WEDNESDAY, March 9, 2022 (HealthDay News) — People with sleep apnea are typically prescribed a CPAP machine to help them get a good night’s sleep, but there is an alternative to the bulky and noisy devices that are growing in popularity.
Mouthguard-like devices – called mandibular advancement devices (MADs) – have been shown to work as well as CPAP in treating sleep apnea in many patients, experts say.
MADs have “become a growing part of our practice. We routinely recommend and offer the oral appliance as one of the treatment options for sleep apnea,” said Dr. Jing Wang, assistant professor of sleep medicine. at the Icahn School of Medicine at Mount Sinai in New York.
“Oral appliances have been around for less time than CPAP, but they’ve grown in popularity a lot over the past couple of years, and they can be as effective as CPAP for the right patient,” Wang said.
Obstructive sleep apnea occurs when the throat muscles relax to the point of collapse and block the airway during sleep. When this happens, your body becomes oxygen-starved and you periodically wake up for a few seconds to get some air.
People with severe sleep apnea may wake more than 30 times per hour while trying to rest, according to the National Sleep Foundation. Daytime sleepiness is the most prominent side effect, but sleep apnea has also been linked to serious health problems such as high blood pressure, heart disease and diabetes.
Patients with sleep apnea who receive a CPAP (continuous airway pressure) machine wear a mask all night that keeps the airways open.
But CPAP machines can be annoying to use, said Dr. Mitchell Levine, president-elect of the American Academy of Dental Sleep Medicine.
Masks can make people feel claustrophobic, machine noise can disturb bed partners, and people using CPAP can experience dry eyes, bloody noses and facial sores, Levine said.
As a result, some patients turn to oral appliances to help with sleep apnea.
Mouth guards keep airways open
These devices consist of two pieces that cover your upper and lower teeth, connected by a mechanism that uses your upper jaw as a lever to push the lower jaw forward, explained Dr. Colleen Lance, a physician at the Sleep Disorders Center of the Cleveland Clinic.
“By bringing the lower jaw forward and pulling the base of the tongue away from the airway, you manually open the airway,” Lance said.
MADs are similar to over-the-counter devices sold to help treat snoring, but are custom-made by dentists working with sleep doctors, Lance and Levine said.
The top and bottom pieces are molded to your teeth, and the dentist does a physical examination of your airway, including x-rays, to determine the exact fit you’ll need.
“They calculate how many millimeters forward — we’re talking millimeters here, little lower jaw movements — they would need to move the lower jaw to keep those airways open,” Lance said.
These adjustments are usually made very slowly over a few weeks to prevent your jaw from hurting or your bite from changing drastically, Lance said.
“Once you get used to sleeping with the device on, they very slowly start moving the lower jaw forward, millimeter by millimeter,” Lance said. “Your jaw really doesn’t like change, and it really hates rapid change.”
These custom devices don’t come cheap, ranging from $1,500 to $2,000but Medicare and most insurance will cover them, experts said.
Standard aids cost much less, between $75 and $150, according to the American Sleep Association. But “one of the biggest challenges is getting the device to stay in the mouth. If it’s not a custom fit, it’s like putting a size 10 shoe on a size 8 foot. “, said Levine.
CPAP remains the gold standard for sleep apnea treatment because “we know we can take your apnea out of the equation right away. That’s a sure thing. I know I can have it for you quickly. It doesn’t matter if it’s mild, moderate or severe apnea,” Lance said.
Oral appliances are not for everyone
Patients these days will typically start CPAP to get their sleep apnea under control, and an oral device will later be offered as a potential long-term solution, Lance said.
“Some people will have both,” Lance said. “When they’re home doing their normal job they’ll have a CPAP machine, but if they’re traveling a lot for work they’ll be traveling with braces.”
Currently, sleep doctors recommend these oral appliances primarily for people with mild to moderate sleep apnea, Lance and Levine said. Weight also plays a role in who will benefit from the device.
“The higher your body mass index, the less likely braces are to work,” Lance said. “Any extra weight is going to close those airways even more.”
But recent studies have shown that MADs may be just as effective as CPAP for some people with severe apnea.
MADs provided as much benefit as CPAP in patients with severe sleep apnea in terms of sleepiness and quality of life, according to a recent study. review of evidence.
However, CPAP was more effective in reducing the number of arousal events patients experienced and improving their blood oxygen levels, the review concluded.
But a French study of nearly 350 patients found that oral appliances reduced arousal events by more than 50% in two-thirds of cases of moderate to severe sleep apnea.
“I think the literature will eventually expand to include patients with higher BMIs and patients with more severe sleep apnea,” Wang said.
The American Sleep Association has more information on mandibular advancement devices.
SOURCES: Jing Wang, MD, assistant professor, sleep medicine, Icahn School of Medicine at Mount Sinai, New York; Mitchell Levine, DMD, president-elect, American Academy of Dental Sleep Medicine; Colleen Lance, MD, Cleveland Clinic Sleep Disorders Center; Opinions on sleep medicineDecember 2021; The LaryngoscopeJune 2021
From articles on your site
Related articles on the web