5 Things You Must Consider Before Trying An Oral Appliance for Sleep Apnea

Depositphotos_63662341_originalIn my last two posts, I described 7 positive and 5 negative aspects of mandibular advancement devices for obstructive sleep apnea.
If you’re thinking about trying an oral appliance for your sleep apnea, here are 5 things you must consider to maximize the chances it will work for you:
1.  Make sure you’re able to breathe well through your nose. For most people, it’s pretty obvious if your nose is stuffy, but for some others, you won’t know if you have a stuffy nose since you’ve had it all your life. By definition, people with obstructive sleep apnea have smaller facial dimensions so the nose will tend to be stuffier than normal. Whether you use nasal saline, Breathe Rite strips, allergy medications, or even surgery, do everything possible to make sure you’re breathing optimally through your nose before starting your oral appliance treatment. Research has shown that having better nasal breathing will significantly increase your chances of benefiting from oral appliances (and CPAP as well). 
2. Research has shown that people with severe obstructive sleep apnea (AHI over 30) don’t do as well with mandibular advancement devices. It doesn’t mean that it won’t work with you, since everyone is different. This makes sense since having years and years of repeated obstructions will cause your throat tissues to cave in and becme floppy, so moving your tongue forward won’t open up other areas in your throat.
3. If possible have your ENT (otolaryngologist) take a look at your throat using a flexible camera with you lying flat on your back. This position maximizes tongue collapse. Note the air space behind your tongue and then thrust your lower jaw forward, beyond your upper teeth. Make sure you’re not opening your mouth too much, since that will push your tongue backwards. Most people will have significant tongue movement when pushing the jaw forward, but there are some people where the tongue doesn’t move very much, or not at all. I’ve had a number of patients who paid $3000 for an oral appliance which didn’t help, and we found that the tongue doesn’t move at all. Rarely, the tongue can move backwards with the jaw thrust forward. 
You also want the soft palate to open up at least somewhat along with the tongue moving forward. The side of the tongue connects with the soft palate via the palatoglossus muscle. For people with severe obstructive sleep apnea, no matter how much the tongue moves, the soft palate still collapses completely.
4. It’s also important to remember that routine dental x-rays and CAT scans of the throat are usually performed sitting up, so the airway can seem wide open. In many cases, the degree of obstruction can be dramatically more severe when lying down on your back. This is why many of you can’t sleep on your back.
5. Not all advancement devices are equal. I get asked all the time which is the best device. There are literally dozens of different FDA approved mandibular advancement devices. All have their pros and cons. Most experienced dentists will have a handful of favorite options that are used for appropriate patients. Ultimately, it’s the dentist’s experience and follow-up care which is more important than which device is used. Similarly, how and why a surgeon uses a laser is more important than which type of laser he for she uses.
In my practice, if you have mild to moderate sleep apnea, can breathe well through your nose, and can open up the space behind the tongue and soft palate by moving your jaw forward, you have a much higher chance of benefiting from mandibular advancement devices.
If you’ve been successful with an oral appliance to treat your sleep apnea, please describe your experience below. 

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4 thoughts on “5 Things You Must Consider Before Trying An Oral Appliance for Sleep Apnea

  1. Dr. Park…….I would like you to be aware that there now is a ‘temporary’ appliance, called myTAP, that meets all the criterion of a well made MAD that is approximately 1/6 of the cost of a permanent appliance. This device can be made right in the dental office. In my office we usually make this appliance first to determine whether or not the patient will be a responder, how they tolerate the appliance and their compliance. MyTAP is completely titratable and that position, once determined, can be transferred to the permanent MAD. In our office the fee for the myTAP is applied to the permanent appliance, so the patient loses nothing except the smaller fee, if the myTAP doesn’t work for them. This appliance has been available for about a year.
    Dr. Jack

  2. Thanks. I saw myTAP at one of the sleep meetings and even had one made for me!

    It’s great to see new innovations with mandibular advancement devices.

  3. There are a number of different variations of these appliances with additional bells and whistles. I’ve seen Oasys being prescribed by some dentists. Honestly I can’t say which is better, since there are no head to head studies comparing various devices. Each have the advantages and disadvantages and the decision to choose one over the other should be based on individual patient factors. Most good dentists will use a number or different devices for this reason.