Snoring and Sleep Apnea

1. What Is the Dental Treatment for Snoring and Sleep Apnea?

Dental treatment for snoring and sleep apnea has been in the literature since the early 1900s, when Dr. Pierre Robin identified that the airway size corresponds to the position of the jaw. Dr. Robin developed a simple monobloc device that held the jaw in a protrusive position. This was the first documented use of an oral appliance for the treatment of snoring.

Modern oral appliance therapy incorporates titratable devices that allow the advancement of the mandible in increments of 1 mm or less. This gives a trained dentist the ability to move the mandible forward or backward depending on the patient’s response to this treatment.

Naturally, there is more than one way to get this kind of adjustment, and as the patient’s comfort is considered, there are different functional components that achieve the desired results.

2. Why Is Airway Size Important for Snoring and Sleep Apnea?

Snoring and its more serious comorbid condition sleep apnea are signs of a collapsing airway. In fact, snoring is the sound that a partially collapsed airway makes. When the patient falls asleep and the tissues of the airway relax, the jaw can fall back in the airway. As the base of the tongue approaches the wall of the hypopharynx, the rushing air vibrates soft tissue of the airway, creating the snoring sound.

When the airway completely collapses, the soft tissues can adhere to each other, creating an obstructive seal of the airway. The seal stops the patient from breathing entirely and can last for 10 seconds to more than a minute, despite the patient’s efforts to breathe. This is a serious medical condition.

If snoring is accompanied by any of the following issues, it may warrant consultation with a dentist or physician for sleep apnea evaluation:

• Witnessed breathing pauses during sleep
• Excessive daytime sleepiness
• Difficulty concentrating
• Morning headaches
• Dry mouth upon awakening
• Restless sleep
• Gasping or choking at night
• High blood pressure
• Chest pain at night
• Loud snoring that disrupts a partner’s sleep

3. How Do Oral Appliances Work?

Oral appliances for snoring and sleep apnea treatment have a very specific method of action. They are designed to cover and engage the upper and lower teeth, like a retainer or nightguard. These appliances all have some mechanism that joins the upper and lower splints, so that they are fixed together. This is how the lower jaw (mandible) is held in a position set by the dentist to apply tension to the muscles and ligaments of the upper airway and support the airway all night long.

As noted above, this position is an anterior or advanced jaw position, and it can be different for every patient. Modern oral appliances are all adjustable between 6 mm and 15 mm. This allows the dentist to adjust the lower jaw position after the appliance has been delivered, and the patient adapts to the initial jaw position.

TheSilent Nite^®Sleep Applianceis adjustable up to 6 mm.

This adjustability is key to sleep apnea treatment because the tissues of the airway can change over time. It is also important to understand that the muscles and ligaments of the jaw and airway will adapt to the protrusive jaw position over time. The slight change in jaw position that comes from this adaptation can result in more snoring. Adjusting the appliance by a millimeter or so will serve to restore airway patency.