How effective are Sleep Apnea Mouth Guards

 

It probably started with your bed partner nudging you while you were sleeping to tell you that you were snoring. After a while, you probably came to accept the painful truth that you are a snorer, and you thought you should do something about it one day. But that day never came. After all, what happens during sleep stays in the nighttime, right? Your nocturnal breathing habits are nobody else's business! But then you noticed changes occurring. Excessive daytime sleepiness - often falling asleep during the day, even at times falling asleep while driving. Morning headaches. Waking up in the night choking and gasping for air. What is happening here? 

You jump online and do some research. You read about sleep studies and you think maybe a sleep study will help you determine if you are suffering from obstructive sleep apnea (or sleep apnoea) and receive some advice on what to do about it. At the very least it should help you stop snoring, right?

A sleep study (technical name: polysomnography) will record your brain waves, oxygen levels in your blood, breathing and heart rates (pulse) as well as eye and leg movements for the duration of the study, usually over one night. The polysomnogram data collected is summarized in an Apnea-Hypopnea Index, or AHI.  Hypopnea is a partial blockage of the airway. An index of 0 - 5 is normal, 5 - 15 is mild, 15 - 30 is moderate, and 30+ is severe. Severe sleep apnea!  Being diagnosed with mild sleep apnea is bad enough, but severe? Your life is potentially at risk!

So, if you have been diagnosed with obstructive sleep apnea -- a condition in which relaxation of the tongue and throat muscles causes the soft tissues to create an airway obstruction which blocks airflow to the lungs while you sleep -- there are a number of treatment options to discuss with your doctor or sleep specialist. Two of the most widely used and most effective are continuous positive airway pressure (CPAP) machines, and dental appliances, also known as mouth guards, mouthpieces, night guards, oral appliances, oral devices, snoreguards, mouthguards, mouth pieces or splints.

 

CPAP (Continuous Positive Airway Pressure)

Widely recognized as the sleep apnea treatment of last resort, CPAP blows air with continuous pressure down your windpipe at night to keep your airways open while you sleep. This treatment is done using a CPAP machine, which consists of three main parts:

  • a mask that fits over your nose -- or your nose and mouth -- and is held in place with straps while you sleep
  • a motor that blows air (compressor)
  • a large tube called a cannula that connects the motor to the mask.

CPAP machines are expensive and can be noisy, especially if the mask becomes dislodged. Getting used to the device can take some time. Some people have difficulty sleeping the first few nights of treatment.

Side effects of CPAP use may include:

  • Feelings of confinement from the face mask (claustrophobia)
  • Sore or dry mouth
  • Nasal congestion, runny nose, sinusitis or nosebleeds
  • Irritation and sores over the bridge of the nose
  • Stomach bloating and discomfort
  • Discomfort in chest muscles.

 Some CPAP machines have special features such as heated humidifiers to reduce problems such as drying of the airways. Other possible problem solvers include using a cushioned face mask, chin straps, and nasal saltwater sprays. Your doctor may have additional suggestions.

 

Mouth Devices

If you have a problem with snoring and obstructive sleep apnea and can't tolerate or haven't been helped by CPAP, oral appliances may be an effective treatment option.

These devices, some of which must be fitted by a dentist or orthodontist, are worn in the mouth at night. Types include:

Mandibular advancement device (MAD). 

The most commonly available mouth device for sleep apnea, MADs look much like a sports mouth guard. They have been around forever and there  are many variations and refinements but the basic premise remains the same: it forces the lower jaw forward of its natural position relative to the upper jaw. Because the tongue is attached to the lower jaw, this has the effect of keeping the tongue forward, thus preventing it falling back and blocking the airway. Some types allow you to control the degree of advancement. 

Prolonged use of MADs is not recommended as problems will develop with the temporomandibular joint (jaw joint), resulting in extreme jaw pain and even dislocation of the jaw. Also, the teeth being used for leverage to force the jaw forward will become loose.

Tongue retaining device, also referred to as a tongue trainer device.

A recent and very welcome development is a type of device which directly holds the tongue and prevents it from falling back and blocking the airway, instead of indirectly achieving the same thing by manipulating the lower jaw, as with an MAD. Recent advances in technology have made the effective tongue "grabbing" system a reality, while the phenomenon known as "muscle memory" means that the device need only be worn intermittently once the tongue is "trained". In effect, the genioglossus, the fan-shaped extrinsic tongue muscle, "remembers" the position it has been in during sleep and stays there.

For people with disordered breathing, from mild snoring to severe obstructive sleep apnea, particularly those who sleep on their backs or stomachs, sleep apnea devices will improve sleep and reduce the frequency and loudness of snoring, and reduce the number and severity of apneic episodes.. Also, people are more likely to use their dental appliances regularly than CPAP, due to the unpleasantness of the CPAP experience.

Dental devices have also been shown to control sleep apnea long term compared to uvulopalatopharyngoplasty (UPPP), the standard surgical procedure for snoring and apnea, in which soft tissue is surgically removed from the back of the throat. However, mandibular advancement devices do have some potential drawbacks, including altered bite, movement of teeth, pain, arthritis of the temporal mandibular joint (TMJ), dry lips, and excessive salivation.

If you are professionally fitted with a dental device you should have a checkup early on to make sure it is working for you and periodic checkups for possible adjustment or replacement. If you experience pain or changes in your bite, your dentist or orthodontist who fitted your device may be able to make modifications to correct the problem, or recommend an alternative device.

To summarize, the best treatment for obstructive sleep apnea depends on a number of factors, including the severity of the problem, the physical structure of your upper airway, the size and shape of your mouth and tongue, the muscle tone in your upper airway, other medical problems you may have, as well as your personal tolerance for the various downsides of the different solutions. Everyone has the right to good, restful sleep which lasts throughout the night, and now that goal is readily achievable.