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Michigan Head & Neck Institute

TMJ Blog

12. 17. 2018

Recent News, TMJ

Oral Appliance Therapy for Sleep Apnea

oral appliance therapy for sleep apnea

Oral appliance therapy is commonly used today in the treatment of mild to moderate Obstructive Sleep Apnea (OSA).  For patients who suffer from severe OSA and are utilizing a CPAP machine (gold standard for severe cases), an oral appliance can be used in conjunction with the CPAP for maximum benefit to the patient.  Some patients also use oral appliances when traveling or if they cannot tolerate the CPAP.  Although oral appliances are not always as effective as the CPAP, they are certainly better than nothing, and have still proven to reduce the effects of OSA and snoring while improving daytime performance.

Just like the CPAP opens up the airway by creating positive air pressure, an oral appliance opens up the airway by moving the lower jaw (mandible) forward.

You’re probably wondering how the oral appliance is controlled and/or measured to each patient.  This process, referred to as titration, is a method used which slowly advances the mandible forward until the patient reaches maximum medical improvement.  The standard titration protocol is to advance the mandible forward in 1 mm increments over a period of several weeks while documenting the improvement/symptoms until the respiratory episodes are eliminated.  A licensed dental sleep medicine practitioner must of course do this titration.

The upper airway has little support. Since there is inconsistency in the soft tissue and bony structures of the head and neck, there has to be mechanisms in place that adjust to these anatomical differences.

Upper airway obstruction increases during sleep, meaning increased collapsibility of the airway. Studies have shown that patients with sleep-disordered breathing (SDB) have anatomically smaller airways, which can trigger increased muscle activity and negative airway pressure.  SDB includes OSA, hypopnea, and UARS (upper airway resistance syndrome).

People suffering from SDB experience frequent arousals from sleep and chronic sleep deprivation.  The most common symptom of this is loud snoring and/or apneas witnessed by bed partners.

What many people don’t realize is that sleep disturbances are often consistently reported in patients suffering from TMD (temporomandibular joint disorder) as well.

TMD is associated with primary sleep disorders, such as insomnia and OSA, and patients that commonly present with overlapping symptoms like morbidity and neuroendocrine disorders.  With long-term use of an oral appliance, a reduction in the signs and symptoms of TMD has been reported.

There are hundreds of oral appliances used to treat OSA.  Some names that may sound familiar include the following:

Herbst            SUAD              TheraSnore

TAP                 Silencer           Silent Night

Equilizer        Esmark            TPE

NAPA             HAP                  SnoreEx

Klearway       Elastomeric     TOPS

Tessi               Z-training         Snore-no-more

EMA               Full Breath        Narval

Moses

One thing that the sleep medicine practitioner must look out for when treating a patient with OSA is any pre-existing jaw problems that are present upon delivery of the oral appliance.  Oral appliance therapy can cause bite changes, which could lead to jaw problems down the road.

Alternatively, treatment with an oral appliance can also act as a healing mechanism, as the physiologic balance of the muscles and their neurological connections are restored.  The patients wearing the appliances are returned to a healthy, balanced configuration as their muscles find the proper positions (jaw relationships).  The most important function of the jaw and surrounding muscles is to maintain an open airway.

Below are 2 examples of oral appliances that Dr. Klein uses in his office:

               

The design has come a long way over the years.

At Michigan Head & Neck Institute, we offer treatment for both TMD and Obstructive Sleep Apnea that consists of creating a custom-fit oral appliance (mouthpiece) which is comfortable and can be adjusted to meet the requirements of each patient.  Dr. Klein works with each patient to provide the best options for their specific treatment.  For more information please call (586) 573-0438 or visit www.michiganheadandneck.com.

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The contents of this website, such as text, graphics, images, and other materials are for informational purposes only. While there are many commonalities among multiple TMD and sleep apnea cases, each patient is unique. Information on this website should be used to educate the reader about what they should discuss with their doctor if they are suffering from the listed symptoms. The information is not intended to be a substitute for professional medical advice, diagnosis, or treatment. Seek the advice of your physician or you may call our office with any questions you may have regarding TMD or sleep apnea. If you think you may have a medical emergency, call your doctor or 911 immediately.


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