Snoring and Sleep Apnea
The field of dental sleep medicine has grown significantly in the last 20 years, and Dr. Rich has been partnering with sleep specialists, primary care physicians, physical therapists, pediatric and adult ENT's, and other health-care practitioners in treating patients with snoring and sleep apnea since the mid-1990's.
Using custom- fabricated oral appliances, Dr. Rich aids in treating physically restricted airways by gently repositioning the lower jaw into a more forward position during sleep, which in turn holds the airway open for less obstructed breathing. In mild to moderate cases, this repositioning alone is enough to treat the snoring or apnea successfully. In severe cases, these appliances may be used in conjunction with a CPAP (Continuous Positive Airway Pressure) machine in order to make the machine more effective at a lower, more comfortable setting.
In general, a CPAP is still considered the standard of care for sleep apnea treatment in all but the mildest cases. However, many people are not able to wear the machine at all, or gradually stop wearing it over time. This can be very dangerous to the overall health of the affected individual. Sleep apnea effectively cuts off oxygen to the brain, and can lead to serious brain damage or even death if the airway remains fully obstructed for longer than a few minutes. For those people who are unable or refuse to wear a prescribed CPAP machine during sleep for any reason, an oral appliance is often the next best alternative to help keep the airway open during sleep. And for those people who love their CPAPs, wearing a nighttime dental appliance may still be necessary to help protect the teeth from grinding or to allow for a lower, more comfortable setting on the machine.
Even children can be diagnosed with sleep apnea. Allergies and enlarged tonsils or adenoids may often be involved, and weight can certainly play a role, but the position of the teeth and bite can also have a significant influence on the size of the airway. If the teeth are positioned so that the lower jaw is held back too far behind the upper front teeth, the airway may be constricted. Functional orthodontic treatment at this early stage can not only help with proper airway development, but it may also help decrease the probability of continued apnea development as an adult.
Evaluation of sleep apnea is not complicated. At your initial evaluation appointment, Dr. Rich will begin by taking a thorough medical history of your symptoms and treatment so far, noting your initial blood-oxygen levels while awake, and then performing a thorough examination of your throat, bite, and mouth.
Prior to making an oral appliance, a diagnosis of sleep apnea from your physician or sleep specialist will be needed. If you’ve not yet been diagnosed, Dr. Rich can refer you for the required overnight testing (often completed in your home) used in diagnosis. Patients who have already had a sleep study performed before seeing Dr. Rich are encouraged have the results sent to the office before their evaluation appointment. Children may sometimes be referred to a physician or pediatric ENT to further evaluate the airway.
Incorporating the results of the overnight sleep study, Dr. Rich then utilizes specialized diagnostic equipment to determine the ideal position of the lower jaw for improved breathing while still protecting joint and bite function. The final appliance is then be made to this custom position. After a few weeks of adjustment to the appliance, another sleep screening or overnight study is recommended to verify that the appliance is working at optimal effectiveness.
To provide you with more in-depth information on airway development, snoring, and sleep apnea, Dr. Rich has prepared a ongoing series of expanded resources called The Airway Series. Please take a look at the following articles to understand more about why sleep apnea occurs and what you can do to reduce your risk factors.
What is Sleep Apnea?
What's Snoring Got To Do With It?
Breathing and Airway Development in Children