Now - we can offer more options, choices and benefits than ever before.
Historically treatment options and opinions have been limited. Although many have not been offered the option, Oral Appliances has always been considered a therapy for only mild and moderate OSA, snoring and for those intolerant of CPAP. Undergraduate and post graduate medical teaching revolves primarily around CPAP, so this is what is usually offered.
With the advent of predictive testing, even those with severe OSA may be considered for an oral appliance. Such determinations may be made within certified sleep facilities. This whole area (both CPAP and OAT) is alas highly competitive and the patient needs to be their own advocate.
A device to predict the likely success of oral appliance therapy is now available (MATRx) and is available through only in a few sleep labs in Canada and North America.
The MATRx device is a ‘predictive test’ and enables remotely adjustment to an inexpensive, custom, temporary dental appliance overnight in the lab where we can discover two things. First, if the dental appliance will fully control your snoring and sleep apnea. Second, we will know how far we need to advance your jaw in order to get this control. We can then write a very specific prescription for OAT knowing ahead of time of the probability that it will work and to what degree of jaw advancement is required. This is an inexpensive way of testing if OAT is for you. If it is effective, you will also save yourself the time normally required to gradually adjust it and unlike the non-lab alternatives, gives a far more sensitive and specific result. This is all about giving you options, not convincing you that is on offer must be right for you.
- Oral appliances were first used in the early part of the 1900s, when the French surgeon Pierre Robin used oral appliances to advance the lower jaw in infants who had a cleft soft palate, high-arched palate, and lower jaw that is very small with a small (receding) chin and tongue far back in the throat. Simplistically speaking, since the tongue is attached to the lower jaw (through the genioglossus muscle) moving and retaining the lower jaw slightly forward, holds the tongue forward and out of the airway - a mechanical method. In a generalized sense, oral appliances have a greater acceptance; compliance and adherence rate that CPAP. There are many Oral appliances available today including, the Somnolent, Herbst, EMA, TAP, Silencer, Klearway, etc. The most important aspect is testing, follow up and appropriate adjustment - For many people, they may be the ideal approach.
- Positive airway pressure (CPAP) may be an excellent choice to keep the airway open as it increases the pressure in the airway preventing it from collapsing. Again there are several types available from many manufacturers.
- Life style modifications. Various aspects of one’s life may help, and could generally be followed regardless of the therapy chosen. These include - weight loss (generally the most important), exercise, quitting smoking, positional therapy, fluid distribution techniques and other health conscious decisions. Promotion of Omega 3 rich foods, breathing techniques and throat exercises (incl. Didgeridoo playing) have also been cited.
- Behavioral Sleep medicine interventions include help with CPAP wear, sleep improvement techniques, other positional therapies, CBT and mindfulness techniques.
- Other emerging therapies such as implanted devices and Nasal Expiratory Positive Airway Pressure Devices may hold future successful options.
Surgery has been an option for years. Starting at the simplest - a hole made in the throat to allow air to pass the obstruction (tracheotomy) works, but isn’t a particularly popular option except in an emergency. Following this, the palate was most often chosen for surgery. The palate can be reshaped, partially removed or stiffened with implants – but it depends on where airway closure occurs, which is often not the palate. The option of tongue tissue shrinkage shows promise especially as an adjunct to other modalities of management.