TMD & Orofacial Pain FAQ'sClick on a question to view the answer.Q WHAT CAUSES OBSTRUCTIVE SLEEP APNEA? A The exact cause of obstructive sleep apnea (OSA) is still unknown, but certain risk factors have been found to contribute to the development of this condition. Excessive weight gain is the primary risk factor that can lead to OSA, due to the accumulation of fat surrounding the upper airway. This excess fat can cause the airway to narrow, and potentially close, as the muscles relax. Other risk factors may include: • Age (OSA is more likely to occur in those over 50) • Gender (Men are more likely to suffer from OSA than women) • Alcohol use • Having a short, thick neck • Smoking • Sedative drug use Top Q WHAT OCCURS DURING AN OBSRTUCTIVE SLEEP APNEA EPISODE? A During an obstructive sleep apnea episode, the tongue and soft tissues fall back during sleep, and block the airway. The brain’s oxygen levels must fall low enough to partially awaken the sleeper in order for the tongue to return to its normal position, and for the airway to clear. This is usually accompanied by a loud gasp, yet those with untreated sleep apnea are usually not aware of their awakenings. These events can occur up to 40 times an hour, or even more in severe cases. Sleep is therefore fragmented, and of poor quality. Top Q WHAT ARE THE EFFECTS OF OBSTRUCTIVE SLEEP APNEA? A Those suffering from obstructive sleep apnea are excessively tired throughout the day and their concentration and overall daily performance can suffer. Irritability, depression and learning difficulties can occur, and bed partners may complain of hearing heavy snoring throughout the night. People with this disorder may also fall asleep during their normal, everyday activities. Top Q WHAT CAUSES SNORING AND HOW IS IT INVOLVED IN SLEEP APNEA? A Snoring occurs when the airway becomes partially obstructed. When air tries to pass through the obstruction, the throat structures vibrate, leading to the snoring sound. There are many factors that can lead to a narrowing of the airway, such as excess fat deposits, large tonsils, a long soft palate or a large uvula. If someone snores loudly, it doesn’t necessarily mean that they have sleep apnea, but it is a common complaint of those who suffer from the condition. Top Q HOW IS SLEEP APNEA DIAGNOSED? A A patient’s primary care physician will most likely be consulted first, followed by a sleep disorder specialist called a pulmonologist. Diagnostic tests such as a polysomnograph (PSG) and a Multiple Sleep Latency Test (MSLT) will typically be performed in a sleep center. A PSG records bodily functions during sleep such as muscle activity, heart rate, blood oxygen levels and electrical activity of the brain. A MSLT measures how long it takes for the patient to fall asleep. Top Q HOW IS MILD TO MODERATE SLEEP APNEA TREATED?? A Nasal continuous positive airway pressure (CPAP) is typically used to treat obstructive sleep apnea. This is a nightly procedure where the patient wears a mask over the nose during sleep, and air is forced through the nasal passages by way of an air blowing machine that is placed next to the bed. While CPAP can be an effective treatment method, many patients feel claustrophobic while using it, have difficulty fitting the nasal mask correctly, and experience nasal dryness or discharge. Certain surgical procedures are available as an alternative to CPAP; however, these procedures are invasive, and not always effective. For many patients, an oral appliance is a less-invasive, highly successful alternative. Top Q HOW CAN AN ORAL APPLIANCE HELP WITH SLEEP APNEA? A Oral appliances vary in design, but all work by repositioning the lower jaw and tongue, which can help prevent obstruction of the airway during sleep. A dentist who specializes in appliances to be worn during sleep will be able to recommend what will work best for each individual patient. Top Q What does the appliance look like? A The oral appliance used to treat obstructive sleep apnea looks similar to a dental retainer or mouth guard. It is relatively small and easy to wear. Those appliances that allow for lateral and vertical jaw movement are generally considered the most comfortable to wear. Certain appliances are adjustable under the supervision of a dentist. Top Q ARE THESE ORAL APPLIANCES APPROVED BY THE FDA? A Yes. All oral appliances used to treat obstructive sleep apnea and snoring are required to have clearance from the Food and Drug Administration before they are marketed. Top Q HOW EFFECTIVE IS THE APPLIANCE? A Both physicians and dentists have found that the majority of patients who are fitted with a well-made oral appliance see a significant drop in snoring, and their symptoms associated with mild to moderate obstructive sleep apnea. The appliance is intended to prevent the snoring and apnea from occurring, and therefore must be worn every night to produce the desired outcome. Although the success rate for treating symptoms is excellent, an oral appliance will not cure obstructive sleep apnea or snoring, and there is no guarantee that the appliance will be successful for every patient. Top Q ARE THERE SIDE EFFECTS ASSOCIATED WITH THE APPLIANCE? A Side effects vary greatly, and depend on the patient. Some studies have shown that minor changes in the dental bite can occur. Additional side effects can include excessive salivation, sore teeth and sore jaw. Top Q WHAT HAPPENS DURING THE FIRST APPOINTMENT? A Prior to a patient’s first appointment, he/she will most likely be required to fill out the Epworth Sleepiness Scale, and obtain a copy of their sleep study from a physician. The first examination will include a medical/dental evaluation, a temporomandibular joint examination, radiographs, and an impression of the upper and lower teeth. This appointment will take approximately one hour. Top Q ARE FOLLOW-UP VISITS NEEDED? A Yes. Three to Four follow-up visits are typically needed to evaluate the health of a patient’s oral structures while using the oral appliance, as well as the effectiveness of the appliance. A follow-up sleep study and reevaluation should also be performed by the physician. Top Q DOES INSURANCE COVER THE COST OF AN ORAL APPLIANCE? A Because oral appliances have been ruled as medical devices by the FDA, medical insurance is likely to cover the cost of the appliance, once it is determined to be medically necessary. Top |
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