Oral Appliance Therapy As A First Line Therapy For Obstructive Sleep Apnea

Oct 28, 2019
Oral Appliance Therapy As A First Line Therapy For Obstructive Sleep Apnea
Obstructive sleep apnea (OSA) is the medical term used when referring to a sleep disorder that is characterized by an intermittent failure to breathe during sleep due to some type of physical obstruction that repeatedly blocks the airway.

Obstructive sleep apnea (OSA) is the medical term used when referring to a sleep disorder that is characterized by an intermittent failure to breathe during sleep due to some type of physical obstruction that repeatedly blocks the airway. The body struggles to breathe but cannot – the effort can go on for 10, 20, 30 seconds or more. When the blockage is finally cleared, gasps for air, snorts and/or choking sounds occur as the body resumes normal breathing. Until the block happens again.

For years, individuals with OSA have been treated with continuous positive airway pressure (CPAP); however, oral appliances as a first line therapy for sleep apnea may be able to address a patient’s obstructive sleep apnea without the need for expensive, bulky and uncomfortable equipment.

Understanding Obstructive Sleep Apnea

As an individual sleeps, the muscles throughout the body relax. This is a natural process and is meant to provide the muscles time to repair themselves; nevertheless, the muscles in the throat and mouth also relax. For approximately 22 million Americans, these muscles relax and fall back, blocking the upper airway. Furthermore, if soft fatty tissues are present, these may also create a blockage.

When an individual stops breathing during sleep, the brain responds by sending the respiratory system signals to work harder to get past the blockage. In order to send these signals, the brain must partially awaken, which is why many people who have untreated obstructive sleep apnea consistently feel tired. In addition, individuals may experience mood disturbance, pounding headaches directly after waking up, memory problems, cognitive impairment, a sore throat upon waking, loud snoring, depression and an overall decrease in their quality of life.

The severity of an individual’s OSA is determined by the number of apnea events he or she experiences during sleep:

  • Mild – 5 to 14 episodes within an hour.
  • Moderate – 15 to 30 episodes within an hour.
  • Severe – 30 or more episodes within an hour.

The side effects of sleep apnea include:

  • heart/cardiac disease;
  • hypertension (i.e., high blood pressure);
  • heart arrhythmias;
  • a stroke;
  • a myocardial infarction (i.e., heart attack);
  • an increased risk for developing diabetes; and
  • death.

Issues That Increase an Individual’s Risk of Developing OSA

There are certain factors that increase the likelihood that an individual will develop sleep apnea.

Factors that increase the likelihood of developing OSA include:

  • genetics (i.e., a family history of the disorder);
  • excess weight;
  • sedative use;
  • age (40+);
  • having a large neck; and/or
  • excessive alcohol consumption.

Addressing Obstructive Sleep Apnea: Getting Started

Following a mild to moderate obstructive sleep apnea diagnosis, a custom-designed oral appliance can be created to prevent the blockage from occurring. Keep in mind that OSA is a serious health condition; therefore, over-the-counter devices are not recommended for treating this disorder.

Oral Appliance Therapy (OAT) is the Leading Alternative to CPAP for Treating OSA

OAT has emerged as the leading alternative to continuous positive airway pressure for the treatment of sleep apnea.

Clinical guidelines recommend the use of MADs prior to implementing CPAP when an individual has mild obstructive sleep apnea as well as in cases where an individual with a more severe case of obstructive sleep apnea refuses to or cannot tolerate treatment with a continuous positive airflow pressure machine.

OAT and Sleep Apnea: An Overview

In the past, CPAP therapy has been the preferred treatment for OSA. Today, doctors focus on recommending the treatment the patient is more likely to use and work hard to make that choice the most effective, also. Some patients should only consider CPAP; most patients become well-informed enough to choose from several alternatives, including OAT.

The side effects frequently associated with CPAP therapy include:

  • development of dry nasal passages;
  • a feeling of claustrophobia while wearing the mask;
  • accidentally removing the mask or nasal cushion during sleep; and/or
  • skin irritation where the mask rests on the face or the nasal cushion sits on the nose.

Furthermore, due to their ease of use and comfort level, many patients with mild to moderate sleep apnea prefer oral appliance therapy over CPAP therapy. Oral appliance therapy devices are similar to orthodontic retainers or the mouth guards worn while participating in sports.

The Oral Appliances Used to Treat Obstructive Sleep Apnea: Explained

Numerous devices are used to treat sleep apnea and while each differs somewhat in appearance, most fall within one of the following categories:

Mandibular advancement devices (MADs) – these appliances reposition the lower jaw by moving it slightly forward and down to make sure that the airway remains open while an individual sleeps. These devices are the most commonly used oral appliances for treating sleep apnea. MADs snap over the patient’s upper and lower arches, with a connection that keeps the lower jaw forward, not allowing it to drop back. There are several variations on the type of MAD that you can discuss with your dentist.

Mandibular advancement devices work by preventing the throat muscles and pharynx from collapsing into the airway; thus, allowing the individual to breathe normal while sleeping. Most of these devices can be adjusted, which allows the sleep apnea dentist to fine-tune the device for maximum effectiveness.

Oral Appliance Therapy vs. CPAP Therapy for OSA

When compared to continuous positive airway pressure therapy, there are many benefits to choosing OAT for the treatment of sleep apnea.


  • Many people find wearing a dental device more comfortable than wearing a CPAP mask or nasal cushion.
  • Equipment entanglement during sleep is a common complaint from individuals who use CPAP machines, since oral appliance therapy does not require any hoses, concerns related to entanglement are eliminated.
  • Mask or nasal cushion removal during sleep is another common problem associated with continuous positive airflow pressure therapy. There are no masks or nasal cushions needed with oral appliance therapy.
  • Patients who use a CPAP machine frequently complain that their nasal passages are dry and/or itch due to the continuous flow of pressurized air as they sleep. This is not an issue when OAT is used.
  • Traveling with bulky continuous positive airflow pressure therapy equipment can be difficult, an oral therapy device can fit in one’s pocket.
  • A CPAP machine requires electricity; however, an oral therapy device does not.
  • The tubing for the CPAP machine must be cleaned once a week: This entails removing the hose and washing it in warm, soapy water and leaving it to air dry. In addition, the CPAP mask must be taken apart and cleaned daily and headgear must be cleaned weekly. Needless to say, an oral therapy device is much easier to clean.
  • When a CPAP machine is used, equipment must be replaced on a regular basis. This equipment includes the mask, filters, headgear, nasal cushion, pillow cushion, chinstrap, full-face cushion, etc. Most of these items must be replaced several times a year. The tubing must be replaced annually and the machines themselves should be replaced every 5 years.

How Much Does a Sleep Apnea Oral Appliance Cost?

Appliance costs vary; however, the use of oral appliance therapy to treat sleep apnea is usually much more economical when compared to the costs associated with continuous positive airway pressure therapy.

Does Medical Insurance Cover Oral Appliance

Therapy for Sleep Apnea?

While the majority of insurance companies will cover OAT treatment, patients should always check with their insurance company before starting treatment for sleep apnea.

Is a Sleep Study Required?

Yes, before receiving treatment for obstructive sleep apnea, a sleep study is required. Understanding the specifics of an individual’s disorder and receiving an accurate diagnosis is essential to determining which treatment will provide you or your child with optimal results.

Contact Premier Sleep Associates in Bellevue, Washington

For more questions about Oral Appliance therapy, feel free to contact Premier Sleep Associates today by calling us at (452) 698-1732. Or click the button below to request an appointment today!