Why don’t more sleep physicians recommend oral appliances for OSA?

It’s an important question that many of us continue to wonder about – why aren’t more sleep physicians recommending oral appliances for sleep apnea? Well, to begin with, there appears to be a lack of data on the subject. While most dentists understand the importance of using oral appliances for the treatment of sleep apnea, physicians are still not in the know. So let’s get them some data.

What information is out there?

After doing a quick search through Google Scholar I found the following studies that showcase how effective oral appliances are for the treatment of sleep apnea in our patients:

Another reason is because they may not be comfortable with the process. If that is the case, then we must help them get more acquainted. This can be done by contacting their offices and educating them on the services we provide. Through proper education and understanding, you can help sleep physicians become better acquainted with oral appliance therapy as a successful alternative to the CPAP machine.

They are ignorant about topics they know little about, which is why it is important to educate them on oral appliances. Look up studies, attend classes and do what you can to provide the information they need to better understand this treatment alternative so we can all continue to help patients get a better night’s sleep.

Embrace Alternative Therapies Besides CPAP

This is important to think about: We are lying to ourselves if we don’t embrace alternative therapies other than continuous positive airway pressure (CPAP) for patients with sleep apnea. While CPAP therapy has been proven to be a successful form of treatment for patients with sleep apnea, it isn’t the only or best way for all patients.

As an alternative to CPAP therapy, oral appliance therapy is important to bring to the attention of your patients. By emphasizing how this alternative therapy option works, you can provide better treatment options for your patients. But, in order to successfully treat patients with oral appliances, I have a few things to point out.

Re-emphasize Bite Change

With your patients, it is important to re-emphasize the bite change that might occur. To help with this, ask the following questions:

  • Are you willing to give two minutes every morning?
  • Are you ok with your back molars not touching?

By asking these questions, you are setting your patients up for success. Oral appliances work, but many patients are hesitant or impatient. Asking if they are willing to give two minutes every morning to perform exercises after wearing the appliance at night will allow you to help them to ensure no bite changes occur.

The exercises work to keep their teeth aligned and bite unchanged. This is also important for the back molars. Use of the oral appliance can keep the back molars from touching if exercises are not completed. Treatment requires dedication from the patient and dentist.

Disruption in Veneers and Crowns

It is also important to note that if a patient has veneers or crowns and they pop off, that has nothing to do with the oral appliance. In fact, it has everything to do with how the treatment was conducted. Veneers or crowns that fall off or crack are typically due to not being cemented in place properly. This has nothing to do with the oral appliance.

Document Everything

This might be the most important part about treatment for your patients–not only because it helps the patient, but because it can protect your office down the road. I cannot emphasize this enough, but you must:

Document everything you say and that it did take place.

I have made this sentence bold while standing on its own because it needs to be said and engrained in your mind for every patient that walks through your office doors. Document everything. And I do mean everything. By including every detail, you can ensure proper treatment is conducted and your patients are made aware of what you said.

 

Should Sleep Apnea Really be the Best Defense in a Trial?

We’ve heard it several times already, “sleep apnea made me do it” or “sleep apnea is the reason I fell asleep.” Is this argument always valid? Should we pay closer attention to those who claim they suffer from sleep apnea? These are all important questions, and while we don’t want to lessen the severity that sleep apnea has on an individual, we also don’t want to overuse it. In a New York Post article, sleep apnea appears to be a lawyer’s new favorite criminal defense.

The Charge

On a flight, a 21-year-old woman had her earbuds in and hood up while she was eating her in-flight lunch when a large middle-aged man sleeping next to her appeared to jump awake. At first, the man grabbed the woman’s shoulder. Soon after he went around and grabbed the woman’s right breast. The groping from the large man lasted about 30 seconds before fellow passengers could pull them apart. The woman’s attacker was brought up on federal sex-abuse charges.

The Defense

In response to the federal sex-abuse charges, the man’s lawyer presented a bizarre defense that has been used far too often. And, that’s a shame for those who actually suffer from this condition. He said, “Sleep apnea made me do it.” The man was eventually acquitted.

Can you believe that? A deadly condition like sleep apnea is not one to be used lightly, and when someone uses this condition as an excuse, it can give sleep apnea a bad name. We don’t want that to happen.

What We Can Do

We’ve seen this happen far too many times now, but what can we do about it? While we can’t change the opinions, we can continue to educate our patients. Through proper education and treatment, we can not only help our patients live healthier lives, but also understand the true definition of this condition.

From train crashes to cases of sexual abuse, where do we draw the line? I wish I knew the answer to this, but I believe that the more we educate ourselves, employees, and patients, the more we can avoid these situations. Whether it is preventing a crash through proper treatment, or allowing for people like the man in this story to not get away with sleep apnea as an excuse for touching a woman by providing proper education, we need to stay strong.

Sleep apnea is a serious condition, and we need to continue to provide the services we offer in order to educate the masses.

Can Sleep Apnea Treatment Improve PTSD in Veterans?

I recently read an article on a study focusing on CPAP treatment and PTSD in veterans. In this study, researchers found that post traumatic stress disorder (PTSD) symptoms improved in veterans with obstructive sleep apnea (OSA) who were treated with CPAP therapy. After reading this article, my question is: will oral appliance therapy have the same results? I definitely think the chances are high!

The Study

There were 47 veterans recruited, with 40 completing the study. Of those participating, 20 had mild-to-moderate PTSD and 18 had severe-to-very severe PTSD. Researchers found that improvements in PTSD correlated with the duration of CPAP usage, and veterans with severe-to-very-severe PTSD had larger improvements in symptoms.

The only significant predictor of overall improvement in PTSD symptoms was the amount of time the veterans used the CPAP machine. The findings of this study indicate that treatment of OSA reduced PTSD severity and diminished frequency of nightmares. With prolonged CPAP use, veterans continued to experience an improvement in PTSD symptoms.

Oral Appliance Therapy

While there doesn’t seem to be an available study on the use of oral appliance therapy in veterans with PTSD and OSA, we can use CPAP therapy as an example. For veterans with PTSD symptoms, he/she might be CPAP non-compliant or just not like the treatment. The availability of oral appliance therapy for our patients allows us to successfully treat OSA, while also potentially improving PTSD symptoms in veterans–it’s worth the try!

Contact my office to learn more about oral appliance therapy and what we as dentists can do to help our patients.