1. Behavior modification.
2. Medical treatment (CPAP).
3. Oral appliance therapy (OAT).
4. Combination Therapy (CT).
At the present state of the medical and dental sleep profession, these are the 5 available options for treatment of various forms of sleep disorder breathing. The options within these treatments are ever changing and sometimes too numerous to list. A review of these options follows.
Five Options for treatment of Obstructive Sleep Apnea (OSA):
1. Behavior modification represents the category that consists of suggestions to help alleviate the collapse of the airway and also to help the patient sleep better. These include a long list of suggestions called “sleep hygiene.” Sleep hygiene are behaviors that promote good sleep. If followed, the result will be better night sleep. Another example of behavior modification will be “positional therapy.” Positional therapy means that if you sleep on your side, then your airway is less apt to collapse simply by the fact that it is shaped as an ovoid. When a person sleeps on the side, the airway does not collapse as much and therefore maintains its integrity. People have been known to wear knapsacks at night or sew tennis balls in T-shirts to keep themselves from sleeping on the back. Of course an elbow to the rib also accomplishes the same thing! There are devices on the Internet that can be purchased to help the person stay on the side. The other examples of behavior modifications that can be discussed by your sleep doctor.
2. Medical treatment. The foremost medical treatment for obstructive sleep apnea is continuous positive airway pressure (CPAP) used in order to maintain the integrity of the airway. This is a machine that pushes air down a tube that goes to the mask on the patient’s face. This air pressure goes into the nose, then down the back of the throat. This air pressure keeps the airway open at night so that person can breathe freely. This mechanism works very well except the mask is a major problem. CPAP compliance nationwide is approximately 51%. Some sleep doctors work very hard with the patients to get them to acclimate to the machine and their success rate is more in the 80% range. The CPAP has well documented side effects that are too numerous to mention here. The main reasons for rejection of this therapy is leakage of the mask, pressure on the face, machine noise and straps around the head.
3. Oral Appliance Therapy (OAT). This type of therapy consists of a mandibular advancement splint (MAS) that goes into the mouth and attaches to the teeth in order to bring the jaw forward at night. By bringing the jaw forward, the tongue that is attached to the jaw comes forward also, thereby opening up the back of the throat. The base of the tongue collapsing against the airway is the cause of the obstruction and by bringing the jaw forward this physically opens up the airway, which makes it easier to breathe. These appliances are well documented to be successful, especially in mild-to-moderate obstructive sleep apnea. There are many different types of appliances on the market today and are too numerous to mention in this report. They are considered Class II medical devices and need FDA approval. For a fairly comprehensive list of variable appliances, please see the following website www.quietsleep.com. There are pros and cons to all these different appliances. Your Dental Sleep specialist will be familiar with them and can review them with you if you desire. The MAS has a very high compliance rate and most people adapt to them very well, however, they do have some side effects that need to be addressed by the treating dentist. These include tooth movement and possible TMJ disturbances. A well-trained dentist who is trained in both of these aspects of dentistry, will easily address these complications if they arise.
4. Combination therapy
. This category consists of combining the mandibular advancement appliance (MAS) with the CPAP machine. This
could be either MAS in conjunction with the CPAP or having the CPAP machine connect directly to an oral appliance. This is a new emerging treatment option. Dr. Prehn is well versed in combination therapy and has several different options to consider. The reason for combination th
erapy would be if the person is unable to adapt or tolerate the MAS, and also unable to tolerate the CPAP machine. By combining these 2 together, all the possible obstacles to treatment can be addressed. These combination devices are very comfortable. Their compliance of satisfaction is very high for this type of therapy. This works best for people who are severe but not necessarily have to be severe in order to obtain benefit from this type of therapy. Dr. Prehn just completed a study on the satisfaction and compliance of these devises and is available upon request.
. There are several types of surgeries out there for OSA, most of them provided by otolaryngologist (ENT). They can be hyoid suspension and tongue,
and uvulopalatopharyngoplasty (UPPP) all of which have limited success rates. It is highly recommended in children with sleep breathing issues to have an ENT remove their tonsils. There is one surgery that has extremely high success rate and that this is orthognathic surgery. The typed of orthognathic surgery would be to cut the lower jaw and advance it permanently. This opens up the airway and basically cures “obstructive sleep apnea.” Usually the upper jaw needs to be advanced also. This is major facial surgery and should be considered and there are many different things to consider before moving into this type of therapy. This option has a 100% success rate and is considered as the only “cure” to OSA. This needs to be discussed by an experienced Dental Sleep specialist in order to be considered as a viable alternative.