What are my treatment options?

Oral Appliances and Dental Devices:

An oral appliance is a comfortable, portable and custom-fitted mouthpeice that is worn in your mouth only while you sleep. The oral appliance works by preventing your tongue and soft tissue from collapsing and thus keeps your airway open. Many different models of appliances exist and our office will help determine an appliance that is best for you.

*Note for patients with TMJ disorders: We also specialize in oral appliances that works without moving the lower jaw forward.

According to the American Academy of Sleep Medicine (AASM):

1. Oral Appliance Therapy must be provided only by a dentist specially trained in sleep disordered breathing including the fabrication and titration of oral appliances.
2. Oral Appliance Therapy is recommended as a first line treatment for patients with mild-moderate sleep apnea and for all patients (including severe Obstructive Sleep Apnea patients) who cannot tolerate to use the CPAP machine.

              American Academy of Sleep Medicine Report, Feb. 2006. Practice Parameters for the treatment of snoring and

               obstructive sleep apnea with oral appliances.

Continuous Positive Airway Pressure (CPAP):

A CPAP machine is a medical device that delivers continuous positive airway pressure through a facemask or nasal tube attached to a pump usually placed next to the bed. electricity through a standard outlet. The CPAP machine is plugged into any standard electrical outlet and the mask is worn whenever you sleep or nap. Proper adjustment of the CPAP mask and machine are vital to achieve maximum clinical benefit and can only be done in a physician's office. The CPAP is the most effective form of treatment for obstructive sleep apnea. However, with studies showing that 55-77% of patient cannot tolerate using it, Oral Appliances can be a great alternative.

Reasons for CPAP Intolerance include:

• Claustrophobia
  
• Embarrassment due to appearance or noise
  
• Noise from the machine disturbs partner
• Nasal Congestion from the pressure
  
• Mask leaks pressure
• Pressure causes pain on tissue and teeth
  
• Difficult to use: requires electricity, parts must be cleaned
• Difficult to travel with (may require additional checked luggage)
• Adjustments or replacement parts must be done at lab
  
• Cost

Please see our comparison chart on OAT vs CPAP here.

Surgery:
Surgery is a viable option for those patients where issues such as a severe obstruction due to enlarged tonsils, adenoids, uvula, nasal polyps, deviated septum or jaw malformations are the culprit. Several types of surgical procedures include (but are not limited to):

• Tonsillectomy
• Genioglossus Advancement
• Maxillomandibular Advancement (MMA)
• Uvulopalatopharyngoplasy (UPPP)

Surgery may be an important step in your treatment, and can sometimes be the only option. During your initial examination, Dr. Shah will inform you if you should consider surgery. In general though, surgery is the most invasive, painful, and irreversible form of treatment. For certain procedures, success rates can be as low as 30-50%. Due to these reasons, and with so many advances in the field of dental sleep medicine, many Ear, Nose, and Throat (ENT) physicians will encourage patients to try Oral Appliance Therapy prior to surgery.

A TEAM APPROACH:

Our "team" approach is what has led to our greatest success in treatment and in positive patient feedback. With our focus on a collaborative approach to most successfully treat your sleep apnea or snoring, we work closely with a collaborating group of physicians and dentists to offer you the most comprehensive treatment available. If we feel you may benefit from other therapies, either alone or in conjunction with your oral appliance, we will refer you to one of our team physicians or to a physician of your choice.