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Sleep Apnea Appliances


Sleep Apnea Appliances used at West End Dental, in Portland, OR]While most people experience the occasional poor night of sleep, these nights are often few and far between. However, there are numerous individuals who just cannot seem to get good quality sleep any night. Every morning, they wake up feeling exhausted and have difficulty getting through their day. If this sounds familiar, you may be living with a condition known as obstructive sleep apnea. West End Dental can help with a sleep apnea appliance.

What is Sleep Apnea?


There are two types of sleep apnea, obstructive and central. Central sleep apnea occurs when there is a miscommunication between your brain and the muscles that control your breathing. Obstructive sleep apnea (OSA) is a disorder characterized by recurring episodes of partial or complete obstruction of one’s airway during sleep that result in lower blood oxygen content for periods of 10 seconds or greater. These episodes terminate when the body responds and creates an exaggerated respiratory effort, such as snoring or gasping, that cause sleep disturbances via microarousal of the brain. This in turn causes an increase in adrenaline, heart rate and blood sugar. This phenomenon can occur hundreds of times at night and has symptoms such as
•  snoring
•  gasping for breathe during sleep
•  excessive daytime sleepiness
•  insomnia
•  observed periods of absence of breathing during sleep
•  morning headaches
•  awakening with a dry mouth or sore throat
•  feeling depressed or irritable
•  difficulty focusing and completing tasks.

Chronic obstructive sleep apnea if left untreated, facilitate other disease entities such as: hypertension, stroke, atrial fibrillation, diabetes, gastroesophageal reflux disease, diabetes, impotence, dementia, nocturnal clenching.

The most common cause of airway obstruction is the tongue, although the nasal passages and tongue are also contributors.

The diagnosis of OSA is made by a physician trained in sleep medicine. It can be made based on clinical symptoms, home sleep tests and in lab sleep testing (polysomnography). Generally, a sleep test is required for medical insurance to provide treatment benefits.

The treatments for OSA include CPAP (Continuous Positive Air Pressure), Mandibular Advancement Devices (MADs) and surgeries. MADs are also known as Oral Appliances. The goal is to reduce the number of apnea, hypopnea and respiratory effort related arousals (Apnea/Hypopnea Index and Respiratory Disturbance Index) to less than 5 events per hour. The classifications are: normal less than 5 events/hour, mild OSA 5 to 15 events/hour, moderate OSA 15-30 events/hour, severe OSA greater than 30 events/hour.

The pictured oral appliances are a type that West End Dental prescribes commonly. They are custom, adjustable, FDA approved and Medicare compliant.

CPAP involves wearing a mask that forces air from a machine that creates increased ventilation pressure into the nose. CPAP is the first line of treatment for OSA and is prescribed by sleep physicians. Some patients tolerate CPAP well, but overall, after one year, compliance rate is only about 50% for those for whom it has been prescribed. Compliance drops another 12-25% after 3 years use. The reasons for lack of compliance are: intolerance of mask on the face or straps around the head, noise and air leakage, restriction of sleep position, lack of portability, expense.

MADs are removable oral appliances made by dentists trained in OSA, that cover the upper and lower teeth, are connected together and hold the lower jaw forward. This keeps the tongue from falling back and obstructing the airway. We create a custom fit sleep apnea appliance based on a digital impression of your mouth. This ensures a proper, effective fit. The sleep appliances we make at West End Dental are FDA approved and Medicare compliant.

Patient compliance rate for MADs is much improved over CPAP and is about 90% after one year. MADs are equally as effective as CPAP for mild and moderate OSA and only slightly less effective for severe OSA. Given this, one might expect their sleep physician to prescribe MADs for those appropriate as the first line of treatment. However, sleep physicians usually prescribe CPAP and will only refer patients for a MAD after they refuse to wear CPAP, can't tolerate or are noncompliant. A small percentage of patients are best served by combination treatment of both CPAP and a MAD.

The disadvantages of MADs are potential bite changes and development of or worsening of TMJ symptoms. However, MADs can improve TMJ symptoms and are recommended for patients with both temporomandibular joint dysfunction (TMD) and OSA.

Snoring can occur in the absence of OSA. A MAD can also be used to eliminate snoring while also curing snoring induced insomnia of bed partners. While you can find oral appliances over the counter at a pharmacy, these devices often are ineffective and can be potentially hazardous.

Dr. Krippaehne completed advanced training in sleep apnea at the UCSF and is a Qualified Member of the American Academy of Dental Sleep Medicine. He can help determine what type of mandibular advancement device is right for you and make the necessary records without using impression trays full of goopy material, instead using our digital scanner. The staff at West End Dental can facilitate the referral to a sleep physician, communicate lack of tolerance with CPAP to help obtain sleep physician approval for a MAD, discover medical insurance benefits for treatment and bill medical insurance for covered benefits. MADs can also be a covered benefit for Medicare patients.
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