You cannot afford not to get tested if you have signs and symptoms of OSA. The quality and quantity of your life depends on it! OSA patients are much more likely to suffer from strokes, heart attacks, congestive heart failure, hypertension, diabetes, and the list goes on and on. We have seen some patients spiral downward into a deep hole that is difficult to climb out of. These individuals need to seek help immediately. As for any disease, the best time to seek help is early on as it becomes more likely for signs and symptoms to reverse. The body has an amazing ability to heal itself as long as the insults are removed.

The key to optimal treatment lies in the proper diagnosis. To do this, one should obtain an overnight sleep study (Polysomnography) from a qualified sleep physician/sleep lab. This is because that in addition to mild, moderate, severe OSA, there are many other types of sleep disorders such as central sleep apnea, restless leg syndrome, and narcolepsy. And no matter how knowledgeable or experienced a sleep health professional claims to be, there is no way of diagnosing all the sleep disorders without a sleep study.

FOUR MORE COMMON WAYS THAT OSA CAN BE TREATED
(In no order of effectiveness)

1. CPAP (Continuous Positive Airway Pressure): This is a breathing mask connected to a pressured air machine. The pressurized air forms a mechanical splint which keeps the airway open, allowing the patient to breathe on their own. Some of these only cover the nose, while others cover the nose and mouth.

   The advantage of CPAP is its high efficacy for all types of OSA as long as it is adjusted properly. Some drawbacks to CPAP includes its size, appearance, and comfort. Some report feeling claustrophobic, while others report being affected socially as the appearance may not seem attractive. Studies have shown that CPAP has a higher efficacy, but lower compliance rate than oral appliances.

2. Oral Appliance: This is a dental appliance that repositions the lower jaw down and forward, thus opening the airway.

   The idea of many appliances is to move the lower jaw down and forward to increase the size of one’s airway. Oral appliances can be very effective if the right one is chosen and is adjusted properly. Some of its advantages include effectiveness (especially in mild to moderate OSA), it is a non-invasive procedure (unlike the surgical option), small size (in comparison to CPAP), ease in use, comfort and portability. Some of its drawbacks include: TMJ, myofacial, and tooth pain, salivation, TMJ sounds, dry mouth, gum irritation, bite changes, and lower effectiveness in severe OSA (although can still be considered in severe OSA cases that are intolerant to CPAP).

   Oral appliances can be very confusing as there are many different types of mouth appliances (not unlike going shoe shopping). As with shoes, one is not likely to wear ill fitting and/or uncomfortable oral appliances. In addition, choosing oral appliances from under qualified professionals has contributed to unsuccessful outcomes of these devices, leading many to believe that they are ineffective.

   A qualified sleep trained dentist should perform a TMJ/muscle/dental exam to assess the risks of wearing an oral appliance. A proper exam will also help a dental professional choose the right type of appliance(s) to successfully treat OSA, while minimizing the possible side effects mentioned earlier. We feel the right appliance is in part based on the health of the TMJ (and its surrounding structures), activity in head and neck muscles, health and number of teeth, lower jaw range of motion and the patient’s manual dexterity. Because of the potential problems that can occur with an oral appliance, we do not recommend anyone purchase the over the counter styles or wear one unsupervised.

   To read about Oral Appliance Therapy, please click here.

3. Surgery: The most common type of surgery involves the removal of soft tissues in the back of the throat. A less frequent option is full on jaw surgery.

   Surgery is usually not the first treatment option, but an option for those who are intolerant to CPAP and oral appliances. Its reported success rates are highly variable considering the different types of surgical procedures available and also the different definitions for which one defines success. The surgical procedure of choice will depend on the location of obstruction down the airway. Regardless of which surgical procedure, one could possibly still need to wear a CPAP or oral appliance. Its main drawback is that it is invasive considering its success rates. Tonsils and adenoid removal are more common in children than adults.

4. Weight loss: This can be effective if an individual is slightly overweight with mild OSA. If used in conjunction with any of the above treatments, it can be very effective (with the proper diagnosis), regardless of the type of OSA.

Currently, with only four common ways to treat OSA (others are on the horizon); there is a lot of confusion, even in the medical and dental communities, over the best treatment. We strongly feel there is not one best treatment option. This is in part because OSA is a chronic disease. We feel a multi-disciplinary approach to treatment will give individuals the best chances for successful resolution. Each individual is unique in their biological make-up, their adaptability, and personality. Each individual can therefore face unique challenges in treating this chronic disease. For some more than others, it may involve encouragement to make lifestyle changes.

To make things more complex, each health professional from Dentist, Internist, Neurologist, Pulmonologist, ENT, Surgeon, Pediatrician, to Nutritionist, etc. will have different views, based on their training, experience, and values. We feel it should begin with the proper diagnosis. Then, with proper input and communication from involved health care providers, a treatment recommendation can be made for an individual. CPAP adjusted at the wrong level as well as an oral appliance titrated at the incorrect setting will not be effective. Furthermore, an ill fitting and improperly adjusted CPAP or oral appliance can be dangerous. It is not just the machine/appliance that will make an individual better, but the care in using one or more tools which will allow an individual to be successfully treated for OSA. Please contact us if you have any questions or concerns, we are here to help.