Sleep Apnea Centers

What is Appliance Therapy

Why do we snore?

The sound of snoring occurs when air cannot flow freely in and out of your throat. This is due to a narrowing of the passages at the back of the mouth and nose. During sleep, muscle tone decreases throughout the body. When your throat muscles relax, the soft palate and uvula (the fleshy structure that dangles from the roof of the mouth) vibrates as you breathe in and out. Snoring tends to become worse with alcohol or sedative consumption before bedtime, weight gain and a blocked nose. Snoring often increases with age.

How is snoring related to obstructive sleep apnea?

While snoring is caused by a partial obstruction, obstructive sleep apnea (OSA) is a temporary but complete closure of your throat during sleep. It results in repeated episodes of stopping breathing (apnea) during which you continue to make efforts to breathe. Loud snoring is the most common symptom of OSA. The sound occurs as you briefly waken at the end of the apneic period and begin to breathe. Some OSA sufferers are described as making snoring or gasping sounds when they resume breathing.

A history of snoring often precedes the development of other symptoms which include excessive daytime sleepiness, fatigue, memory impairment, morning headache, poor work performance and loss of sexual interest. Severe OSA can result in serious complications including high blood pressure, heart rhythm disturbances and heart failure. The diagnosis of OSA is confirmed by specialized testing. An overnight sleep study is required to confirm the diagnosis and determine its severity

Snoring without apnea is not usually harmful to your health and many snorers who have none of the above symptoms do not have significant OSA. However, many people with OSA are unaware they have it. Thus, careful medical attention is required to ensure the OSA is properly diagnosed and treated.

How long must I wear the appliance?

An oral appliance is a small device, similar to an orthodontic retainer or an athletic mouthguard. It is worn in the mouth during sleep to prevent the soft throat tissues from collapsing and obstructing the airway.

The appliance we use is unique from all others because it not only repositions the jaw but, more importantly, prevents the tongue from falling back and obstructing the airway. Unlike many appliances that are simply custom formed to the teeth then left alone, our approach involves consistent care and follow-up to ensure that we are getting optimal results. We will modify and adjust your appliance to find the exact positioning that best suits your body and achieves the greatest reduction in your apneic events. It is FDA approved and has many patents protecting it's unique nature. This is the only appliance Dr. Greenburg uses because of the tremendous success he has had with his patients.

Do I have to wear the appliance all night?

Yes. Studies indicate that Obstructive Sleep Apnea is most severe during the early morning hours. It is, therefore, very important for you to use the appliance at all times during sleep. During the first few weeks while you are adjusting to the appliance, it may be necessary to start with shorter periods and gradually increase the length of time until you can comfortably wear the appliance all night. Many patients are able to wear the oral appliance on the first night and experience no discomfort.

What are side effects associated with the use of an oral appliance?

Patients may experience morning soreness in the teeth or jaw muscles while adjusting to the appliance. In addition, some patients experience excessive salivation. All of these side effects improve within a few weeks of regular use and some adjustments of the appliance. Patients with arthritis or jaw joint dysfunction may have difficulty tolerating an oral appliance. These possibilities need to be discussed with your practitioner before the appliance is fabricated. Colds and allergies where the nose is blocked can interrupt the effectiveness of the oral appliance but this stops once the nasal passages are clear again.

How do I start oral appliance therapy?

If you are interested in trying an oral appliance you can simply schedule an appointment for a consultation with our office. At that time we will discuss the treatment options for you and, if you do not have a recent sleep study, arrange one for you. We will also utilize a specialized tool called a pharyngometer (developed by Harvard University) to measure the volume of air moving through your airway. This will give us an indication of how effective an oral appliance will be for you before you commit to moving forward with appliance therapy treatment.

What is an oral appliance?

An oral appliance is a small device, similar to an orthodontic retainer or an athletic mouthguard. It is worn in the mouth during sleep to prevent the soft throat tissues from collapsing and obstructing the airway.

The appliance we use is unique from all others because it not only repositions the jaw but, more importantly, prevents the tongue from falling back and obstructing the airway. Unlike many appliances that are simply custom formed to the teeth then left alone, our approach involves consistent care and follow-up to ensure that we are getting optimal results. We will modify and adjust your appliance to find the exact positioning that best suits your body and achieves the greatest reduction in your apneic events. It is FDA approved and has many patents protecting it's unique nature. This is the only appliance Dr. Greenburg uses because of the tremendous success he has had with his patients.

How do oral appliances work?

Oral appliances work non-surgically to open the airway during sleep by realigning the tongue and jaw in relation to the head. The appliance we chose to use has an added feature unlike any other appliance marketed. Using a small, posterior tongue restrainer it prevents the tongue from falling back and blocking the airway, which is a major contributing factor to obstructions. An appliance must be worn each night to produce the desired effect.

What will the dentist do?

On your first visit, the dentist will thoroughly examine your teeth and mouth and take a series of x-rays to see the condition of your airway, sinuses and TM joints. Dental impressions are required to fabricate an oral appliance, which are then sent to the laboratory where the appliance is made. Once the appliance is made, it will be inserted by the dentists who will show you: how to insert and remove it yourself, how to clean it and care for it when you are not using it

He will then see you on a weekly or bi-weekly basis to determine the effectiveness of your positioning with the appliance and make adjustments accordingly. Once you have been using the appliance regularly and have notable relief from symptoms, such as improvement in daytime sleepiness and elimination or lessening of snoring has occurred, we will do a follow-up sleep study to obtain concrete data on the effectiveness of your appliance on your sleep apnea. You will continue to visit us at regular intervals and we will work with you to maintain and modify your oral appliance so it remains effective.

Can I wear an oral appliance if I have a bridge or denture?

Sufficient healthy teeth are required to anchor an appliance. Patients with crowns or bridges can be successfully fitted with an appliance. Adjustments are made in the appliance to ensure that fragile crowns and bridges are not harmed. Patients with partial dentures can also be successfully fitted with an appliance as long as there are enough teeth to anchor the appliance. Patients will be evaluated on a case by case basis.

What is the difference between an anti-snoring device and oral appliance therapy?

Anti-snoring devices are mouthpieces that function very similarly to OSA appliances by opening the airway to increase airflow and prevent the vibration of tissues that create the snoring sounds. An anti-snoring device does not specifically target upper airway blockage and treatment with such a device does not require comprehensive follow-up. An OSA appliance is designed to ensure the upper airway is not blocked during sleep and will require regular check-ups to ensure it’s effectiveness.  A pleasant by-product of OSA treatment with appliance therapy is a dramatic reduction, if not complete elimination, of snoring as well.

Payment for oral appliances?