Reasons You Should Not Use an Oral Appliance to Treat Your Sleep Apnea

Severe Sleep Apnea, Expense, Time, and Your Anatomy May Be Factors

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The Somnodent oral appliance is used to treat snoring and mild to moderate obstructive sleep apnea by advancing the lower jaw forward. Brandon Peters, M.D.

Oral appliances are small devices similar to a mouth guard, typically made by dentists, that move the lower jaw forward to treat snoring and obstructive sleep apnea. If you wish to avoid the use of continuous positive airway pressure (CPAP) therapy, it is a tempting option. However, what are some reasons why you may not want to use an oral appliance to treat your condition? Explore 7 reasons why you shouldn’t use an oral appliance as sleep apnea treatment.

  • Your sleep apnea is severe.

If you have obstructive sleep apnea that is classified as severe, oral appliances are not adequate to treat your condition. Sleep studies identify sleep apnea severity according to the apnea-hypopnea index (AHI) or respiratory disturbance index (RDI). When these measures are greater than 30 events per hour, this is considered severe sleep apnea. If your oxygen levels were low in the study, this also reflects a more serious condition. Oral appliances may improve mild to moderate sleep apnea, but they will rarely provide adequate relief when it is severe and they are not approved for this indication.

  • You have problems with your jaw joint.

Oral appliances work by shifting the lower jaw, or mandible, forward during sleep. The tongue rests here and is also moved forward with treatment, opening up the back of the airway to reduce snoring and sleep apnea. This movement can put strain on the temporomandibular joint (TMJ) where the lower jaw connects to the skull.

If you have clicking, popping, or pain in your jaw joint, you may not want to add additional strain while sleeping. These problems frequently coexist with teeth grinding, an occurrence often associated with sleep apnea. Oral appliances may worsen TMJ dysfunction and if you have it to start, you shouldn’t exacerbate the problem.

  • They are too expensive.

It is shocking how much some dentists charge for an oral appliance. Inexpensive “boil-and-bite” appliances that can be purchased online and elsewhere often do not fit and frequently don’t work. These devices work best when they are properly fitted to your teeth based on plaster molds of your bite, created by a trained dentist. From these molds, acrylic trays are fabricated. The initial evaluation and consultation may be followed by other visits in which the appliance is fitted and further adjusted. These oral appliances may frequently cost in the range of $2,000 to $4,000 and some dentists charge more than $10,000. These costs are frequently not covered by insurance. If it doesn’t work, you won’t get a refund.

  • Your teeth are moving or missing.

The appliance is secured by fitting it over your teeth. If you are undergoing orthodontic treatment, with anticipated movement of your teeth, you can’t be fitted until your bite is permanent. If you are fitted for an appliance and your teeth undergo further adjustment, the appliance won’t fit any longer.

Moreover, if you lack teeth, especially if you have dentures that you remove at night, you may not be able to use an oral appliance. You must have adequate teeth to anchor the device in place to be able to shift the lower jaw forward.

  • Your nose is the real problem.

Obstructive sleep apnea may occur due to nasal obstruction, rather than due to a shift of the tongue into the airway. If you have a deviated nasal septum, nasal allergies, or swelling of turbinates within the nose, you may have decreased nasal airflow. This may contribute to mouth breathing and dryness. It also can add to snoring and sleep apnea and won’t be improved with an oral appliance. There may be other obstructions along the airway as well that are not addressed by the oral appliance.

  • You don’t have obstructive sleep apnea.

Beyond snoring and obstructive sleep apnea, there are other types of sleep-disordered breathing that can affect susceptible individuals. Central sleep apnea occurs in heart failure, after a stroke, or when taking narcotic medications. It is not improved with an oral appliance and typically requires bilevel therapy. In addition, obesity hypoventilation syndrome should not be treated with an oral appliance. There may be other conditions as well, and you should discuss your health and the most appropriate treatment option with your sleep specialist.

  • It takes too long to know if it works.

Finally, an oral appliance is not a quick fix to sleep apnea. It can take weeks to months to get fitted and adjusted. At some point, sometimes as long as 6 months after initiating treatment, it will be maximally adjusted. Your bed partner may note improved snoring or you could feel less sleepy. In order to really assess its effectiveness, it is necessary to have a sleep study with the appliance in your mouth. If it doesn’t work, you have wasted time and money when you could have been sleeping better. If sleep apnea persists despite its use, you should explore other treatment options such as CPAP, which works quickly, is covered by insurance, and treats the full spectrum of sleep-disordered breathing.

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