Professional oral appliance therapy remains a great option in treating obstructive sleep apnea (OSA), snoring and Upper Airway Resistance Syndrome (UARS). Today, let’s discuss how to know if your device is working or needs to be adjusted as discussed by your prescribing dentist in regards to snoring levels.
Please be advised that all instructions given to you by YOUR sleep apnea dentist overrides any information in this article.
Adjustable Sleep Apnea Dental Devices
There are over 100 different types of sleep apnea dental devices. Custom dental sleep devices help eliminate or reduce snoring, as well as obstructive sleep apnea events. Many, but not all, of these devices are of the type that have adjustable lower segments which increase the chances of successful therapy.
This article is most helpful for those apnea patients that have custom adjustable dental sleep apnea devices and need some objective help to know if they are snoring and considering adjusting their device. Others who suspect that they may be snoring and are unsure, may also find this article helpful.
The adjustment of a dental sleep apnea mouthguard may differ considerably from one device model to another. Some have a tool to engage in a particular direction, or a lever to turn. Others may have a series of oral devices made at different settings to change out based on a number or letter etched into the devices. It is important to listen to your qualified sleep disorder trained dentist in regards to details of your particular device advancement mechanism.
Home Dental Sleep Apnea Device Adjustment Period
The first stage after receiving a dental sleep apnea appliance, many times involves a home adjustment period, often referenced by the medical community as a home titration period. During this time, the patient is getting comfortable with the device and may need to advance the device based on noticeable apnea or UARS symptoms.
The only true way to be certain an oral sleep mouthguard is effective in controlling apnea is to have a sleep test with the oral device inserted. But prior to that, in most cases your prescribing dentist will want you to advance the device during the home titration period based on noticeable symptoms. These symptoms can vary drastically from individual to individual with some patients experiencing no symptoms except snoring.
The goal for successful oral appliance therapy is to not only stop apnea events, but also to stop all symptoms associated with OSA (and UARS). Some of these symptoms may include snoring, excessive daytime sleepiness, poor sleep quality, morning headaches and frequent nighttime bathroom breaks.
Many oral appliance patients can decipher improvements of apnea symptoms. In these cases, if all the symptoms are gone, the patient may pass on adjusting their device until they meet with their dentist unless instructed otherwise. If the patient still has noticeable symptoms, they usually have been directed to advance their device according to the instructions that were given to them at their oral appliance delivery appointment.
Adjusting the device does not mean you are making your sleep apnea dental mouthguard tighter or looser. When you are adjusting your device, we are referencing that you are advancing the lower segment of your mouthguard as instructed by your sleep disorders dentist. When the dental device is advanced, the lower jaw is moved forward, often opening the airway more. With a successful outcome, eventually, snoring can be reduced or eliminated.
Evaluating Snoring Levels if You Live Alone
Getting feedback from a bed partner or family member is one of the easiest ways to know if you should advance your device. However, if a patient lives alone and snoring is the main symptom to work through, it may be difficult to know if the device is working and if adjustment of the device is required.
In some cases when the device is working to reduce snoring, patients may notice less self-awakenings or gaspings. Some individuals will also notice that their throat passage feels less irritated or dry.
Snoring, OSA and UARS patients without bed partners may need another option for snoring feedback levels. For these patients a phone app may be a good start for adjustment guidance.
There are many apps that record snoring levels. Today, let’s review the snoring analysis app called SnoreLab.
The SnoreLab App
SnoreLab is easy to use and is available for Iphone and android downloads. There is a free and a premium version.
According to the developer here are the differences between the free and premium versions:
Free SnoreLab: The app is free to download and use but some features require a premium upgrade to access. The free version does not allow consecutive night recordings, which is often not needed. There is also some limitation to how many nights you can use the app.
Premium SnoreLab additional features includes (approximately $5):
- The option to listen to more samples or make audio recordings for the whole night
- Consecutive night recording. Use SnoreLab as much as you like
- Access to the Trends screen to compare your snoring and sleep stats over time
- Access to soundscapes to help you drift off
- No advertisements
How to Use SnoreLab App
The main screen looks like this. You simply press “Start” and the app will guide you to place the phone face down and be plugged in. You go to sleep and when you awaken slide the “Slide to stop session” at the bottom of the screen. You will be able to see the results of the snoring levels in a summary or detailed format . That’s it!
Prior to recording with the device inserted, It is recommended that you get a night or two of sleep recordings WITHOUT your oral device inserted for a base reference point.
SnoreLab OPTIONAL SETTINGS to consider:
On the main screen look for “Remedies”:
Factors: In this section, if you had alcohol or ate a late meal, for example, you can click on those and other factors that may be helpful in assessing your sleep and oral device advancement needs. And press “Confirm” to save settings.
To view RESULTS of SnoreLab App
This page will tell you the following:
- How long your recording session lasted and the times
“Snore Score” summary of the night.
- Graph representation of the loudness of the snoring and associated times.
- Any sleep notes you added.
If you need to add extra Sleep Notes you can add them on this page as well.
How does SnoreLab calculate Snore Scores?
The Snore Score is calculated using the average volume and the total duration of suspected snoring episodes during the night. A higher Snore Score indicates louder or more frequent snoring, and a lower Snore Score indicates quieter or less frequent snoring.
The Snore Score within the SnoreLab app is designed to help you compare your snoring across multiple nights and to measure the impact of remedies and factors. A typical Snore Score for a new user is around 25, while a score of 100 or more puts you in the highest 15% of users.
From the developers regarding the snoring loudness:
How accurate is the SnoreLab? A note from the developers:
SnoreLab is intended for informational purposes only. Whilst we invest much effort into creating and improving our snoring measurement algorithms, we cannot guarantee the accuracy of data and information we provide through the app. SnoreLab’s results are estimates only and may be influenced by microphone sensitivity, noise interference, device placement and other factors.
Warning: if you use this app and someone is in the room with you that snores (including pets), they may register on the app and add to your count. This may confuse your advancement direction.
Recordings and Adjustments
After you have a base night recording without the device inserted and you have one night with the device inserted it’s time to compare. It’s easiest if you start with the Snore Score summaries. If there is no change or still considerable snoring levels, and if prescribed by your dentist, it’s time to advance your device as directed.
You can repeat this in the intervals recommended by YOUR dentist. For my patients, advancements are usually done every 3-4 nights if no jaw discomfort is present.
Please remember, there is a limit to what distance your jaw will be able to comfortably reach. It’s important to NOT adjust beyond discomfort in the jaw areas or teeth that doesn’t improve after an additional night or 2 at a current setting, even if you are still snoring. It would be then recommended that you return your device to the most recent comfortable setting that was well tolerated.
If there seems to be an improvement in the summaries, you can try to record again in the next few nights. If the snoring has been eliminated, usually you do not need to advance the device at this time unless directed by your dentist.
Recording your device every night is not necessary unless your dental provider has requested you to do so. But it’s a good idea to monitor your sleep after advancements to see if you are on the right path.
It’s important to note that some patients need NO advancements beyond the setting that the device was fabricated for and given to you. Others may need from a few to many advancements to obtain favorable results.
Device Adjustment Limits
The particular device choice of your prescribing dentist also has a limit to the advancement capability. Some professional devices do not allow for any advancements. However, most trained and qualified apnea treating dentists choose a type that is custom and is advanceable to a variety of distances (several millimeters).
If you feel you have advanced your device correctly and considerably, and the device does not appear to advance further, contact your prescribing dentist for guidance.
This SnoreLab screen is not needed early on in dental apnea adjustments. The History Screen will give you data over a period of months. However, most patients with proper guidance from a qualified sleep apnea dentist reach their most therapeutic level of adjustment within a few weeks. Those at high risk for “TMJ” or jaw discomfort may take several weeks longer.
Most sleep disorders trained dentists use information from the Snorelab app or similar apps as a rough guide when snoring feedback is not available. It is very important to return to your prescribing dentist for further guidance whether the Snore Score decreases or not.
A majority of patients need further advancement beyond symptom relief which can only be assessed though sleep testing.
For More SnoreLab Information:
SnoreLab Frequently Asked Questions: https://www.snorelab.com/faqs/