Treatment of Primary Snoring (on OSA and no Sleep Bruxism)
These patients are probably the easiest to treat as the position can be started with very minimal advancement and slowly moved forward until the snoring resolves. We often start at a 25-30% advancement for Mallampati 3 and 4 with good results.
Clinically you can recline the patient, ask them to protrude slightly, and try to snore. This can give you a guideline on where you may wish to start them.
As with Sleep Bruxism and OSA, make sure the wings contacts are balanced and that the contact when biting is even on both sides. Adjust as with Sleep Bruxism as needed for comfort.
These patients require monitoring (6 months is acceptable) as snoring can easily turn into sleep apnea.
You still should record the patient’s range of motion every appointment and record in their chart.
Some snoring patients will relapse a bit after a few months. This is due to a decrease in muscle tone in the pharynx. Advance these patients 1-1.5 mm and re-assess in a week (to ensure resolution of the snoring).
Some patients will always make some noise while sleeping due to upper airway restrictions and air turbulence. Oral appliance therapy cannot correct this, only surgery of the upper airway can help.
