WHAT WILL HAPPEN AT THE FIRST APPOINTMENT?
The first appointment consists of two types of airway testing, learning about the disease and learning about how we treat OSA.
WHAT CAUSES SNORING?
Snoring is most often caused by loose, weak, or excessive tissue at the back of the throat which collapses into the airway during sleep. This tissue flutters or vibrates as air is breathed in. This fluttering tissue, like a flag flapping in a strong breeze, is the cause of the aggravating noise we know as snoring.
WHY DOES SNORING OCCUR DURING SLEEP?
During sleep, the muscle tissue that causes snoring tends to relax. The deeper we fall asleep, the more relaxed this tissue becomes. This relaxed tissue will begin to cover the airway and thus the snoring sound begins. By the time we start to snore, we are in a deep enough sleep not to hear the noise.
MY SPOUSE LITERALLY STOPS BREATHING. IT SCARES ME TO DEATH! IS THIS NORMAL?
NO, THIS IS NOT NORMAL. It is a symptom of a far more serious problem called Obstructive Sleep Apnea.
WHAT IS OBSTRUCTIVE SLEEP APNEA?
Obstructive Sleep Apnea (OSA) is a sleep disorder where the airway becomes covered, usually by the tongue, due to abnormal muscle relaxation of the tongue and surrounding muscles in the throat area. With the airway covered, a person does not breathe. Since no breathing is taking place, one’s oxygen level in their body drops and their heart rate increases. This lowered oxygen level is dangerous because it can cause a stroke or heart attack. The higher heart rate is dangerous because it can aggravate high blood pressure. In an attempt to breathe, a person either awakens or partially awakens gasping for breath. Since an individual is always awakening to catch their breath, they never get the deep restful sleep needed by the body.
IS OBSTRUCTIVE SLEEP APNEA DANGEROUS?
YES! Sleep apnea has been linked to heart disease, strokes, high blood pressure, personality changes, impotence, depression, and nocturia. One of the most significant symptoms is excessive daytime sleepiness. Because of excessive sleepiness, tired drivers have a higher propensity for auto accidents.
HOW DO DENTAL DEVICES WORK?
Dental devices treat obstructive sleep apnea (OSA) by advancing the lower jaw which keeps the airways open. It acts as more than just a snoring mouthpiece! The appliance is custom-made to fit your mouth and consists of upper and lower splints that cover your teeth and will be titrated to advance your lower jaw throughout the treatment process. As your jaw moves forward, the mouthpiece helps open your airway, allowing you to breathe easier and sleep more comfortably for longer periods of time. This allows you to reach deep, REM sleep.
ARE ORAL APPLIANCES A VALID CPAP ALTERNATIVE?
Definitely yes. In 2006, the American Academy of Sleep Medicine published a position paper stating that oral appliances are comparable therapy to CPAP for mild and moderate apnea, and a treatment option for patients who were CPAP and surgery failures. One of the major advantages of the oral appliance is patient compliance. Over 95 percent of those given an oral appliance have reported continued use of the appliance after two years! The oral appliance has been shown to effectively control snoring in over 90 percent of patients. Mild and moderate sleep apnea respond extremely well; even many cases of severe apnea have been resolved with oral appliance usage.
IS A DENTAL DEVICE COMFORTABLE?
Most people easily adapt to wearing a dental sleep device at night. After wearing the device for a short period of time, it will become part of your routine, and most people will hate to go to sleep without it after they realize how much better they feel in the morning.
Compliance rates for dental sleep therapy are much higher than for other forms of non-surgical treatment of obstructive sleep apnea . In other words, patients are much more likely to use a dental device successfully than any other form of treatment. Most scientific studies show that up to 95 percent of individuals will comfortably wear their devices nightly.
Once patients experience better sleep and improved health associated with the use of a dental device, it is rare for someone to stop using it. Dr. Kempter himself wears a dental sleep device, and he knows firsthand the benefits of dental device use.
DO DENTAL DEVICES REALLY WORK IN TREATING SNORING AND APNEA?
YES! Medical research has shown that oral appliance therapy is very effective for mild and moderate sleep apnea, and very helpful for CPAP intolerant severe sleep apnea patients. This therapy is also very effective for people who have had surgery and the surgery was not successful. One of the major advantages of the oral appliance is patient compliance. Over 95 percent of those given an oral appliance have reported continued use of the appliance after two years! The oral appliance has been shown to effectively control snoring in over 90 percent of patients.
WILL AN ORAL APPLIANCE HELP ME IF IT ONLY PARTIALLY CONTROLS MY APNEA?
Definitely. Research has shown that being 70 percent, 80 percent, or 90 percent controlled is much better than 100 percent uncontrolled. One of the major advantages of the oral appliance is patient compliance.
IF I WEAR AN ORAL APPLIANCE TO TREAT MY SNORING OR APNEA, HOW WILL THIS AFFECT MY JAW JOINT?
Research and clinical data show that there is no adverse effect on the jaw joint. This is not to say that, in rare cases, jaw problems cannot occur. A certain percentage of patients will have tooth or jaw movement. This is a small inconvenience in comparison to the dangers of sleep apnea. Always remember, your ability to breathe trumps everything else.
WILL THE INEXPENSIVE BOIL AND BITE MOUTHPIECES I SEE ADVERTISED ON TV, INTENDED TO TREAT SNORING, SLEEP APNEA, AND OTHER SLEEP DISORDERS, WORK AS WELL AS A CUSTOM-DESIGNED ORAL APPLIANCE MADE BY A QUALIFIED DENTIST?
No, they will not. Research has shown that simple boil and bite mouthpieces are not effective in treating sleep apnea. Substantial scientific evidence indicates that custom-made adjustable dental sleep devices are far more effective and comfortable than self-fitting, “boil and bite” devices. The self-fitting devices are typically much larger, which decreases their effectiveness because the device may actually obstruct your airway during sleep. Most “as seen on TV” self-fitting devices are not adjustable, which can lead to discomfort and pain. Successful dental sleep therapy is extremely dependent on precise adjustments of the dental sleep device. Without this ability to finely adjust the device, treatment success rates drop dramatically.
Obstructive sleep apnea (OSA) is a serious and life-threatening medical disorder. It is unwise to treat obstructive sleep apnea or any other serious medical problem without proper medical supervision and guidance. Failure to seek medical supervision and choosing the ‘do it yourself’method can have serious medical risks, and can lead you to believe the problem is fixed when, in fact, it is not.
CAN MY PHYSICIAN OR REGULAR DENTIST MAKE MY DENTAL DEVICE?
The American Academy of Sleep Medicine (AASM) recommends dental sleep devices as the first line of treatment option for anyone who has mild to moderate apnea and for anyone (even patients with severe apnea) who cannot tolerate CPAP. The AASM states that these devices should be made by a dentist who has had specialty training in the field of sleep medicine. This prohibits physicians from making the dental devices, and your device should only be made by dentists with proper training. Dr. Kempter has devoted numerous hours to advanced training to ensure the highest level of care. We work closely with your physician to make sure that your dental sleep therapy is medically successful.
HOW LONG DO DENTAL SLEEP DEVICES LAST?
Longevity of dental sleep devices is highly dependent on the person using the device, and it depends on the specific device made, forces placed on the device, and your care of the device. If the device is well-maintained, it should easily last for three to five years before needing to be replaced. Most medical insurance providers will pay for construction of a new dental sleep device every two years, and their longevity can be from one to many years in length.
Each type of device has its own warranty. Typically after the first year, if a dental sleep device needs repair or to be reconstructed, the replacement fee is less than the initial cost of the device
CAN I KEEP SEEING MY EXISTING DENTIST?
Yes! We encourage you to continue to see your existing dentist for routine and preventative dental care. The goal of Preferred Sleep Solutions is to successfully treat your snoring or Obstructive Sleep Apnea (OSA).
Although it is necessary for your Preferred Sleep Solutions dentist to evaluate your teeth, their goals and your normal dentist’s goals are very different.
Preferred Sleep Solutions dentists evaluate your teeth to ensure that they are stable enough for dental sleep therapy and generally do not perform routine preventative care. Our staff works closely with your existing dentist and other medical providers, and we forward copies of any pertinent records or x-rays that were completed during your visit to help in future treatment. We work hard to provide the best possible treatment to you by providing coordinated patient care.
CAN YOU MAKE AN APPLIANCE JUST FOR SNORING?
Yes, dental sleep devices work quite well at reducing the sound and severity of snoring. However, if you are a snorer and have never had a sleep test it is advisable to be screened or tested for a more serious disorder, Obstructive Sleep Apnea (OSA). Many snorers also have obstructive sleep apnea, often without even realizing it. Preferred Sleep Solutions can help you coordinate a sleep test.
If your sleep test shows a diagnosis of Primary Snoring, then a dental sleep device can be made to control the sound and severity of your snoring. Usually, the procedures needed to treat snoring are simpler than for treatment of obstructive sleep apnea. This often results in fewer office visits and follow-up observations for people whose primary symptom is snoring.
IF I HAVE TMJ (JAW) PROBLEMS, CAN I STILL WEAR A DENTAL SLEEP DEVICE?
The answer to this question is unique for each patient, but most patients who have TMJ (jaw joint) problems can be treated successfully with a dental device. Many people incorrectly believe that they are not candidates for a dental sleep device if they have TMJ or jaw disorders. In some instances, dental sleep devices are not recommended when certain TMJ or jaw disorders are present, but often these problems will not prevent treatment with dental sleep devices. Use of some dental appliances can sometimes even improve TMJ symptoms.
For the cases where there are TMJ and jaw concerns, there are several types of dental sleep devices available that don’t move the jaw forward and have little effect on the jaw joint. If you have jaw problems, your Preferred Sleep Solutions dentist will be happy to discuss your TMJ concerns and help decide whether you are a good candidate for dental sleep therapy.
WHAT IF THE ORAL DEVICE DOES NOT WORK?
Although dental devices are effective in the vast majority of patients, there could be an occasion where the device is not working or is not meeting your therapeutic needs. In these occasions, please keep in close contact with your sleep dentist throughout the treatment process. If you feel that it is not working, then the sleep dentist will need to evaluate the device and make any necessary adjustments. If you feel your sleep apnea symptoms are worsening, we will help coordinate with your physician for alternative treatment options, as you may have a severe case of OSA.
ARE THERE SIDE EFFECTS OR COMPLICATIONS FROM WEARING A DENTAL DEVICE?
As with any medical treatment, there are possible complications or side effects to dental sleep therapy. Considering the well-documented health risks of leaving obstructive sleep apnea (OSA) untreated, most of the side effects are considered minor. However, most patient’s side effects will subside after the first week or two. The three primary side effects are tooth discomfort, TMJ (jaw joint) or muscular discomfort, and tooth movement or bite changes. It is important to note that other minor complications are possible, like salivation changes and dry lips.
Tooth discomfort is the most likely complication but is also generally the least concerning. Dental devices can put pressure on the teeth and may cause temporary soreness. If this does occur, it can often be easily alleviated by adjustment of the oral device by your sleep dentist. Research suggests that there is no evidence of long-term tooth discomfort with properly fitted dental sleep devices.
Dental devices work by moving the lower jaw forward to open the throat and collapsible airway. Due to this forward positioning of the jaw, there is a risk of TMJ (jaw joint) muscle discomfort. Dental devices are adjustable, so each device can be adjusted gradually to help achieve advancement with minimal discomfort. Long term muscle discomfort is rare. Short-term discomfort is usually treated by adjusting the dental device to a more comfortable setting. Certain patients with existing TMJ (jaw joint) problems may not be able to wear dental devices, while other patients with TMJ (jaw joint) problems may actually improve their jaw problems by wearing a dental device. Your trained Preferred Sleep Solutions dentist will be able to help determine solutions to any of your discomforts or concerns.
Dental devices are custom fit to your mouth and consist of an upper and lower splint that covers your teeth. Due to the device’s fit, there are forces exerted on the teeth and on the jaw while wearing a device. These forces can cause teeth to move slightly, or the forces can cause the jaw to be repositioned, which can change your bite. There are recommended jaw exercises that you can use for a few minutes each morning after wearing the dental sleep device that will help reset your bite. Speak with your Preferred Sleep Solutions dentist for more information on exercises suitable for your treatment.
Despite the above-described side effects, however, obstructive sleep apnea may pose serious health risks and should be treated. It disrupts normal sleep patterns, can reduce normal blood oxygen levels, and may result in excessive daytime sleepiness, irregular heartbeat, high blood pressure, heart attack or stroke. Although some changes might be undesirable in certain patients, the effective treatment of a life-threatening disease such as sleep apnea supersedes the maintenance of regular bite. Even if major tooth movements are seen, the discontinuation of oral appliance treatment should occur only if the patient accepts another treatment form, such as a CPAP (Continuous Positive Airway Pressure) device, as directed by your physician.