Oral Appliance Therapy for Sleep Apnea

The Snoring & Sleep Apnea Center offers appliances to manage your sleep disorder breathing, snoring, and obstructive sleep apnea. Appliance brands and designs come and go, so knowing brand names is secondary to understanding fundamental differences. Seattle sleep dentist Dr. Katharine Christian created this appliance reference guide to educate patients about sleep apnea appliances.

Long Term and Short Term Appliances

Long term appliances are stronger, and more stain and odor resistant. Long term appliances can last up to seven years. They require impression accuracy more similar to that required for a crown or permanent bridge. At our Seattle office, we create one-of-a-kind appliances for each patient. We work with several laboratories that custom process processes the appliances to be compact and harmonize with mouth contours. Dr. Christian schedules two to three appointments from start to first insertion plus adjustments. Long term appliances have characteristics and advantages that benefit our Seattle patients seeking sleep apnea and snoring treatments.

The characteristics of a long term sleep apnea appliance:

• Requires 3-6 clinical appointments to complete and insert.
• Requires accurate impression of upper and lower teeth.
• Custom fabrication at qualified, professional laboratories.
• Made of internal elastomeric and external rigid, dense acrylic.
• Can adjust to obtain preferred starting position
• Custom contours create less bulk and easy patient accommodation.
• Incorporated metal components allow finer adjustment increments.
• Dense material resistant to odors and stain.
• Durability is approximately 3-7 years.
• Anterior, posterior, lateral and vertical adjustments.

The advantages of a long term sleep apnea appliance:

• Easier accommodation.
• Multi-directional adjustments.
• Smaller adjustment increments.
• Tough and durable.
• Snug fit.
• Stain and odor resistant.
• Covered by most insurance carriers.
• High patient satisfaction.

Short term appliances are indicated when long term durability is secondary to obtaining a quick, cost effective appliance for short term wear or testing. These are often called "boil and bite" appliances. They consist of a "one-size-fits-all" rigid plastic u-shaped shell approximating the shape of the jaw. The material inside the shell becomes soft when placed in hot water. The heated material is pressed and adapted over the teeth before it reaches a firm, but slightly elastic state at mouth temperature.

Short term appliances are more bulky, less stable and retentive, and more difficult to accommodate. However, they require about 70% less clinic time than a long-term appliance, and require no laboratory processing. Unfortunately, short term appliances are more prone to stain and odor, and are more fragile. Their durability is measured in weeks or months rather than years. Short term appliances are adjusted in "mega" increments. Long-term appliances have "mini" adjusted increments. This is important for long-term wear.

CPAP

The historic "Gold Standard" of sleep apnea appliances is still the CPAP (Continuous Positive Air Pressure) machine. The CPAP is a sophisticated air pump with a hose connecting to a mask. This mask is secured over the nose with elastic straps.These machines require electricity to work, and are 100% effective for 60-70% of the population. However, 30-40% of sleep apnea sufferers cannot tolerate CPAP for a number of valid reasons.

Oral Appliances

Oral appliances that are used to treat sleep apnea resemble an athletic mouthguard. However, the oral appliances have more sophisticated features to dilate your airway by supporting the lower jaw in a slightly forward position. Seattle sleep medicine dentist Dr. Katharine Christian separates appliances into two broad types. The "passive" appliance provides no additional breathing assistance. It allows you to breathe naturally either through your nose or mouth. Some oral appliances can connect to a CPAP when a nasal mask can't be tolerated, but the additional breathing assistance is needed. Adding the pressured air makes them "active" appliances. Oral appliances enjoy a much higher acceptance from patients who need sleep apnea treatments. However, these appliances also have limitations.

First generation oral appliances had limited success in treating OSA and earned a poor reputation in sleep disorder medicine. These one-piece appliances held the jaws rigidly and were not adjustable. Technology, research, and creative design have produced some two-piece adjustable appliances with higher success rates. These sleep apnea treatments allow a slight lateral jaw movement while holding the mandible in the prescribed forward and vertical position. This feature is critical for people who grind or clench their teeth at night or have histories of TMJ-related problems.

With new materials and processing techniques oral appliances are smaller, stronger, and enable smaller adjustment increments. A single millimeter can dilate the airway greater than that provided in a single nostril.

Dental Sleep Medicine for Seattle Patients

Any device must be comfortable and easy to maintain to be effective. This includes artificial limbs, CPAP machines, and oral appliances. At our Seattle sleep medicine office, Dr. Christian has yet to discover a one-for-all type of appliance that works for everyone. Qualifying the patient and selecting that device that best meets your needs will provide the best assurance for OSA and snoring treatment success. Patients and referring doctors in Seattle, Tacoma, Everett, Redmond and Alaska can contact us now!