Snoring and Sleep Apnoea
Everyone would have some sense of a relationship between sleep and an ability to function throughout the day. Clumsiness, lack of focus, fatigue and bad mood are just some of the signs of the symptoms that follow a poor night’s sleep. What many people do not realise is that a lack of sleep, especially on a regular basis, can be associated with serious consequences.
Trained dentists are in a unique position to be able to help treat snoring and sleep apnoea. By providing a dental device which brings the lower jaw forward and opens the airway, symptoms of snoring and sleep apnoea may be alleviated.
Benign snoring has been associated with an increase in occurrence of some conditions such as tiredness, heart attack and stroke.
Snoring is caused by relaxation of the muscles of the throat to narrow and partially obstruct the airway. This results in vibration of the soft tissues which causes the sounds. Contributory factors to snoring include large tonsils, a long soft palate and uvula and excessive fat deposits.
For mild or occasional snoring and OSA symptoms, some alleviation may be provided by lifestyle changes including:
- Weight loss
- Avoiding sedatives (alcohol, cigarettes, some medications) and heavy meals within 3 hours of bedtime
For more severe symptoms and cases:
- Positive Airway Pressure (PAP) devices (including APAP and CPAP devices)
- Use of a nasal or mouth mask connected to a device which forces air into the airway and holds it open
- Considered the gold standard in management of OSA
- Oral Appliances
- Work very well for snoring and are often effective in managing mild to moderate OSA, often considered as first line treatment in these cases
- Can be used in conjunction with PAP devices
- Can be used in severe cases when PAP devices are intolerable
- Surgery to the nose, throat, tongue or jaw, including:
- Laser palatoplasty
- Maxillary/mandibular advancement
- Shrinkage of the tongue base or advancement of the tongue
- Various nasal patches that can help keep the nasal airways patent
- They are relatively small and usually well tolerated
- Light weight and easy to travel with
- Relatively inexpensive
- Non-invasive treatment
- Oral appliances work by manipulating the oral anatomy to correct the cause of the problem. Typically, there are 3 modes of action:
- Holding the tongue forward
- Bringing lower jaw forward
- Lifting the soft palate
There are many different brands and designs of oral appliances. Some are made of a hard acrylic material, others a softer material more like a sports mouth guard. Some are tongue-retaining devices that hold the tongue forward. Others reposition the lower jaw, bringing it forward in order to open up the airway by bringing the tongue forward. This increases the space behind the tongue. These devices are called mandibular advancement splints (MAS).
To be fitted with a MAS, it is important that the patient does not have any jaw dysfunction and is free of dental decay and gum disease.
- As with any current treatment of OSA, there are a number of side effects. Most are minor, short-lived and settle shortly after removal of the appliance in the morning.
Short-term side effects:
- Dry mouth
- Excessive salivation
- Difficulty swallowing (with appliance in place)
- Irritation to the gums, cheeks, lips or tongue
- Loosening of teeth
- Temporary discomfort to the teeth and/or jaw joint
- Temporary minor changes to the bite
Most of these side effects will resolve on their own or with minor adjustment of the device.
Long-term complications (uncommon):
- Permanent changes to the bite; due to tooth movement or jaw repositioning
- Initial management is cessation of use of the oral appliance. If this doesn’t work, dental restorations or orthodontic intervention may be required
- Significant pain to the jaw
- Usually will correct with cessation of use of the oral appliance.
Although PAP devices are effective, it has been found that they are typically not well tolerated, and often removed part way through the night or not worn at all. On the other hand, oral appliances are typically far better tolerated and patients tend to prefer them over PAP devices. The main down side of oral appliances is that they may not be adequately effective depending on the severity of the condition.
- Discuss you symptoms with your dentist, GP, ENT or sleep physician
- Have a sleep study completed to confirm diagnosis
- Once diagnosis is confirmed, discuss treatment options with your sleep physician
- If an oral appliance seems to suit your needs, contact your dentist for further discussion
- A follow up study with the device being worn is usually required to confirm it is working effectively and efficiently