Let's face it some patients either cannot or simply will not wear their CPAP machine. Most understand the importance of treating their condition, but for a number of reasons do not comply with the recommended treatment. For some, the mask can feel overwhelming and the tubing is uncomfortable to manage while sleeping. Other complaints include nasal congestion, runny nose, or headache. In addition, it is common for bed partners to complain about the noise level from these machines. For these reasons the average compliance rate for CPAP users is only 50 percent.
Oral Appliance Therapy (OAT) can be an effective way to treat patients with snoring and sleep apnea. The American Academy of Sleep Medicine states that oral appliances are indicated for patients with mild or moderate sleep apnea who prefer OAT to CPAP. OAT can also be used for patients with severe sleep apnea who cannot tolerate a CPAP and refuse surgery.
Many patients prefer the benefits of oral appliances when compared to CPAP. OAT works by physically moving the lower jaw forward and repositioning the structures that form the airway to open the obstruction rather than forcing air through this obstruction. Bed partners enjoy not hearing the air pressure from the machine, allowing them to sleep comfortably in the same room. This preference toward oral appliance therapy is what we see in our practice every day. We have had many patients thank us for allowing them to awaken more refreshed, while improving their relationship at home.
Let's look at one of our patients, Tony, who was non-compliant with his CPAP and could not sleep in the same room as his wife due to his loud snoring. His sleep study revealed his apnea-hypopnea index (AHI) was severe at 57 events per hour. A board certified sleep physician diagnosed him with severe sleep apnea and hypopnea.
Tony was informed of all possible treatment options including CPAP, surgery, and an oral appliance. He already knew that CPAP would not work for him and was unwilling to consider any surgical procedures. For oral appliances it is critical for the patient to have healthy teeth and gums. A full dental evaluation with radiographs was completed to ensure that the device would have good long term success. After discussing his treatment options, Tony elected to move forward with an oral appliance. Photographic records along with digital impressions were taken and submitted to a dental laboratory that specializes in sleep apnea devices. The oral appliance was delivered within a few weeks.
Follow up over the next few months revealed that Tony was feeling more energetic during the day, sleeping better throughout the night, and his wife reported complete elimination of snoring when wearing the device. This married couple was finally sleeping in the same room together. Follow up analysis, including comparison of his pre-treatment Epworth Sleepiness Scale and an Observation of Sleep Scale, demonstrated that it was appropriate to order an efficacy sleep study to determine how well the device was working. The results of the efficacy study showed a reduction in AHI to 8 events per hour, which is considered mild sleep apnea. We have adjusted his appliance, advancing his mandible, to see if we can reduce his AHI even more. Another efficacy study will be ordered in just a few months to monitor his progress.
Patients being treated for sleep apnea are typically seen on a yearly interval in our office. We evaluate the fit and discuss the efficacy of their device, while making adjustments as needed. If any dental treatment is necessary we can adjust the device to accommodate the new tooth form. We typically pair these follow up appointments with their dental cleanings for convenience and improved compliance.
As providers we are always looking for solutions that increase compliance, which is essential for successful treatment. There is not one solution for all patients. Our office strives to educate patients on what treatment options are available and find the solution that fits best into their lifestyle.
Dr. Ivan Montijo earned his Doctorate in Dental Medicine from the University of Florida and practices at Lake Nona Dental Group. He is trained in all aspects of dentistry and stays on the cutting edge of dental technology. Dr. Montijo is a Fellow of the Academy of General Dentistry which is awarded to dentists with a commitment to continuing education beyond the post-graduate level and is achieved by less than 3% of practicing dentists nationwide. Visit www.lakenonadentalgroup.com