Sleep Treatment Options

Sleep Treatment Options

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 site of obstruction is the base of the tongue collapsing against the airway. Therefore, by bringing the lower jaw forward, the airway is physically made larger, which makes it easier to breathe. These appliances are well documented to be successful, especially in mild-to-moderate obstructive sleep apnea. Both the American Academy of Sleep Medicine and the American Academy of Dental Sleep Medicine recommend it for consideration as a first line treatment for mild to moderate 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. Most medical insurance have these devises on their list of benefits. 

There are pros and cons to all these different appliances. A trained and experienced Dental Sleep specialist like Dr. Prehn 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.

Medical Treatment

The foremost medical treatment for obstructive sleep apnea is continuous positive airway pressure (CPAP) that is used in order to maintain the integrity of the airway. This is a machine that maintains a certain pressure 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 can be a major problem. Research has shown that CPAP compliance nationwide is approximately 51% . Some committed 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. 

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 (Type I) or having the CPAP machine connect directly to an oral appliance (Type II). This is a new emerging treatment option. Dr. Prehn has been a leader in the development of this option and is well published in the literature. He has worked with its inventor and developer, Dr. Keith Thornton, to bring combination therapy into the profession as a viable option. Dr. Prehn is well versed in combination therapy and has several different options to consider. The reason for combination therapy would be if the person is unable to adapt or tolerate the MAS, and also unable to tolerate the CPAP machine (failure with both those options). By combining these 2 together, almost 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 on the more severe side of the spectrum of sleep apnea, but not necessarily have to be severe in order to obtain benefit from this type of therapy. Dr. Prehn has completed a study on the satisfaction and compliance of these devises and is available upon request.

Surgery

There are several types of surgeries for treating OSA (obstructive sleep apnea), most of them provided by otolaryngologist (ENT) or an Oral Maxillofacial Surgeon (OMS). An ENT can offer a hyoid suspension and tongue, and uvulopalatopharyngoplasty (UPPP) all of which have limited success rates. The latest type of surgery that an ENT can provide, is called a “Sleep Endoscopy.” The ENT puts the patient to sleep and with a scope through the nose, can observe down the airway the area of obstruction, and then use surgery to open that area. It is currently being done in this area with robotic surgery at Baylor School Medicine by Dr. Mas Takashima. With children, it is highly recommended to have an ENT remove large tonsils that are causing obstructive or limited breathing at night. There is one surgery that has extremely high success rate which is orthognathic surgery. This surgery is done by an OMS. The typed of orthognathic surgery would be to cut the lower jaw and upper jaw (Maxillary Mandibular Advancement (MMA)), and advance the jaws permanently. This opens up the airway and basically the only real “cure” to OSA. This is major facial surgery and should only be considered under optimal conditions for success. This can be determined by an experienced Dental Sleep specialist like Dr. Prehn, as there are many factors to consider moving into this type of therapy. 
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