Obstructive Sleep Apnea (OSA)
What is it?
Sleep apnea is a potentially serious sleep disorder, affecting more than 18 million Americans in which breathing repeatedly stops and starts. If you snore loudly and feel tired even after a full night's sleep, you might have sleep apnea. The most common type of sleep apnea is obstructive sleep apnea or OSA, where the throat and jaw muscles relax and causes breathing pauses while sleeping.
Treatment
CPAP Therapy
The most common treatment for obstructive sleep apnea is continuous positive airway pressure or CPAP. It keeps the airway open by providing a constant stream of positive pressure air through a mask. However, the majority of people have trouble using CPAP and stop the treatment before achieving any lasting benefit.
In a study from 2008, they found that a significant proportion of patients diagnosed with OSA either do not initiate or eventually abandon CPAP therapy. In another study from 2019, they found that an estimated of up to 83% of patients with CPAP therapy were non-adherent, with a mean duration of 3 hours of use per night in those who were non-adherent. 6 hours of use per night is recommended for maximum benefit from CPAP therapy.
Some complications from CPAP therapy include, a sensation of suffocation or claustrophobia, difficulty exhaling, inability to sleep, musculoskeletal chest discomfort, sinus discomfort, and bloating. However, forcing air into the airway does not address the fundamental problem of relaxation of the muscles of the throat and jaw obstructing the airway while you sleep.
Mandibular Advancement Device
An alternative form of treatment uses what is called a mandibular advancement device or MAD. Rather than using a mask that covers your nose and mouth, these devices cover the surfaces of your teeth, much like a night guard or sports guard, and position your lower jaw forward while you sleep there by opening up your airway. Research indicates that patients with mild OSA, MAD is a beneficial and cost-effective method of treatment. MAD should be considered for those who decline or cannot tolerate using a CPAP in severe OSA. Another study showed that adults with predominantly moderate to severe OSA, the use of an adjustable MAD was not inferior to CPAP in its impact on 24 hour mean ambulatory blood pressure, daytime sleepiness, disease specific and general quality of life.
The traditional method in fabricating an MRD has been making impressions of the upper and lower teeth, obtaining a bite record at an arbitrary open jaw position, sending these to the dental lab, and they fabricate one of several types of devices depending upon the recommendation of the dentist. Most of these appliances tend to be bulky in the mouth and position the lower jaw in an arbitrary forward position. These devices rely on some type of mechanism (metal hooks with a key system or bands) that allow the wearer to adjust the position of the lower jaw until they are comfortable and maintains a patent airway during sleep.These types traditional appliances often prevent your lips from closing and allows for ease of breathing through your mouth, often leading to a dry mouth when you wake in the morning.
Using Technology
With current advances in digital imaging technology, we can now fabricate MADs that will position your jaw with more accuracy. Called OPTISleep, this is an advanced oral appliance made based on digital technology. It is the only oral appliance that is planned and created using 3D software. Digital planning of this appliance ensures a higher level of accuracy, removing much of the guesswork in determining the ideal position of the jaw in order to maintain an open airway. This MAD is made using cutting-edge technology that reduces the fitting process all together. It is thin, durable and comfortable. Comprised of a 2-piece thin, milled appliance, it has a natural feel and allows you to open your mouth naturally to speak or drink. Unlike other traditional appliances, OPTISleep allows you to close your lips so you can breathe normally through your nose.
