Treating Obstructive Sleep Apnea with a Mouthpiece

By Clinton Marquardt - Sleep & Fatigue Specialist

August 20, 2013

better sleep, fatigue, sleep apnea

ResMedCPAP
ResMedCPAP

Four out of every 100 men have obstructive sleep apnea (OSA) and 2 in every 100 women have it[1]. Some researchers estimate that as many as 10 in 100 men between the ages of 40 and 60 have OSA[2].  This sleep disorder disrupts sleep by causing very brief awakenings, lasting only a few seconds. The disrupted sleep significantly increases the risk of very high levels of fatigue[3]. In most provinces and states, medical doctors are required to file a report to the ministry of transportation when one of their patients is not complying or responding well to treatment.

Guess what happens when that report gets filed?  Yup, that’s right, the patient’s driving license is suspended until they can prove that they are not a risk on the road. Patient’s get caught up in a very frustrating system of medical tests, transportation ministry reporting and occupational health and safety assessments.  To avoid getting caught up in this sticky web, be proactive and make sure your OSA is being treated properly and that you can stay alert at all times.

I get a lot of e-mails asking about the best treatments for OSA. Here is what I usually say…

For Obstructive Sleep Apnea (OSA), the best remedy is Continuous Positive Airway Pressure (CPAP). A CPAP mask and unit are about 99% effective in solving obstructive sleep apnea providing the system is tolerable. Surgical techniques are painful and not very effective. The SnorBan mouthpiece was developed to reduce snoring. This device is known as a Mandibular Advancement Device (MAD). Although I am not a medical doctor, and therefore cannot treat your OSA, SnorBan is a great alternative and adjunctive therapy for mild OSA when it is used carefully. In fact, the Academy of Dental Sleep Medicine (ADSM) supports the guidelines published by the American Academy of Sleep Medicine in the January 2006 issue of the journal SLEEP regarding the use of oral appliances to treat mild to moderate obstructive sleep apnea and snoring (see: Kushida,C.A., Morgenthaler,T.I., Littner, M., et al. Practice Parameters for the treatment of snoring and obstructive sleep apnea with oral appliances: an update for 2005. SLEEP 2006; 29: 240-243). MAD’s can also be used with more severe degrees of sleep apnea where CPAP is not tolerated. This means that with mild sleep apnea, the SnorBan Anti-Snoring Mouthpiece will likely remedy the snoring problem 100%! If the apnea is moderate or severe you might not achieve a 100% reduction.

If you are unsure of the severity of your OSA, let me know your respiratory disturbance index (RDI) or the number of respiratory disturbances per hour of sleep or your CPAP pressure and I will give you an idea of your severity rating.

For people with OSA, I recommend the following steps (please discuss them with a medical doctor):

  1. Have an initial overnight sleep study performed in a sleep disorders center to assess the severity of the OSA. Choose a sleep disorders center that employs doctors accredited by the American Board of Sleep Medicine. I do not recommend having a sleep study performed in your own home or with portable equipment because they are typically not as accurate. If you need instructions on how to request a sleep study let me know, I can give you some pointers.
  2. If an overnight sleep study is not possible, then buy the SLEEP ADVISOR SYSTEM.SAPackage Simply pop the Sleep Advisor CD into your computer, answer a few questions and within minutes you will know the approximate severity of your OSA. The Sleep Advisor CD uses SOPHISTICATED DIAGNOSTIC FORMULAE to analyze your answers and provide you with a Personalized 10 – 15 page SLEEP HEALTH ANALYSIS REPORT. This detailed report will tell you exactly what is going on with your sleep and whether or not you have OSA.
  3. Next, buy the SnorBan Anti-Snoring Mouthpiece and use it for fast, affordable and guaranteed relief while you work on the next steps.

    SnorBan Anti-Snoring Mouthpiece Kit
    SnorBan Anti-Snoring Mouthpiece Kit
  4. Work on getting set up on CPAP. This usually requires another sleep study, although some CPAP units have an auto-set function that determines the correct pressure while you use the unit in the comfort of your own home. Ask your sleep disorders center staff about the use of this type of CPAP.
  5. If CPAP is well tolerated and provides some relief, then use it nightly. The SnorBan Anti-Snoring Mouthpiece can be used when you need a break from CPAP or while traveling and a CPAP unit is too troublesome to carry around.
  6. If CPAP is not well tolerated, then have a 3rd sleep study performed while using SnorBan. If the sleep study confirms that the mouthpiece is effective, then consider buying a new one every year. They will sometimes lose their shape a little and this compromises effectiveness. If you don’t want to buy a new one every year, then make an appointment to see a dentist who specializes in Sleep Related Breathing Disorders (SRBD) who can make a MAD customized perfectly to your jaw and teeth lines. Make sure the dentist is accredited by the American Academy of Dental Sleep Medicine. You can find a list of these dentists here. The custom-fitted MAD’s cost anywhere from $800 to $2,000 and because they are customized units, dentists cannot give you your money back if the MAD does not work. That is why I recommend starting with the SnorBan Anti-Snoring Mouthpiece.
  7. Make sure your progress is followed closely by a medical doctor and never stop any treatment without talking to your medical doctor first. Remember that medical doctors are required to report any patient who stops treatment without the doctor’s recommendation.

References

[1] Young, T., Palta, M., Dempsey, J., Skatrud, J., Weber, S., & Badr, S. (1993). The occurrence of sleep-disordered breathing among middle aged adults.  New England Journal of Medicine, 328(17), 1230-1273.

[2] Bearpark, H., Fell, D., Grunstein, R., Leeder, S., Berthon-Jones, M., & Sullivan, C. (1990). Road Safety and Pathological Sleepiness: The Role of Sleep Apnea. Sponsored by the Roads and Traffic Authority, NSW and the Federal Office of Road Safety, Canberra, Australia. Road Safety Bureau Consultant’s Report CR 3/90.

[3] See for examples:

(A)Chung, F., Yegneswaran, B., Liao, P., Chung, S., Vairavanathan, S., Islam, S., Khajehdehi, A., & Shapiro, C. (2009). STOP questionnaire: A tool to screen patients for obstructive sleep apnea. Comment in: Anesthesiology, 110(1), 193; author reply 193-194. Anesthesiology, 108(5), 812-821.

(B) Mills, P., Kim, J., Bardwell, W., Hong, S., & Dimsdale, J. (2008). Predictors of fatigue in obstructive sleep apnea. Sleep & Breathing, 12(4), pp. 397-399.


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