- If you’re overweight, lose weight with diet and exercise.
- Avoid alcohol, sleeping pills, and other sedatives-especially before bedtime.
- Avoid caffeine and eating a heavy meal before bed, both of which can interfere with a good night’s sleep.
- Sleep on your side, rather than on your back where you’re more likely to snore. You can either buy a pillow to keep you on your side, or even possibly sew a tennis ball into the back of your pajamas to prevent you from flipping over.
- Tilt the head of your bed up a few inches. The higher angle will help you breathe better.
Oral Appliance Therapy (OAT)
OAT is a therapy that treats snoring and Obstructive Sleep Apnea using a dental appliance that opens the airway during sleep. This opening is accomplished by a variety of means in which the lower jaw is protruded or the tongue is repositioned. Oral devices have been used since the early 1980’s for patients with snoring. The initial device will reduce the amount of snoring to a point that it is tolerable for the bed partner and hopefully will eliminate snoring completely.
These devices are similar to orthodontic retainers or sports mouth guards. Oral Appliance Therapy involves the selection, design, fitting and use of a custom designed oral appliance that is worn during sleep. This appliance then attempts to maintain an opened, unobstructed airway in the throat by repositioning the lower jaw, tongue, soft palate and uvula.
In 1995, the American Academy of Sleep Medicine (ASM) issued a position paper stating that oral appliances were the second line of treatment for CPAP non-compliance patients. In February 2006, however, the ASM published a position paper stating that oral appliances are now the gold standard for mild to moderate cases of Obstructive Sleep Apnea and should be used prior to opting for a surgical procedure for severe Obstructive Sleep Apnea.
My sleep physician and PCP never even mentioned Oral Appliance Therapy (OAT) as a treatment choice, why is that?
The average Medical School in the United States spends exactly 4 hours teaching their future graduates about sleep—the one part of the human existence that takes up (or should take up) one-third of our life. There isn’t enough time in a 4-year medical curriculum to cover everything in depth—that’s why residencies, specialty training and continuing education exist.
If you did broach the subject of an oral appliance with your physician, did he/she merely pass it off? Was there a consideration that surgical options are laden with risks (and only 40% effective) or that you’re not sleeping anyway because you can’t use the CPAP? The CPAP is, will be, and always has been the “gold standard” in sleep medicine because it works 100% of the time–but only in 25% or so of the population that needs it–so it is hardly “gold standard-worthy” in the eyes of many. If one can’t use a CPAP and surgical procedures don’t work–what other choice does one have?
I have asked my physician about oral appliances for sleep apnea, he has said that they have not been very effective for significant sleep apnea. What’s the general consensus?
It’s unusual in 2012– ten years after the American Academy of Sleep Medicine granted acceptance to oral appliance therapy for OSA treatment, especially in cases where the CPAP is not tolerated– for your doctor to report that oral appliances don’t work for significant apnea. The majority of my patients have confirmed up to half of all apnea sufferers can’t tolerate a CPAP. To add to the dilemma, half of all those who can tolerate it, can’t where it all night!
The rest of our patients are post-surgical patients (only 40% or so of surgical procedures are effective) that still can’t breathe at night, or those that can’t put up with the hassles, stigma, or claustrophobia that accompanies the use of a CPAP in bed every night.
Continuous Positive Airway Pressure (CPAP)
CPAP is a type of therapy used to effectively treat obstructive sleep apnea in which an air compressor forces air through the nose and airway.
CPAP treatment consists of three parts: the CPAP compressor, tubing and a special CPAP mask or cannula. The CPAP Machine is essentially a quiet air compressor that continually forces air thorough the tubing to the mask or cannula (cannulas are small tubes that fit within the nose). The continuous air pressure forces the airway to remain open, which allows for normal breathing for the entire night. Difference between Bi-level and Auto CPAP machines: Bi-level CPAP machines have two different settings, one for inhalation and one for exhalation. Auto CPAP machines automatically adjust to the resistance a patient’s breath gives and provides the appropriate amount of pressure. While Bi-level CPAP machines will work without problems, Auto CPAP machines provide maximum comfort. CPAP is a lifestyle change and many patients do not tolerate this treatment. Oral Appliance therapy can become very useful for this subset of people who dislike the cumbersome mask, tubing and machine every night.
The Pillar procedure is a solution for both snoring and mild to moderate sleep apnea originating from the soft palate. This breakthrough procedure is office-based, requiring only a conscious sedation and local anesthetic. Four to five small, flexible implants are placed into the upper soft palate to add support during sleep. Within three months of implantation, the palate flutters less and snoring is improved. Pillar implantation takes about 20-30 minutes to perform. This procedure is associated with minimal discomfort with most patients returning to work the following day. The Pillar Procedure was originally performed with three implants and the majority of studies regarding its efficacy were carried out using three implants. The width of the soft palate will determine whether four or five implants will be placed. Most patients will experience a sore throat for one to two days, which is typically relieved with the use of throat lozenges and over the counter pain medications. The majority of patients return to work by the next day after implantation. The majority of patients notice an effect within four to six weeks after implantation, although 10-20% will notice an immediate snoring reduction. The natural tissue response to the implants will progressively support the soft palate over the 3-12 months after implantation to further minimize the sound of snoring. Pillar® implants are made of a strong woven material that lasts a lifetime. Designed to be permanent, the implants are capable of being removed although there is rarely a reason to do so.
Radio Frequency (RF) of the Soft Palate
Radio Frequency uses radio waves to shrink the tissue in the throat or tongue, thereby increasing the space in the throat and making airway obstruction less likely. Over the course of several treatments the inner tissue shrinks while the outer tissue remains unharmed. Several treatments may be required, but the long-term success of this procedure has not as of yet been decisively determined. Also please refer to Somnoplasty® below.
Somnoplasty is an effective, minimally-invasive choice for the treatment of obstructive sleep apnea syndrome. Delivering radiofrequency energy submucosally to the base of tongue, Somnoplasty creates limited zones of coagulation beneath the tissue surface. As lesions resorb, they stiffen and reduce the tissue in the base of tongue. A study published for OSAS/UARS reported a 55% reduction in the mean respiratory disturbance index (RDI) from baseline for all subjects – with an overall mean reduction in tongue volume of 17%.
Clinical results show that Somnoplasty effectively treats obstructive sleep apnea by shrinking the base of the tongue (the most difficult source of obstruction to treat) in moderately and severely affected patients. Sophisticated testing and analysis following treatment with Somnoplasty has indicated that patients experience an average of 17%, and as much as a 35%, reduction in tongue tissue volume, a range that is comparable to conventional surgical techniques.
All potential candidates should be evaluated by a sleep physician to confirm the presence of obstructive sleep apnea (including an overnight sleep study) and identify the possible sites of airway obstruction.
Somnoplasty has been cleared by the FDA for use in the treatment of 3 conditions: habitual snoring (soft palate and uvula), chronic nasal obstruction (enlarged inferior turbinates), and Obstructive Sleep Apnea. More than 80,000 patients have been treated with Somnoplasty procedures.