Can a mouth appliance treat my Snoring and Sleep Apnea?

How do oral appliances work?

Mandibular Advancement Devices (MAD) are small dental trays that are worn in mouth during sleep. These appliances are used for treatment of Snoring and Sleep Apnea. They work by stabilizing lower jaw in a forward position, tensing soft tissue and muscles in throat and preventing tongue from collapsing back into the airway. Thus, an open airway makes it easier to breath and reduces snoring. The Apnea and Hypopnea events, that would normally occur in sleep apnea are also reduced, which means a person is able to breath and sleep restfully.

These devices which are also known as Mandibular Advancement Splints (MAS) or Oral Appliance Therapy (OAT) are custom made according to a person’s dentition. There are several designs of these devices. A dentist who is specialized in sleep medicine will be able to check your oral condition and advice the design that is best suited for your mouth.

Are Mandibular Advancement Devices effective?

American Academy of Sleep Medicine and American Academy of Dental Sleep Medicine in their guidelines in 2015 and 2017 have proposed the use of these Oral appliances as an alternate therapy to CPAP for treatment of mild to moderate Sleep Apnea and also in Severe Apnea when patient is noncompliant or intolerant of CPAP. A lot of research and publications have gone onto studying the efficacy of these appliances and currently these oral devices have more than a 30-year track record of success.

There are certain advantages that a Mandibular Advancement Device has over CPAP. They are smaller, easier to use and clean, more comfortable. Your friends and family will not be able to tell that you are wearing something in the mouth. This is an ideal situation for people who travel a lot in trains or planes and who are afraid to go to sleep in case they start to snore in a public place. Overall, patient compliance with usage of these oral appliances has been reported to be higher than with usage of CPAP

Ultimately the therapeutic goal of MADs is to make sure the person is able to breath better, sleep better and have a well-rested night. Various studies have been done to assess the effect of MADs on general health of a person. In a person diagnosed with Sleep Apnea, Upper Airway Resistance Syndrome or primary Snoring, Oral Appliance therapy has shown a better quality of life ( QOL) , better control of previously uncontrolled Hypertension ( high blood pressure) , less sleep fragmentation, improvement in daytime sleepiness and a better ability to focus on work throughout the day, reduction in sleep bruxism ( night teeth grinding ) and even showed improvement in libido and sexual dysfunction.

How do these Mandibular advancement devices compare to the anti-snoring devices that can be bought online?

Mandibular advancement devices that are custom made and delivered by your dentist are precision made, have better retention and can be titrated (otherwise called adjustable) until they are effective in stopping snoring and sleep apnea. On the other hand, Over the counter anti snoring mouth pieces, are usually bulky and uncomfortable. They are nonretentive, cannot be titrated and generally cause more side effects on the teeth and jaw muscles.

What is the procedure to get a Mandibular Advancement Device?

If you are thinking of getting a mandibular advancement device for yourself, make sure you schedule an appointment with a dentist who is specially trained in Dental Sleep Medicine. Not all dentists are familiar with this. After your consultation, your doctor may recommend a sleep study to check for apnea and rule out other sleep disorders. An ENT evaluation may also be recommended, if necessary.

After proper diagnosis, your dentist will take impressions of your teeth or do a digital scan of your teeth. These impressions or scans will be sent to a specialized lab where the device will be fabricated and sent back to your dentist. This device will then be fitted and adjusted for your mouth, until you are comfortable. Two or three follow-up appointments will be suggested during which the device will be titrated until your snoring or sleep apnea is effectively controlled. Some specific exercises and a morning aligner will also be given to be used for a few minutes, after removal of the device. After titration of the device, it is highly recommended that a follow-up sleep study is done to ensure Sleep Apnea events are reduced and the person is getting adequate Oxygen saturation.

Again, it is important to understand that not all patients would respond favourable to Oral Appliance therapy, so it is important to consult a dentist who is specialized in dental Sleep medicine. This Sleep Specialist will be able to perform a thorough evaluation and help you decide if an Oral appliance is the right therapy for you and if any additional measures and therapies need to be done to effectively control your snoring and sleep apnea.

How do I proceed with getting fitted with a Mandibular advancement device?

Please contact Dr Nivedita Kumar in Bangalore at +91 6366909091, to set up an appointment for consultation or connect with us on NK'S Snoring and Sleep Apnea

There is also a listing of dentists in India, trained in Dental Sleep Medicine, through NKs Sleep and Breath Academy. Follow the link for more information NK's Sleepwell Global Healthcare