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Oral Appliance for Sleep Apnea

When I have diagnosed sleep apnea some of my patients will ask, “What can I do besides wear that mask?” While it is completely true that nasal CPAP is the treatment of first choice for adults with sleep apnea, clinical research indicates that for some carefully selected patients a mandibular advancement device (MAD) may be an appropriate option.

What? Me MAD?

A MAD is an orthodontic device that opens the mouth slightly while moving the lower jaw (mandible) forward (advancement). This generally increases the size of the upper airway especially behind the tongue. The best ones are made to fit a specific individual’s mouth by a dentist who is familiar with making and adjusting them, a process which takes a number of weeks to optimize. Sometimes final adjustments to the devices are made during a sleep study.

The adjustment phase consists of two parts, the initial one out of the lab and a follow up. Initial adjustment is considered complete when the patient’s snoring is abated, preferably completely. A follow up sleep study is always recommended to ensure that the device has effectively eliminated the sleep apnea.

Pros and Cons

The main potential advantage of the MAD is convenience. Some patients find it less intrusive and cumbersome than nasal CPAP.

The main disadvantage is that one will not know whether it will work until after the follow up sleep study has been completed. Its initial cost is generally higher than nasal CPAP. Some patients will experience a change in their occlusion, i.e. how the upper and lower teeth fit together, but most do not find this to be a limiting problem. Other patients may develop TMJ (Temporomandibular Joint Disorder) pain from MADs.

Who should go MAD?

As with the success or failure of the majority of medical treatments, patient selection is critical in the decision to go with a MAD. In general, the MAD is a second line therapy. It is most effective in patients who have mild to moderate sleep apnea (based on sleep study findings), are non-obese and have apnea that occurs exclusively or predominantly while lying on ones back.

Bottom line an accurate diagnosis is the most important thing. Diagnosis obstructive sleep apnea requires testing by competent professionals, an attended sleep study being the gold standard. Once the diagnosis is clear, one can discuss management options with his/her physician. Regular follow up is essential to ensure proper functioning of the device and optimal results e.g. better sleep quality and improved daytime functioning.