Dental Appliances for Sleep Apnoea | Snorer.com

Dental Appliances for Sleep Apnoea | Snorer.com

Dental Appliances for Sleep Apnoea

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What is a Dental Appliance for Sleep Apnoea?

Dental appliances for sleep apnoea / apnea, hold your jaw forwards to aid breathing, while you sleep. They are prescription medical devices, for diagnosed obstructive sleep apnoea (OSA) patients.

If you snore or are worried you may have sleep apnoea (but are not yet diagnosed), then read this first: How to stop snoring: the definitive, step-by-step, Guide (2019).

Dental appliances for sleep apnoea / apnea
I’m a sleep-industry insider (learn more about me: Adrian Zacher) with a quarter of century of dental sleep medicine (DSM) experience. Adrian Zacher MBA

Author, DSM Instructor and Sleep Apnoea Evangelist

How to get a dental appliance for sleep apnoea?

Dental appliances for sleep apnoea are an option for diagnosed obstructive sleep apnoea patients, who are unable to use Positive Airway Pressure (PAP) therapy.

Sleep apnoea dental appliances are prescribed by sleep-trained dentists upon referral from a sleep unit.

A dental appliance may also be recommended by the doctor when automatic PAP therapy pressures are very high. The idea is to attempt to reduce the pressure required. This is typically for patients with severe obstructive sleep apnoea (OSA).

PAP therapy is considered the most effective way to treat obstructive sleep apnoea.

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) whats that?, 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:

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

  There is no guarantee they will work

  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 they're used:

The inability to determine BEFOREHAND, who will and who will not find oral appliance therapy effective, has impacted upon 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.

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, dental appliances for sleep apnoea, 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 our KnowSleep™ Academy is for you!

What is the cost of a dental appliance for sleep apnoea?

  • 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 1800 GBP for both the dental appliance and dental clinical fees. The price varies for the proximity to London, and of course the sophistication and quality of the dental appliance.
  • 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 of dental appliance for snoring and sleep apnoea:

Category 1: 'One-Size-Fits-All'

Not a lot positive to say about category 1 dental appliances. Read this if you want to understand more about the interesting claims made for them. 

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, dental appliance:

Example dental appliance for sleep apnoea

Figure 1. SomnoWell dental appliance for sleep apnoea. Image used with permission.

Example dental appliance for sleep apnoea

Figure 2: SomnoMed dental appliance for sleep apnoea. Image used with permission from SomnoMed UK Ltd.

How to prescribe oral appliances for snoring and sleep apnoea / apnea
How to stop snoring: The definitive, step-by-step Guide

There is now a 3rd category:

Figure 3, shows the actual predictor prototype 'in the flesh' and Figure 2 illustrates where predictor dental appliances fit in the overall taxonomy.

3rd Category of MAD. The predictor / titration MAD

Figure 3:
The Predictor / Titration dental appliance for sleep apnoea
invented by Adrian Zacher MBA.

Taxonomy of dental appliances for sleep apnoea and snoring
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 a prototype sleep apnoea dental appliance (predictor) there is no sound.

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

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

What questions do predictor dental appliances answer?

The predictor dental appliance finally emerging commercially, interests me as 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 a dental appliance? 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 a dental appliance - 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 with a dental appliance in the position determined by the Predictor dental appliance

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.

Predictor dental appliances 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 for a dentally prescribed custom-made dental appliance

2  That the patient will be effectively treated with a dental appliance, and is 'prescribing' a jaw relationship

And the patient knows BEFOREHAND if a dental appliance will work!

I let my patent lapse. This was over 15 years ago! (2003) Damn.

 

Learn more about dental appliances for sleep apnoea:

Download the free bonus below and train at the on-demand KnowSleep™ Academy from Snorer.training:

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.

Snoring & Obstructive Sleep Apnoea Overview

Meet the co-authors and peer reviewer

Adrian Zacher. Click for full profile [new tab]

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

Dr Shouresh Charkhandeh DDS

Award winning Dental Sleep Medicine Dentist

KnowSleep™ Academy: Snoring courses for dentists

Snoring & Obstructive Sleep Apnoea (OSA) - the role of the dentist.

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

Our on-demand snoring courses for dentists, teach dentists (and GPs) how and when to prescribe custom-made, dental appliances for sleep apnoea and snoring. 

Reviews and Testimonials

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If you are seeking professional and unbiased help with a snoring problem then Adrian Zacher is the 'go to' person.

Jeff How to stop snoring: The definitive, step-by-step Guide (2019) November 5, 2018

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If you think you have a sleep disorder please seek appropriate medical advice.
Created by Adrian Zacher | Page last updated 14th Nov 2018

Dental Appliances for Sleep Apnoea | Snorer.com

Dental appliances for sleep apnoea are an appealing option. But how do you know if they will work without buying one? This post explores how predictor or titration dental appliances for sleep apnoea came to be and the vital role they may play building trust between medical and dental sleep professionals.

read more