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Dec

Dental Appliances for Sleep Apnoea | Snorer.com

Estimated reading time: 11 minutes

Dental appliances for sleep apnoea / apnea, hold your jaw forwards to aid breathing, while you sleep. Read how to get a prescription medical device for diagnosed obstructive sleep apnoea (OSA) patients.

In the UK?
If you snore or are worried you may have sleep apnoea (but are not yet diagnosed), then its easy to find out, and get signposted to the most appropriate professional to help you.

Consult a sleep-trained pharmacist.

Adrian Zacher MBA

Author, Snoring and Sleep Apnoea Care Navigator

I teach healthcare professionals how to help their patients stop snoring; sleep and breathe at the same time.

How to get a dental appliance for sleep apnoea?

Time needed: 30 days.

Dental appliances for sleep apnoea are an option for diagnosed obstructive sleep apnoea patients, who are unable to use Positive Airway Pressure (PAP) therapy. PAP therapy is considered the most effective way to treat obstructive sleep apnoea (OSA).

They are prescribed by sleep-trained dentists upon referral from a sleep unit.

They may also be recommended by the doctor to be used in combination with PAP therapy, when pressures are very high.

The idea is for the dental appliance to mechanically open the airway and it is hoped to reduce the PAP pressure required. This is typically for patients with severe obstructive sleep apnoea (OSA). 

  1. Consult your General Medical Practitioner

    You will need a referreral from your GP to secondary care.

  2. Have a sleep study

    The hospital sleep unit will supply a home sleep apnoea test device for you to wear one or more nights at home to monitor your sleep.

  3. Be diagnosed with Obstructive Sleep Apnoea (OSA)

    If you’re diagnosed with OSA but cannot tolerate Positive Airway Pressure (PAP) therapy, second-line therapy is a custom-made dental appliance

  4. Be referred from the sleep unit to a sleep-trained dentist

    The dentist will then assess you to see if you are a candidate for oral appliance therapy. They will take X-rays and determine if you have enough healthy teeth, gums and good oral hygiene.

  5. Be prescribed a custom-made dental appliance for sleep apnoea

    If you’re suitable you may then be prescribed the most appropriate appliance for you.

  6. Wait

    Laboratory manufacture of your custom-made device may take anything from a week to a month.

  7. Return to the dentist

    The sleep-trained dentist will then fit the device to you and show you how to insert and remove it.

  8. Start to use it

    The first two weeks are the most difficult time – and when most people who are going to quit – quit. Persist.

  9. Return to the dentist

    Adjustment of the position the device dictates to your lower jaw is called ‘titration’. The dentist will do this until you no longer snore.

  10. Have another sleep study

    As you have sleep apnoea, it is vital that objective evidence of effect is obtained. Does it work?

  11. Follow up and review

    If the home sleep apnoea test (HSAT) shows that your dental appliance is effective then you move to annual reviews. If not, further titration may occur until you either achieve a satisfactory outcome or you can not tolerate further jaw advancement (in which case oral appliance therapy is not an effective option for you).

Tired of the sleepiness and the snoring?

Then read our free, definitive step-by-step how to stop snoring Guide.

This comprehensive Guide walks you through self-help, signposting, screening, professional assessment and diagnosis, the three categories of prescription treatment, follow-up and rounds off with a substantial FAQ.

Dental appliances for sleep apnoea: an appealing option?

Dental appliances for sleep apnoea may seem a good idea because apart from being far more discreet than PAP (Positive Airway Pressure therapy) what’s PAP?, there is no need for:

  1. A mask over your face
  2. A pump machine beside the bed
  3. A power supply
  4. A hose connecting you to the pump machine.

But the problem is:

How to know before buying one, if a dental appliance for sleep apnoea, will actually work?

The trouble with a custom-made dental appliance for sleep apnoea, is that you have to wait for it to be made for you.

They’re also:

  • 1

    Expensive (don’t forget to factor in the dentist’s fees)

  • 2

    There is no guarantee they will work

  • 3

    You don’t know if you can even tolerate wearing it in your mouth

So, if like me you’re wondering….

Hang on, before I get one, I’d like to know if it works, and if I can wear it!” 

Then keep reading. You’re not alone in wanting to know if they work before you’ve paid for them:

The inability to determine BEFOREHAND, who will and who will not find oral appliance therapy effective, has impacted upon the wider adoption of dental appliances (by the medical community) for patients with anything other than snoring or mild obstructive sleep apnoea.

So then, you’ll be interested in this brief introduction to the topic of a little known, third category of dental appliance for sleep apnoea.

But first, are dental appliances effective for sleep apnoea?

Can a dental appliance help sleep apnoea?

Yes. Prescription, custom-made, adjustable dental appliances are a valid option for sleep apnoea. They are however, considered second-line therapy (meaning there is a preferred therapy [first-line] i.e. PAP). 

‘Second line’ means that PAP is considered the best option and dental appliances are only considered when a patient fails with PAP therapy. The next best thing.

Can dentists treat sleep apnoea?

A qualified yes:

When a patient has been medically diagnosed and is then referred to a sleep-trained dentist, with a view to the dentist prescribing a custom-made dental appliance.

Such a sleep apnoea patient would require ‘objective titration’. This means that the protrusion (forward movement of the jaw achieved through use of the dental appliance) would be adjusted with reference to data obtained from repeat sleep studies, to ensure the patient’s sleep apnoea was effectively treated.

What is the best treatment for sleep apnoea?

Positive Airway Pressure (PAP) is considered by the medical profession to be the best treatment for sleep apnoea.

However, PAP is an arduous therapy and compliance (those who actually use it) for more than 4 nights a week and more than 4 hours each night are surprisingly few.

Consequently, although they may be considered less effective in terms of overcoming sleep apnoea (measured by oxygen desaturation), there is evidence that patients use them more than PAP.

Can dentists diagnose sleep apnoea?

Dentists cannot diagnose obstructive sleep apnoea (OSA). The diagnosis of obstructive sleep apnoea (OSA) is the exclusive preserve of the specialist consultant respiratory physician. 

Uniquely, sleep-trained dentists in the UK may:

  • Screen and recognise obstructive sleep apnoea (OSA) symptoms and refer for further investigation to the GP with a view to a home sleep study.
  • Then in defined circumstances:
    • Provide dental devices without a prior medical diagnosis for those without OSA symptoms

If you’re a dentist interested in training to provide dental appliances for snoring and sleep apnoea patients, then Snorer.training is for you! We’re independent of any device manufacturer.

How much does a dental appliance for sleep apnoea cost?

  • Some countries in Europe will pay for a dental appliance for a diagnosed sleep apnoea patient.
  • In the UK, this is a grey area. You may be able to obtain an NHS funded dental appliance (don’t expect the best or even a choice) but in my experience, you probably won’t get any help. It’s wrong and it needs to change. A ‘ball park’ price would be anything between ~350 to 2000 GBP for both the dental appliance and dental clinical fees. The price varies for the proximity to London, and of course the sophistication, quality and warranty provided for the dental appliance. Warranties of 5 years plus are available for certain appliances.
  • If you’re in the US and diagnosed with sleep apnea (different spelling) then you should find your dental appliance is a ‘reimbursed therapy’ my advice is to check which dental appliances ARE paid for by Medicare (not all are).

Categories of dental appliance for sleep apnoea

‘One-size fits all’ and custom-made dental appliances comprise two categories:

Category 1: ‘One-Size-Fits-All’

Not a lot positive to say about category 1. Read this to understand more about the exaggerated claims made for OTC anti-snoring devices.

Category 2: Custom-made dental appliances for sleep apnoea

Here are some examples of the 2nd category of dental appliance for sleep apnoea:

The prescription, custom-made, bi-bloc design:

Figure 1. SomnoWell for sleep apnoea. Image used with permission.
Figure 2: SomnoMed. Image used with permission from SomnoMed UK Ltd.

There is now a 3rd category:

Figure 3, shows the actual predictor prototype ‘in the flesh’ and Figure 2 illustrates where predictors fit in the overall taxonomy.

Figure 3:
The Predictor / Titration dental appliance for sleep apnoea
invented by Adrian Zacher MBA.
Figure 4: Taxonomy of dental appliances for snoring and obstructive sleep apnoea.

Why a 3rd category of dental appliance for sleep apnoea?

Predictor dental appliances for sleep apnoea are not the same as over-the-counter (OTC) anti-snoring devices. OTC anti-snoring devices have been researched (learn how they faired in this definitive guide ↗).

Some years ago (struth it was 2011), I witnessed the competitive emergence of a third category of dental appliance for obstructive sleep apnoea / apnea and snoring:

The Predictor

A Predictor dental appliance is NOT intended to provide long-term therapy. 

Below is short video animation of my prototype (predictor) there is no sound.

Remember, this is an early prototype and it’s NOT intended to be worn for any length of time!

3D model of the titration device

Figure 5. CAD prototype of a predictor dental appliance for sleep apnoea and snoring

What questions do predictor dental appliances answer?

The predictor finally emerging commercially, interests me because in 2003, I patented new-window (yup, that long ago) a dental appliance with the design intention being to determine: 

  • 1

    Can a patient wear it? Something that I consider is an underestimated challenge

  • 2

    Does it work?

This second point means both:

  • Subjectively = Partner reported incidence of snoring (during this time the wearer also has the opportunity to adapt to wearing it – or perhaps NOT – and the custom-device will of course feel far more discreet)
  • Objectively = In a sleep lab setting the Physician can feel confident ‘signing off’ that the patient will be effectively treated in the position determined by the Predictor device

So what? ‘Building the Bridge’

If obstructive sleep apnoea (OSA) patients’ are to be effectively treated the medical and dental profession must work together in a more patient-centric way.

Predictors are perhaps the means to ‘build the bridge’ between the two.

The medical professional knows:

  • 1

    If the patient responds to mandibular protrusion prior to referral to a dentist

  • 2

    That the patient will be effectively treated and is ‘prescribing’ a jaw relationship

And the patient knows BEFOREHAND if it will work!

I let my patent lapse. This was a long time ago! (2003) Damn.

Learn more about dental appliances for sleep apnoea:

Download the free bonus below:

Download the ‘Mouthpiece’ Guide as a PDF

Co-author by Adrian Zacher MBA
Co-author Dr Roy Dookun BDS
Peer reviewed by Dr Shouresh Charkhandeh DDS

In this NHS England’s Information Standard accredited Guide, you’ll learn in jargon-decoded language:

  • About the different types of ‘Mouthpiece’
  • How to get one (that actually works)
  • About the possible side-effects

No signup is required.
No credit card.
Nothing at all in fact.
We do this to help – because we can.

Mouthpiece

Meet the co-authors and peer reviewer

Adrian Zacher MBA

Adrian Zacher MBA

Author and Founder of Snorer.com

Dr Roy Dookun BDS, MFGDP (UK), MGDSRCS (Eng), FFGCP (UK), DIP DENT SED

Co-founder and former President British Society of Dental Sleep Medicine

Shouresh

Dr Shouresh Charkhandeh DDS

Award winning Dental Sleep Medicine Dentist

Snorer.training: CPD courses for dentists and pharmacists

We provide enhanced CPD (continuing education) training courses for dentists and pharmacists wishing to further their knowledge and understanding about treating patients who snore and/or may have obstructive sleep apnea / apnoea (OSA).

Looking to compare custom-made appliances with the gadgets you often see sold online? Then check out our best anti-snoring device expert guide. In the guide, I compare custom-made anti-snoring devices with OTC gadgets against my top 13 criteria.

Gareth Evans Pharmacist Course review for Snoring and Obstructive Sleep Apnoea for the Pharmacist 07/10/2020

Thank you for the opportunity to train as a sleep trained pharmacist. Your training platform was simply superb – well thought out, engaging and highly informative for all things snoring and OSA. I can’t wait to utilise my new-found knowledge and help the many people out there lead a healthier life. In fact now that I know how important this field is I may even save a few lives in the process. Thank you again and I hope every pharmacist takes up this opportunity!!

Created by Adrian Zacher

3 Comments

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