Dental treatment
of snoring and sleep apnea

Frequently Asked Questions

What is Obstructive sleep apnea

Obstructive sleep apnea is a potentially life-threatening disorder characterized by recurrent episodes of breathing cessation during sleep.

It is caused by the excessive relaxation of the upper pharyngeal muscles and the tongue, resulting in complete obstruction of the airway and therefore reducing oxygenation of vital organs of the body.

People with sleep apnea snore loudly and suddenly stop breathing for short periods.

People who suffer from obstructive sleep apnea, feel tired when they wake and lack the refreshing effect that a sleep of good quality provides.

Which are the Types of sleep apnea?

There are two types of sleep apnea: obstructive apnea and central apnea.

Obstructive sleep apnea is characterized by repetitive episodes of excessive relaxation of the upper airway muscles during sleep. This relaxation partly obstructs the airway, whereby the episode is classified as hypopnea, or completely obstructs the airway, whereby the condition is designated as apnea. These episodes can last for a few seconds to, in some cases, more than a minute. People with obstructive sleep apnea exhibit hundreds of such incidents during night.

Central apnea is a sleep disorder less common than obstructive apnea, but equally dangerous. In central apnea, the brain centers that stimulate the muscles of respiration "forget" to give the appropriate signals.

This results in the cessation of breathing, but in this case the cause is not some kind of airway obstruction. The sufferer stops breathing for a few seconds. During this time he/she does not make any effort to breathe and does not produce any sound of gasping or choking, as happens to people who suffer from obstructive sleep apnea. Afterwards, the person will start breathing again, often with a somewhat faster pace, due to the increased levels of carbon dioxide in the blood.

Some patients exhibit a combination of obstructive and central sleep apnea episodes. This type of apnea is called “mixed apnea” and requires individualized medical treatment of the problems caused by both types of apnea.

What is Snoring?

Snoring is a very common sleep disorder. Almost all of us snore occasionally. Mild snoring is simply annoying. Snoring intensively on a permanent basis significantly disrupts sleep and can be a sign of a much more serious situation - obstructive sleep apnea.

Snoring is a sound produced during sleep by the vibration of the pharyngeal wall. It is a sign of a partial obstruction of the airway by soft tissues such as the tongue, the soft palate, the uvula and the tonsils. When the width of the airway is reduced, the out pressure pushes the tissues backward. These tissues pulse vibrate the passage of air, causing the characteristic sound of snoring.

Just snoring or suffering from sleep apnea?

Sleep apnea often remains undiagnosed because many patients think they just snore when they are in fact suffering from this extremely serious sleep disorder.

Snoring and obstructive sleep apnea have the same cause. Apnea occurs when the soft tissue of the upper respiratory tract completely obstruct the airway, causing cessation of breathing. The air does not reach the lungs and the oxygen concentration in the blood decreases. When oxygen in the blood falls below a certain level, sleep is interrupted and the individual wakes up and tries to breathe. This is done so quickly that often the sufferers do not realize it.

Snoring in patients suffering from obstructive sleep apnea has certain peculiar features. Snoring intensity is not stable and fluctuates robustly. At times the snoring is very loud, after a while it diminished greatly, or no breathing can be heard. A new cycle then ensues.  Parallel to this, the person can produce breath noises or sounds of choking sensation as he/she tries to breathe. In the morning, he wakes up without feeling the refreshing effects of sleep. He feels weak and fatigued.

If you think you demonstrate the above signs and symptoms, it is advisable to consult a specialist who will diagnose the disease and advise you on the most appropriate treatment.

What is the dental treatment of snoring and sleep apnea?

Dental treatment of snoring and sleep apnea is based on the construction, implementation and use of specific intraoral appliances that have the capacity to maintain the airway open during sleep.

When is the use of intraoral appliances to treat snoring and obstructive sleep apnea indicated;

The use of intraoral appliances is indicated in cases of:

• Patients with snoring, or patients with mild or moderate obstructive sleep apnea who do not respond to treatment using general practices, such as weight loss, sleep posture modification etc.
• Patients with severe obstructive sleep disorder who have tried using treatment with CPAP but cannot tolerate it.
• Together with CPAP in patients suffering from very severe obstructive sleep apnea. The combined use of CPAP and intraoral appliance requires lower pressure air to be injected from the CPAP device in order for the patient to breathe normally, making the treatment more tolerable and effective.

In 2006, the American Academy of Sleep Medicine, after assessing the results of long-term clinical studies, issued a clinical guideline according to which intraoral appliances should be the first line treatment for snoring and of mild to moderate obstructive sleep apnea. This is due to the proven efficacy of intraoral appliances in combination with their ease of use and acceptance by patients.

How do the intraoral appliances for the treatment of snoring and obstructive sleep apnea work?

The intraoral appliances place and stabilize the lower jaw, the tongue, the uvula and the soft palate at suitable positions so as not to prevent the passage of air, allowing the patient breathe comfortably and naturally during sleep. There are many types of intraoral appliances. A dentist that deals with the treatment of snoring and obstructive sleep apnea will assess the anatomical features of the oral cavity and select the intraoral device most appropriate for each patient.

What are the advantages of using intraoral devices for treating snoring and obstructive sleep apnea;

• Intraoral appliances are comfortable and easy to install and use.
• Treatment with intraoral appliances is non-invasive and very effective.
• Apart from snoring and apnea, intraoral appliances also treat bruxism, which is the clenching and grinding of teeth during sleep. Bruxism can cause serious damage to the teeth, as well as pain in the muscles and joints of the mouth. Recent studies have shown a correlation between bruxism and obstructive sleep apnea.
• The compliance of patients to treatment with intraoral appliances is very positive. The rate of long-term use of intraoral appliances is higher than of other treatment options.
• Intraoral appliances have small size, thus they are easier to transport and used by patients who travel frequently.