February 9, 2013

Treatment Options Expanding for Sleep Apnea Patients – Oral Devices an alternative to clunky CPAP machine

By Jim Hall

The most common treatment for those with sleep apnea is a forced-air machine which aids in breathing, called the CPAP.

But a second option, a custom-made device that fits inside the mouth, is increasingly used by some apnea patients.

Called the oral appliance, the device resembles a sports mouth guard and is available for those with mild to moderate forms of the sleep disorder.

“I think it’s important for a person who has sleep apnea to know of their options, not to think that they’re stuck with CPAP,” said Dr. Maha Alattar, a Fredericksburg sleep specialist.

More than 18 million adults in the U.S. have obstructive sleep apnea, according to the National Sleep Foundation.  For them, sleep is not a welcome respite at the end of a busy day.

Instead, their airway becomes blocked, and their sleep is interrupted, often dozens of times a night.

The interruptions are usually caused when the tongue falls backward in the mouth, preventing air from reaching the lungs.  This continues until sufferers rouse themselves, often with a snort or choking sound.

Snoring is one of the hallmarks of the condition, though not all snorers have sleep apnea.

Kip Yost, a Spotsylvania County resident and apnea sufferer, said his fiancée complained about his loud snoring.

“I think she said, in her words, ‘I was ripping the paint off the walls’ ” Yost said.

Sufferers also complain of morning headaches and daytime sleepiness.

“We have a couple of patients who have fallen asleep at stoplights.  They’re so tired,“ said Dr. John W.Willhide, a Fredericksburg dentist who treats apnea patients.

In addition to drowsiness, patients experience a drop in the oxygen level of their blood, which puts them at risk for medical problems, such as stroke, high blood pressure and heart attack.

In the past, most apnea sufferers either ignored their condition and lived with the complications or used a continuous positive airway pressure machine, better known as the CPAP.

CPAP sits on the user’s nightstand and forces a stream of room air through a tube into the nose and mouth.

Clinical studies have shown that this forced air is effective at opening the airway and eliminating the nighttime disturbances that define sleep apnea.

Despite its effectiveness, however, the CPAP is a difficult machine to love.

Users dislike having the mask of their face.  They also complain that it’s uncomfortable, because of the dry mouth they experience and the air leaks.

“I travel for work so it’s a little cumbersome to lug it through the airport,” said Jan Clarke, a fundraiser at the University of Mary Washington and a former CPAP user.

In recent years, however, sleep specialists like Alattar have offered a subset of their patients the oral appliance as an alternative to the CPAP.

“It’s well-established,” Alattar said.  “We have almost 10 years of data to show that the oral appliance works.”

At least 60 oral appliances are now marketed for sleep apnea.  Some have been available for 30 years.

Typically, the devices are custom-made by dentists and cost from $1500 to $3000.  Insurance coverage can be hit-or-miss.

Alattar refers many of her patients to Willhide for their appliances.  He creates two impressions for the patient’s teeth, one for the upper teeth and another for the lower.

Willhide uses a lab in Texas to make the device, which consists of a hard plastic shell and a softer liner.  Patients return to his office to adjust the device in their mouths.

“It’s a fairly simple solution to a serious problem,” he said.

The appliance works by moving the lower jaw forward and opening the airway.

“Your tongue is attached to the bottom jaw.  So if you’re pulling the whole jaw forward, the tongue has to move forward,” said Dr. B. Gail Demko, president of the American Academy of Dental Sleep Medicine.

Demko said that as dentists heat about the appliances, more want to learn how to make them.  Membership in the Dental Sleep Medicine academy has gone from 300 members 10 years ago to 3,000 members now, she said.

Yost, 42, went for a sleep study last year when Robin Sterling, his fiancée, complained about his snoring and described how he stopped breathing during the night.

“When I would go to bed before the appliance, I recognized that I was waking up through the night,” he said.  “Now it’s very rare that I wake up.”

Clarke, like Yost, learned that he had sleep apnea after someone commented about his snoring.

He used a CPAP for about 10 years, before switching to the oral appliance.

“Compared to the CPAP, it is a whole lot easier,” he said.