By treating sleep apnea and snoring patients for over two decades now, I have noticed there are certain characteristics of patients who have been very successful with wearing sleep apnea dental devices, an alternative to CPAP therapy (continuous positive airway pressure).
The dental service that includes the area of snoring and apnea treatment with oral devices or retainers is called oral appliance therapy. The retainers that are used in this area of expertise are also called mandibular advancement splints, oral appliances, dental orthotics, and sleep apnea dental devices.
The majority of patients that attempt oral appliance therapy will find successful results after obtaining an oral device. Such symptoms as snoring, poor sleep quality, excessive daytime sleepiness, and morning headaches are just a few of the symptoms that are often alleviated with oral appliance therapy.
Although not as effective as CPAP therapy, oral devices are often tolerated more easily and worn for more hours during the week, often bridging overall effectiveness rates with CPAP therapy.
But what about long-term results? This is where it gets trickier. For example, if CPAP doesn’t prove to be effective at a given point in time, often a higher pressure setting may improve results. But with oral appliance therapy, there’s a finite amount that the jaw can be comfortably advanced. The jaw advancement is what is responsible for dental devices to work in stopping apnea events and symptoms.
I’ve gathered 7 areas that successful oral appliance users embrace for the best long-term success lasting years.
1. Patients who make the jump into oral appliance therapy realize it’s an investment into their health.
Often, it’s easy for patients with symptoms related to sleep apnea to move forward with oral appliance therapy as a treatment choice. It’s easier to understand the investment when you are frustrated with a bed partner’s snoring, you’re tired of driving to work and fearful of an accident, or toss and turn continuously throughout the night. These apnea sufferers usually have a higher sense of urgency with finding a treatment option and are often eager to make the investment of seeking oral appliance therapy.
However, some severe apnea patients do not experience these symptoms and approach treatment with less urgency. Even though you may not be suffering from poor sleep or drowsiness, it is just as important to seek treatment as soon as possible to prevent cardiovascular and other systemic damages.
Research has shown that not treating apnea can take years off your life, even for those who do not show symptoms. Whether or not you experience symptoms and you are diagnosed with moderate to severe apnea, seeking oral appliance therapy as an investment into long-term health is key not only for health but also for survival.
2. Successful oral appliance users seek help from qualified dentists.
The likelihood for an oral device to work is about a 60-85% chance. Often, this is higher based on case selection, which usually has been sifted through by dentists who are trained specifically in dental sleep medicine.
There are side effects that can be prevented and managed with oral appliance users. Also, success and failure can rely on guidance from an oral appliance therapy dentist. Adequate training on selection of devices or proper follow up care can often determine the failure or success of the device.
A qualified and well-trained dentist can also help troubleshoot problems that can help with long term success.
Depending on the area you live, it may be tricky to find a sleep disorder trained dentist. A good source remains the American Academy of Dental Sleep Medicine’s Find- A-Dentist section. The AADSM is the premiere educational non-profit organizations whose mission is to increase access to qualified sleep apnea trained dentists.
Start your path to successful oral appliance theory by finding a qualified dentist.
3. Successful oral appliance users come in for recommended follow-up visits.
One of the worst things sleep apnea patients who obtain an oral device do is to never come back to see their healthcare provider after delivery of the oral appliance. Successful results with oral appliance therapy include far more than just obtaining a device.
Even if a patient gets a device and feels great and their symptoms are resolved, it does not mean the device is fully working on a blood-oxygen level. Proper guidance at follow up visits is critical. With further analysis, approximately 50% of patients need to have the device adjusted to alleviate apnea-oxygen episodes regardless of their symptom resolution.
Follow up visits can prevent other issues from arising other than inadequate adjustment levels. Very often, I see patients coming in with their devices after a few weeks and they have incorrectly advanced their device, which could impact the area of their jaw joint also known as TMJ or temporomandibular joint.
After the delivery of a device, anywhere from one to several appointments are necessary to help guide the patient through the home adjustment period. Then depending on the original diagnosis, a follow up sleep test may be advised to determine the effectiveness and the ideal setting of the device.
Once it is confirmed that the device is effective, it is usually advised that the patient return for follow up visits to help prevent or manage potential side effects, check compliance, and catch device fractures early.
It’s not uncommon to see costly tooth alignment changes that could have been prevented with follow up care. Visits every six months, and then annual visits are usually recommended unless a patient is high risk for tooth shifting.
Don’t skimp on the follow up visits! They are important!
4. Successful oral appliance users get a follow-up sleep test if advised to confirm effectiveness.
Many people who obtain a sleep apnea dental device often are convinced the device is fully working because their symptoms (snoring, headaches, drowsiness) are no longer present. I have found that approximately 50% of patients who feel that they are adequately treated still need further adjustments to resolve apnea events and maintain healthy night time oxygen-blood levels.
The only way to determine full effectiveness of the device is through a sleep test with the device inserted. Currently, moderate and severe apnea patients would benefit most from a follow-up sleep test. Mild apnea patients may also be recommended to have a follow-up depending on details of their original diagnosis.
Highly successful oral appliance users have confirmation that their device is fully effective, beyond just relief of symptoms.
5. Successful oral appliance users adequately clean and maintain their dental health, and their devices.
Maintaining good dental and periodontal (gum) health is crucial to wearing an oral device. Retention of the sleep apnea oral device depends in part with the number and condition of teeth. Maintaining good gum health is important in preventing future tooth loss which could negatively impact the fit or ability of wearing a device.Maintaining good dental and gum health can also help prevent side effects that are common in oral appliance users, such as tooth mobility or a change in dental alignment.Once you get a device, it can last for years, but only if properly maintained as recommended by your sleep disorder trained dentist. Adequate cleaning based on the particular device chosen can decrease corrosion and make the device last for several years.
On the other hand, I have seen some devices that have been neglected due to poor care and have become either more brittle, or more difficult to make adjustments on due to the poor maintenance. Sometimes the mechanical and mobile parts of device don’t operate well if the device is not maintained and cleaned properly.
Small visible fractures can often be repaired for nominal fees. Waiting too long or neglecting repair can lead to a shorter lifespan of an oral device.
Keeping up with your preventative dental visits and proper maintenance of your specific device can protect your investment and add to your success as an oral appliance user.
6. Successful oral appliance users do consider additional treatments.
Oral appliance therapy is often fully effective for an individual. Other times, oral devices only partially resolve an apnea sufferer’s condition. Successful patients do consider additional treatment if needed.
Additional treatments can include positional devices, which keep patients from sleeping in a certain position. Adjustable mattresses or incline wedges can also help improve results.
Long standing nasal-sinus issues may decrease oral appliance results. In these cases, a referral to an ears, nose and throat (ENT) surgeon may be advised.
In other circumstances, some patients would benefit from combination therapy, where CPAP (continuous positive air pressure) is introduced. For example, if the oral device was 50% effective, some people will use it in conjunction with the CPAP. Oral devices often bring down the pressure, making CPAP therapy more tolerable.
Other types of combination therapy might include alternating between CPAP and oral devices throughout the week, or using the CPAP during the week but during travel taking advantage of the easy transportability of the oral device.
Consideration of additional treatment options can help improve long term oral appliance results.
7. Successful oral appliance users focus on lifestyle changes.
This is a biggy! A significant amount of apnea patients are not overweight and have a good hand on weight maintenance, nutrition, and exercise.
But on the flip side, a majority of apnea patients are overweight. And let’s face it, in today’s culture it’s so easy to gain a few pounds each year and continue on that path.
Although oral appliance therapy can indeed prove to be effective for overweight apnea sufferers, it’s important to realize that with aging and weight gain, the device may need to be further advanced for optimal effectiveness; each individual has a limit to how far his-her jaw can be advanced to without discomfort.
So what does this mean? Once the device is working, if you gain weight over time, the device may reach a point it will no longer work for both symptom relief and apnea control.
For long term success, embracing a lifestyle that promotes a healthy BMI (weight) is imperative. For those who have studied or lived through the changes necessary for long term success with weight management, there is awareness of several areas that need to be focused on extensively. Quick weight loss diets are ultimately ineffective.
Areas to focus on include nutrition, exercise, and adequate sleep amount. A positive attitude is often the best play to start in making new health goals and strategy. Mental health and stress management also play a huge role in building new healthy habits.
Hopefully for those where the oral device increases their daytime alertness and energy, they will decide to now concentrate on better health. For patients who decide to not just hit the couch after a long day but rather walk or exercise and concentrate on eating healthier see the most benefits.
It is crucial for overweight patients who have a successful oral appliance to know that they must change their lifestyle habits.
If you currently wear an sleep apnea dental device and have successful result, great! But please remember the points above to help improve long term success for years to come.