We can offer more options, choices and benefits than before.
Historically several Treatment options and opinions have existed. Things change. Until quite recently Oral Appliances have been considered a first line therapy for just mild and moderate OSA, snoring and for those intolerant of CPAP. Undergraduate and post graduate medical teaching revolves primarily around CPAP, so a “first line therapy” has rarely been embraced. With the advent of predictive testing, even those with severe OSA can be considered for an oral appliance. Please note that such determinations should be made within certified sleep facilities only. Predictive tests in a general dental practice sessions give only limited information, for instance the equipment cannot tell when the patient is asleep. This whole area (both CPAP and OAT) is alas, driven strongly by a profit incentive, the patient needs to be their own advocate.
Working within the Kelowna Sleep Clinic, Dr. Bray has many years of training and uses a new device called MATRx which is available only in a few sleep labs in 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 that it will work and 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 Somnodent, Narval, Herbst, EMA, TAP, Silencer, Klearway, etc. The most important aspect is testing, follow up and appropriate adjustment, otherwise they become simply “expensive pieces of plastic”
- Positive airway pressure (CPAP) is 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. 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, and other health conscious decisions. Promotion of Omega 3 rich foods and throat exercises have been cited.
- Behavioural Sleep medicine interventions include help with CPAP wear, sleep improvement, positional therapies, CBT and mindfulness.
- 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 - simply 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. The option of tongue tissue shrinkage shows promise especially as an adjunct to other modalities of management.