Types of Treatment

Most Common
Types of Treatment

The treatment of sleep disordered breathing depends on the diagnosis of the cause of the disorder. If the cause is obstruction, then depending on the severity, an oral sleep appliance may be used. Sometimes the cause is not primarily obstruction but may be neurological or a combination of causes. If a child has the disorder, other treatments may be offered.
MAD MAD stands for Madibular Advancement Device. There are many types and you will see a couple of types pictured on this page. These are selected by your dentist based on your particular dental needs. Each one has its advantages and disadvantages. All of them tend to do similar functions. It is to bring the lower jaw forward and with it the tongue creating more room for the airway to be open. These appliances also improve muscle tone. This is also called a oral sleep appliance. This most often results in relief of snoring, UARS, sleep apnea and hypopnea. Some of the most common types of professional OSAs are TAP 1 and TAP 3, SomnoMed, Suad, EMA, Micro O2, Clear Dream and Herbst but there are many more. Some of these appliances will only work if you have a full complement of teeth to anchor them to, while others can work with less teeth. Denture patients need different types of appliances and may need dental implants to help anchor the MAD.. Some people also need to get Oral DNA type treatment and orthodontics to reopen the airway and remodel the bone.. Others may need concurrent myofacial/TMJ treatment to correct the bite and relax over stimulated muscles. Others may need laser treatment of the soft palate to shrink the tissue and open the airway.
Some appliances are less restrictive of the tongue. Others allow for better side to side movement of the jaw, while others allow you to open while sleeping and yet keep the jaw forward to keep the airway open. At times an oral appliance can be used with a CPAP. No approach works optimally for every patient. This is why you should see a professional for care. Even if you find a way to stop snoring this may not correct your sleep apnea and the serious diseases that can result from improper management. Snoring cessation is not the only evidence that you have corrected sleep apnea. There are appliances that are advertised just for snoring. You must understand that a self diagnosis of snoring and treating that is dangerous to your health. Snoring is often a sign of sleep apnea and the lack of snoring does not mean you do not have sleep apnea. And in addition to that, you can correct sleep apnea and still snore. What this means is that a professional can correct the serious sleep apnea but you may still snore. Snoring is NOT the only measure of sleep apnea.
CPAP/BPAP Wikipedia’s definition of CPAP “is a form of positive airway pressure ventilator, which applies mild air pressure on a continuous basis to keep the airways continuously open in a person who is able to breathe spontaneously on their own. It is an alternative to positive endexpiratory pressure (PEEP). Both modalities stent the lungs’ alveoli open and thus recruit more of the lung’s surface area for ventilation. But while PEEP refers to devices that impose positive pressure only at the end of the exhalation. CPAP devices apply continuous positive airway pressure throughout the breathing cycle. Thus, the ventilator itself does not cycle during CPAP, no additional pressure above the level of CPAP is provided, and patients must initiate all of their breaths. CPAP type devices are not administered by dentists but usually by physicians in a sleep lab clinic setting.
CPAP typically is used for people who have breathing problems, such as sleep apnea. CPAP also may be used to treat preterm infants whose lungs have not yet fully developed. For example, physicians may use CPAP in infants with respiratory distress syndrome. It is associated with a decrease in the incidence of broncopulmonary dysplasia. In some preterm infants whose lungs haven’t fully developed, CPAP improves survival and decreases the need for steroid treatment for their lungs.
CPAP at home utilizes machines specifically designed to deliver a constant flow or pressure. Some CPAP machines have other features as well, such as heated humidifiers. CPAP can be the most effective treatment for obstructive sleep apnea, in which the mild pressure from CPAP prevents the airway from collapsing or becoming blocked.
Although delivery of CPAP through nasal mask is the most common modality of treatment, other systems exist for interfacing with adults and children. Nasal CPAP is frequently used in infants, though its use is controversial. Studies have shown nasal CPAP reduces ventilator time but an increased occurrence of pneumothorax was also prevalent. Oral mask, and naso-oral masks are often used when nasal congestion or obstruction is an issue. Devices that combine nasal pressure with maxillary advancement devises (MAD) also exist.”
The above reference to “maxillary advancement” devises by Wikipedia is incorrect and should say mandibular advancement devises. The lower jaw is moved not the upper or maxillary jaw.
BPAP, Further Wikipedia defines (BIPAP) “is a form of non-invasive mechanical pressure support ventilation that uses a time-cycled or flow-cycled change between two different applied levels of positive airway pressure. It generates inspiratory (IPAP) and expiratory (EPAP) pressure gradients that complement the patient’s own respiratory cycle, optimizing the lungs’ efficiency and reducing the work of breathing. BPAP has been shown to be an effective management tool for COPD and acute and chronic respiratory failure.” The BiPAP can also be used in combination with an oral appliance called an OPAP (oral positive airway pressure) with built in airway system and mandibular positioning for those who are moderate to severe obstructive sleep apnea patients and unable to get control of the disorder with CPAP alone.
BPAP should be distinguished from continuous positive airway pressure (CPAP), which applies a single level of positive airway pressure throughout the whole respiratory cycle and is used for different clinical conditions.”

There are problems to solve with every therapy used to treat OSA. CPAP, for example, can produce central sleep apnea in some people. This is where the brain fails to signal you to breath.
POSITIONAL THERAPY AND WEIGHT LOSS/SLEEP HYGIENE
Some people only have sleep apnea and snoring in one certain sleeping position and if they are sleeping in another position if goes away. In this case a body wedge that can be fixed to the back to keep a person on their side while sleeping can be effective.
Other people can see significant relief by losing weight. This removes some of the fat deposits in the throat and some visceral fat that may place pressure on the chest and diaphragm. .
Sleep hygiene includes going to bed at the same time each night, allowing adequate time for sleep, (generally 8 hours), blocking out noise and light in the bed room, turning off cell phones and placing them at least 3 feet away from your body. Some pillows can tilt the head forward and impair the airway in the neck.. Those with congestive heart disease may need the bed slightly elevated. There are other sleep hygiene measures that may be customized for your particular needs by your dentist or physician.
NIGHTLASE
NightLase is a laser that can shrink the soft palate and open the airway. NightLase reduces the effect of sleep apnea and through a gentle laser light treatment. The NightLase treatment tightens the tissue and will reduce the snoring sounds and the effects of sleep apnea. There is no cutting of the roof of the mouth or other oral tissues and generally no pain or anesthetic needed for this treatment.
Dr. Richard Downs is NightLase certified. Not all dentists use NightLase or are NightLase certified.. Those who do will work with your physician as part of the medical team with your diagnosis, treatment, and on-going care. Determination of proper therapy can only be made by joint consultation of your dentist and physician. Initiation of oral appliance therapy can take from several weeks to several months to complete. The dental and medical team will continue to monitor your treatment and evaluate the response of your teeth and jaws.
MARKETED ITEMS AND OVER THE COUNTER PRODUCTS
There are numerous over the counter sleep apnea and snoring aids on the market. They include throat sprays, chin straps, specialized pillows and beds, nasal cannulas, nose strips, self applied oral appliances, herbs and much more. While some may give apparent relief, a professional should be informed and they should be tested on you to see if they are helping or not. Most people cannot tell if they are. Most importantly these suggested modes of treatment completely ignore a proper diagnosis. It is dangerous to treat yourself when you do not even know what the cause of your sleeping disorder is. For example, if you have a central sleep apnea (which is a condition in which your brain fails to signal you to breath and is not caused by obstruction) and treat yourself with an oral appliance, you could die from that treatment!
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EMA Type Sleep Appliance
Clear Dream Appliance (Dorsal Class)

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(TAP 3) Thornton Adjustable Positioner Oral Sleep Appliance

 

 

 

 

 

 

 

An Oral Sleep Appliance
or mandibular advancement device (MAD) that allows for more room for the tongue. This devise may also open the nasal airway.