TREATMENT OF OBSTRUCTIVE SLEEP APNEA…
The most important step in OSA treatment is a proper diagnosis. An over night sleep study by a certified sleep specialist is manditory, to diagnose the type of sleep disorder, the severity of the sleep disorder and the best course of treatment. There are central and mixed apneas that are part obstructive sleep apnea and part the brain forgetting to send the signal for breathing. The only way to diagnose this is through a sleep study. There are hundreds of other sleep disorders that may occur concurrently with obstructive sleep apnea that also must be treated to achieve treatment success. These can only be diagnosed in an over night sleep study with a certified sleep specialist. Home study machines do not diagnose these other types of sleep disorders. They are primary for sleep apnea.
Treatment of sleep apnea mostly depends upon the severity as well as the patient’s ability to tolerate the treatment modality.
Mild sleep apnea can be treated with something as simple as sleep position. There are special cushions that can be worn secured in the back area. If the patient rolls on their back (the worst position for snoring and sleep apnea), the cushion prevents the patient from staying on their back and they quickly resumes sleep on their side. Alternately, an oral OSA appliance may be used, to hold the lower jaw and tongue forward. This approach allows the patient complete freedom while sleeping including sleeping on their back. If a patient has a chronic back problem requiring them to sleep on their back, an oral appliance works extremely well. If this is not effective, your sleep specialist may recommend an oral appliance as these are very effective in mild OSA.
Moderate sleep apnea is best treated with an oral appliance as the airway blockage is much worse than in mild apnea. Alternately, a CPAP or similar forced air machine can be used. Many people prefer the freedom and comfort of an oral appliance over a CPAP. The American Academy of Sleep Medicine recommends oral appliances for mild and moderate sleep apnea (when CPAPs cannot be used) as the compliance rates are much higher than with CPAP therapy.
Severe sleep apnea is treated almost always with a CPAP. As the airway blockage is severe, it is very effective and can effectively treat the symptoms. Unfortunately, research has shown that only about 52-62% of patients prescribed a CPAP use it regularly. In the refractory untreated cases, oral appliances may be used to treat severe apnea. Although not as effective for severe apnea, oral appliances can reduce the apnea from severe to moderate or even mild apnea. This is much more preferable to untreated severe apnea. And improvements in quality of life have been shown to be comparable to CPAP therapy.
In some cases patients with severe apnea cases were treated by combining a Luco Hybrid OSA appliance in combination with a CPAP. This approach allows the pressure to be significantly lower reducing the associated side effects of distention (air in the stomach). Other patients, who travel a lot, will use an oral appliance while on the road or camping, and a CPAP when they are at home. This ensures that they are receiving treatment every night, not only when can use their CPAP.
It should be noted that oral appliances and forced air devices such as a CPAP, NPAP and BiPAP do not always work. Sometimes there are too many anatomical factors present to overcome. These treatments are effective for most OSA patients but there are still some they are not.
In some cases, anatomical structures (such as a very long soft palate or deviated septum) are too abnormal for conventional treatments outlined above. LAUP (Laser Assisted Uvuloplasty), UPPP (Uvulopalatopharyngoplasty), RFP (Radiofrequency Palatoplasty) are all used to surgical alter the soft palate and uvula regions.There are some new treatments emerging such as soft palate implants. These are small metal or ceramic rods that are embedding into the soft palate making it stiffer and preventing it from sagging and blocking the airway. This does involve a surgical procedure and general anesthetic (with the associated risks). There are surgical procedures to remove the center or back portion of the tongue, reducing its size if too large. Recently approved treatment for sleep apnea involves the placement of a pacemaker-type device in the patient’s chest with wires run inside the body and connected to the hypoglossal nerve, the nerve that oral appliances stimulate to advance the mandible. The stimulation of the nerve causes the tongue to position forward out of the throat.
All treatments have benefits and associated problems. Oral appliances cannot be used if the patient has no teeth unless implants are placed into the upper and lower jaws to hold them in. Some appliances allow for missing upper teeth but there must be a minimum number of teeth present for oral appliances to work on the lower jaw. Some patients with deep overbites may find it hard to bite their back teeth together over time (the appliance is actually treating the overbite). CPAPs have masks over the mouth and nose or over the nose only with hoses running to a machine. Restless sleepers often displace the masks causing air leaks and treatment failure. Patients who sleep on the stomachs cannot effectively use a mask. Arms can be tangled in the hoses. And, in the event of a power failure, they are not being treated. Placement of a pacemaker type devices or metal palatal implants involves inserting metal devices permanently into the patient’s body. An MRI can not be done after placement of these units as the energy of the MRI can cause heating of the unit and wire leads causing tissue damage in the adjacent tissues. This can be a serious problem should a cancer develop as MRIs could not be used to determine the size and shape of the lesion without first removing the device.
Over the counter type OSA appliances are now flooding the market. These are not FDA approved and are not covered by insurance plans or Medicare. They have numerous risks associated with them as they are not the same as custom dentist- fitted appliances. These appliances are not recommend due to the associated risks. Many patients develop serious TMD conditions as a result of wearing these OTC type appliances. Tooth damage and shifted is common with these if used long term. And they can get very smelly quickly as they absorb much more oral fluids (and bacteria) than custom fit. They are made from inexpensive materials that are not durable and often of unknown composition.
The Luco Hybrid OSA appliance has been market cleared by the FDA as a Class II medical device for the treatment of mild to moderate sleep apnea and primary snoring. The approval process is extensive to ensure that all materials used in the appliance are safe and that the design meets currently accepted principles of treatment. This is extremely important to ensure the safety of the product for its intended uses. The Luco Hybrid has met the FDA’s criteria and has been assigned the number K130797 to designate that it is cleared for use in the USA as a Class II medical device. The American Academy of Sleep Medicine also recommends oral appliances for the treatment of severe apnea cases that cannot tolerate CPAP, NPAP or BiPAP devices. In April 2014, the Royal College of Dental Surgeons of Ontario released to their members a policy paper on sleep apnea and also list the indications for use in severe cases with CPAP failures. The Luco Hybrid OSA Appliance has been used successfully in CPAP failure cases. It has also been very successfully used in severe cases in conjunction with a CPAP to effectively manage the airway. The Luco Hybrid helps stabilize the airway allowing the pressure of the CPAP to be lowered. This reduces the complications such as gastric distension (air in the stomach), dry eyes, conjunctivitis, and other side effects. Many patients have benefited from this combination therapy, as it is known.
In all regions of Canada (except Quebec) and the European Union, the Luco Hybrid OSA Appliance is also indicated in the treatment of sleep-related bruxism .