Dental Sleep Medicine:
Poway and Rancho Bernardo, CA
Treating Snoring, Obstructive Sleep Apnea & Upper Airway Resistance Syndrome with Oral Appliance Therapy.
What Is Obstructive Sleep Apnea (OSA)?
Apnea literally means “cessation of breath.” Obstructive sleep apnea (OSA) is the most common type of sleep apnea and is caused by obstruction of the upper airway. It is characterized by repetitive pauses in breathing during sleep, despite the effort to breathe, and is usually associated with a reduction in blood oxygen saturation.
What Causes Obstructive Sleep Apnea?
During sleep the airway becomes blocked due to a collapse of the throat. When the patient’s airway becomes blocked, they are not able to take a breath. Because the brain and heart are deprived of oxygen, blood pressure and heart rate increases can put the OSA patient at risk for heart attack and stroke. The breathing pauses can happen hundreds of time during the night, causing lack of energy and daytime sleepiness. The patient is usually unaware of this occurrence, however, their bed partners will often observe that the patient has stopped breathing, is holding their breath or gasping for air.
If untreated, sleep apnea can lead to serious health problems such as:
•High blood pressure
•Gastric Acid Reflux
•Excessive Daytime Sleepiness, etc.
Common Symptoms Of Sleep Apnea:
•Difficult nose breathing
•Dry mouth upon awakening
•Choking/gasping sensation that wakes you up
•Stop breathing while sleeping, then snort
•Restlessness and tossing and turning during sleep
•Inability to sleep through the night
•Excessive daytime sleepiness
•Short-term memory loss
•Decreased sex drive
Snoring And Sleep Apnea Treatments:
The treatment options for OSA are:
•Sleep Appliances/Oral Appliance Therapy (OAT)
•CPAP (Continuous Positive Airflow Pressure)
What Is Oral Appliance Therapy (OAT) and how does it work?
The new guidelines from the American Academy of Sleep Medicine now consider oral appliances to be a first line treatment for mild to moderate sleep apnea and an alternative to CPAP for severe apnea when patients do not tolerate CPAP.
The oral appliance, also called a mandibular advancement splint (MAS) or mandibular advancement device (MAD) is a custom-made mouthpiece that shifts the lower jaw forward, opening the airway during sleep. The sleep appliance successfully widens the airway by bringing the jaw and the tongue forward, away from the throat, since the base of the tongue is attached to the jaw; and also bringing the pillars of the soft palate (roof of the mouth) forward which are attached to the base of the tongue.
The CPAP machine (Continuous Positive Airflow Pressure) is effective only if the patient is compliant using it, but it isn’t the only solution. Studies have shown that the majority of patients prescribed CPAP do not use it on a regular basis because of many reasons including: discomfort from the face mask, inability to sleep due to the noise of the machine, dry mouth and throat, skin irritations, keeps their bed partner awake due to the noise, interference with intimacy, etc. When the CPAP is combined with a sleep appliance (mandibular advancement appliance) allows a dramatic drop in the pressure of the oxygen being used and a dramatic increase in comfort. Oral appliances are well tolerated by patients and a majority of patients offered a choice between oral appliances and CPAP prefer oral sleep appliance therapy.
At the initial appointment, Dr. Cook will perform a comprehensive examination. If oral appliance therapy is indicated, she will use TENS therapy (Transcutaneous Electrical Neural Stimulation) to relax the airway and jaw musculature, to design and create the custom-made sleep appliance in the physiologic neuromuscular position of the jaw.
Dr. Cook prescribes the most advanced FDA approved sleep appliances that are designed and created not only to open and support the airway during sleep, but also to maintain the jaw in its physiologic and neuromuscular position. The sleep appliances prescribed by Dr. Cook are custom made medical devices created to fit your mouth, and help your unique condition, unlike over-the-counter appliances that can cause a distortion of your bite and TMJ problems.
Micro2 Sleep and Snore Device by Microdental Laboratories
Often patients who suffer from Obstructive Sleep Apnea also suffer from TMJoint dysfunction. These patients might also experience TMJoint problems or muscle pain. Often patients with Sleep Breathing Disorders who also have TMJoint disorder may need a night-time sleep appliance to support the airway during their sleep and a daytime functional appliance to support their bite during the day and correct the bad bite and TMJ problem. The outstanding fact is that 90-95% of oral appliance users report long-term satisfaction with their treatment. Many patients who start with treating their sleep apnea problems find that correcting the underlying TMJ disorders is an advantage not a problem. TMJoint problems are almost never a reason to not use oral appliances but they need to be addressed and treated by a dentist trained to deal with TMJ Disorders. The American Academy of Sleep Medicine actually advised in their recommendations that oral sleep apnea appliances be fit by dentists trained to deal with TMJ disorders. Dr. Cook and her team have received advanced training in Neuromuscular Dentistry, TMJ Disorders and Sleep Breathing Disorders at LVI, the world’s premier learning center for neuromuscular dentistry. Dr. Nicol R. Cook has earned the designation of Fellow from LVI Global, the Las Vegas Institute for Advanced Dental Studies and Neuromuscular Dentistry, recognized by dentists around the world as the premier post-graduate institution for continuing education in Neuromuscular Dentistry. Dr. Cook is Member of the American Academy of Dental Sleep Medicine.