proper usage and maintenance of sleep apnea appliances can manage sleep apnea effectively and improve your quality of life. Here are some tips for proper management:
- Regular cleaning to prevent the build-up of bacteria and other particles. Use distilled water to prevent the build-up of deposit and brush with a toothbrush before each use.
- Adjust fits when/if needed. Fits should be adjusted by you, a dentist, or other physician.
- Replace parts such as tubing, mask, and filters should be replaced when worn out. Also, replace if there are cracks in the acrylic and failure of the device to maintain retention in the patient’s mouth.
- Store in a safe place to avoid damage or loss. Store dry in the provided case when not in use.
- Once you have determined the need for a new appliance, please send a new prescription with a new set of models and bites.
- Carefully remove the device to avoid breakage.
Sleep apnea appliances with Dandy
Adding oral sleep apnea treatment to your dental practice is simple with Dandy and allows you to grow your practice’s value-per-patient exponentially. Dandy offers both Herbst and Dorsal appliances as well as education on medical billing. Explore Dandy’s custom 3D-printed mandibular advancement devices to treat your patients.
