For Sleep Apnea, a Mouth Guard May be a Good Alternative to CPAP

For Sleep Apnea, a Mouth Guard May be a Good Alternative to CPAP

People with sleep apnea who can’t tolerate the noise and discomfort of a CPAP machine might benefit from a mouth guard or surgery.

By Nicholas Bakalar

Article Published May 31, 2021

Oral device that us used to treat sleep apnea

Many people wear a CPAP machine at night to treat the interrupted breathing of obstructive sleep apnea, a condition that affects an estimated 22 million Americans. But CPAP machines can be noisy, cumbersome and uncomfortable, and many people stop using the devices altogether, which can have dire long-term consequences.

Mouth guards may be a more comfortable and easy-to-use alternative for many people with obstructive sleep apnea, according to a new report. The study, published in Laryngoscope, looked at 347 people with sleep apnea who were fitted with a mouth guard by an otolaryngologist. Two-thirds of patients reported they were comfortable wearing the devices, and the devices appeared to be effective in helping to relieve the disordered breathing of obstructive sleep apnea.

The lead author of the study, Dr. Guillaume Buiret, head of otolaryngology at Valence Hospital in Valence, France, said that if he had sleep apnea, he would choose an oral appliance first.

“It’s easy to tolerate, effective and it costs a lot less than CPAP,” he said. “Thirty to 40 percent of our patients can’t use CPAP, and these patients almost always find the dental appliance helpful. I would recommend it as a first-line treatment”

Loud snoring may be the most obvious consequence of sleep apnea, but the condition, if left untreated, can lead to a broad range of complications, including high blood pressure, heart disease, liver dysfunction and Type 2 diabetes.

The problem develops when the soft tissue at the back of the throat collapses during sleep, blocking the airway. This leads to breathing cessation for brief periods, gasping for air, difficulty staying asleep, and all the problems of daytime sleepiness, from poor job performance to fatal accidents. Animals can have it too — bulldogs, for example, have a narrow airway and a soft palate that can easily block it. Their sleep apnea is almost identical to the human version.

The severity of the condition varies widely from a very mild problem that may need no treatment at all to severe or even life-threatening disease. Dr. Sara E. Benjamin, a neurologist and sleep specialist at Johns Hopkins, said that spending a night in a sleep laboratory monitored by a technician is the best way to diagnose apnea. A lab study offers the most thorough analysis, and can detect many other sleep problems besides apnea, but there are home test kits that are easy to use and cost-effective. They test breathing effort and oxygen levels, but not the brain waves, muscle tone and leg movements that a lab test records.

How can you know that you need a sleep assessment? “It’s a low standard to get evaluated, either by home testing or in a sleep lab,” Dr. Benjamin said. “If a person feels sleep problems are impacting daily activities, that’s enough to go and get evaluated. If the cause is a breathing problem, you don’t want to ignore it.”

A CPAP — continuous positive airway pressure — machine is usually the first option for treating sleep apnea. The device has a motor that delivers pressurized air through a tube attached to a mask that covers the nose, or both the nose and the mouth. This keeps the airway open. Some machines can automatically change the pressure to compensate for changes in sleep position; others require manual adjustment. Headgear varies, but all have adjustable straps to get the right fit. There are newer models that can deliver heated or humidified air, depending on the patient’s preferences, and there are small travel models as well.

“We recommend a custom device made by a dentist,” Dr. Benjamin said. “And you should be retested to see how well it’s working. There’s subjective and objective improvement that should be tracked.”

But there are people for whom neither CPAP nor dental appliances work, either because they cannot use them consistently or correctly, or because the devices themselves do not solve the problem even when used properly. For these patients, there are various effective surgical procedures.

The most common is soft tissue surgery, which involves modifying or excising tissue at the back of the mouth. Depending on the structures and musculature of the mouth, the surgeon can trim the soft palate and the uvula, remove the tonsils, shrink tissues with a heated instrument, straighten a deviated septum, or alter the position of the tongue muscles, all with the aim of improving air flow.
White plastic mouth guard for Obstructive Sleep Apnea by O2Vent Optima

There are also bone surgeries that move the jaw forward to make the entire breathing space larger, a procedure that can involve a protracted recovery period.

In 2014, the Food and Drug Administration approved a device called Inspire Upper Airway Stimulation. This is a small appliance implanted under the skin like a heart pacemaker. Using two electrical leads, it senses the breathing pattern and stimulates the nerve that controls the tongue to move it out of the way and allow air to pass freely. Implanting it is a day surgery procedure that takes about two hours.

“It doesn’t change the anatomy, and recovery is easier than with other surgeries,” said Dr. Maria V. Suurna, an associate professor of otolaryngology at Weill Cornell Medicine who specializes in surgery for sleep apnea. “It’s effective. It has the lowest complication rate of all the surgeries.

“But it’s not for everyone. It’s approved only for adults 18 and older who are not overweight and who have moderate to severe apnea.” Some people may be ineligible because of the structure of their anatomy.

“Surgery is tricky,” Dr. Suurna said. “But there’s no ideal treatment for apnea. Each has pros and cons, benefits and risks.”

What do insurance companies consider oral appliance for sleep apnea?

What do insurance companies consider oral appliance for sleep apnea?

Suffering from sleep apnea can not only disrupt your sleep, but it can be a serious health problem. This is why it’s important to get diagnosed so that you can get the treatment you need. One of the treatments that many people choose is an oral appliance. For many, this is much easier to use than some other available therapy options.

But, as with many medical treatments, the cost can be an issue. Although you have health insurance, many people still wonder, what do insurance companies consider oral appliance for sleep apnea? Let’s answer that question and look at some of the issues surrounding sleep apnea.

What is Sleep Apnea?

If you are diagnosed with sleep apnea, this means you pause when you’re breathing during sleep, or there is a reduction in your breathing. If someone stops breathing completely or takes less than 10% of a normal breath for ten seconds or more, they are experiencing an apnea or obstructive sleep apnoea.  If you are experiencing sleep apnea, you may suddenly wake up or move from a deep sleep to a more shallow sleep.

To determine if you have sleep apnea, a sleep study is generally needed. During a sleep study, sleep patterns are monitored to see if someone stops breathing during the middle of the night and at what frequency. This will help doctors determine if they have sleep apnea and what type. From there, the proper course of sleep apnea treatment can be devised.

Treating Sleep Apnea

Once you’re diagnosed with sleep apnea, it’s time to get treatment. Oral appliances are a popular option over using a continuous positive airway pressure (CPAP) machine.  Some people find these cpap therapy machines to be noisy and intrusive.

Oral appliance therapy works to treat sleep apnea by moving the lower jaw forward to open the airway and unblock the windpipe, which can improve breathing and lead to a better night’s sleep. FDA-registered oral devices can be used to treat sleep apnea when they are given by a qualified dentist trained in dental sleep medicine.  At Sleep Better Columbus, we can help you find the right oral appliance to treat your sleep apnea and get you a better night’s sleep.

Insurance and Oral Appliance Treatment  for Sleep Apnea

Since all insurance companies are different, you’ll need to contact your specific insurance company to make sure that you are covered for an oral appliance for sleep apnea. Generally, plans will at least cover a portion of the cost.

Most health insurance plans consider oral appliances or dental appliances for sleep apnea as a piece of medical equipment. This is why they will cover it. There are more than 100 FDA-approved oral appliances available to help treat sleep apnea. Your insurance may specify the type of oral appliance that they will cover instead of letting the doctor and patient choose. These are things you will need to ask your benefits department.

To get coverage for an oral appliance for sleep apnea, you’ll have to show that you suffer from the condition and not just chronic snoring. A copy of the sleep study and any medical notes from your sleep apnea screening appointment is also necessary. Your medical history will also be considered. Some insurance companies may also require other documentation, so it’s best to ask so that you are prepared.

Of course, for your insurance company to pay for an oral appliance for sleep apnea, it needs to be prescribed by your doctor. The insurance company will need to see that documentation to provide any level of coverage.

Although the equipment goes in your mouth, an oral mouthpiece is treated under your health insurance, not your dental insurance. The device is being used to treat a medical condition, not one that is specific to your dental health. An oral appliance is seen as a piece of medical equipment because it can be used to improve your health.

When people begin using oral appliance treatment for sleep apnea, they can also help to avoid serious health problems such as:

  • High blood pressure
  • Stroke
  • Diabetes
  • Heart disease

If you have a medical history of any of these or a family history of them, it’s important to get treatment for your obstructive sleep apnea as soon as possible.

How Much Do Oral Appliances for Sleep Apnea Cost?

This is a difficult question to answer because there are so many oral devices  for sleep apnea available. Since they are custom-fit to each patient and everyone may choose something different depending on their condition, it’s best to ask your doctor which ones are best for you. From there, you can price them out and get a better idea of the cost.

Once you have an estimate, you can find out how your insurance may cover it. This will also vary depending on your plan. If you have a deductible, this will come into play, as well as if you have any co-insurance. Many times patients do need to pay for a percentage of the cost. But, the exact dollar amount will depend on your insurance coverage.

Contact Us!

When you need an oral appliance to treat obstructive sleep apnea (osa), visit Dr. Mark Levy at Sleep Better Columbus.  Dr. Levy is trained in treating sleep apnea and can recommend dental appliances for sleep that can help. Let Dr. Levy and his dental sleep staff show you the alternative to CPAP machine to improve the quality of your sleep.

The dental sleep medicine staff at Sleep Better Columbus can help you find an oral device for sleep apnea that your insurance will cover so that you can get your obstructive sleep apnea under control. Once you do, you’ll notice you’re getting a better night’s sleep as well as an improved quality of life. When you have your sleep apnea treated, you’ll feel energized and healthy.

Call Sleep Better Columbus today at 614-362-7292 to find out more about oral appliances to treat your sleep apnea.

How Wearing a Face Mask Can Cause TMJ Problems

How Wearing a Face Mask Can Cause TMJ Problems

Face mask-wearing has become the norm these days due to the COVID-19 pandemic. The CDC has recommended wearing face masks to stop the spread of the coronavirus through particles released in the air. In many areas, wearing a face mask is mandatory in public.

While dentists and surgeons have been used to wearing surgical masks as part of their job for years, it’s an entirely new concept for most of the general public. Many people have had to get used to wearing masks, or in many cases, are still getting used to it.

As we wear face coverings to protect us from coronavirus, some people have begun experiencing headaches and jaw pain associated with TMJ. We’re going to take a look at these pains as well as what you can do to relieve them while still wearing your mask to prevent infection.

Headaches from Wearing Face Masks

Face mask-wearing has led many people to change the way they breathe. This may mean holding their mouths open and taking shallow breaths. Holding your mouth open when wearing a mash can cause muscle imbalances in the neck and jaw. These types of imbalances can cause headaches.

When you’re wearing a face mask all the time, you may not be drinking as much water as you used to. This can leave you dehydrated. Dehydration can lead to headaches and fatigue. One easy way to eliminate this problem is to set a timer for yourself to drink water. This will help to keep you hydrated while giving you a quick mask break throughout the day.

Jaw Pain From Wearing Face Masks

You may not even realize it, but you may be pressing your lips together or clenching your teeth under your mask. When the jaw and facial muscles are in this contracted position for a long time, they can get overworked, just like any other muscle in your body. When this happens, lactic acid builds up and irritates nerve fibers, causing pain.

Other factors that can contribute to TMJ pain while face mask-wearing come from tugging down on your ears or wearing a face mask with tight bands. When you do this, you draw your ears down and forward toward your jaw. This creates compression on the disc of your jaw.

If you are experiencing jaw pain from wearing a mask, you may want to consider the type of mask you’re wearing. There are cloth masks, surgical masks, and N95 masks. N95 masks can give a tight fit and when you combine that with a tugging on your chin, it can lead to more compression of the jaw and jaw pain. If you find this happening, you may want to try out different types of masks that will still give you protection from COVID-19, but with more comfort for your face.

What Can You Do to Relieve Pain from Face Mask-Wearing?

Since face mask-wearing is not something you can ignore, you have to find ways to decrease pain while remaining safe. Here are some ideas:

1. Be aware of your jaw when wearing a face mask

When you have your mask on, try not to make your jaw tense or push it forward to keep your mask on. The elastics are on your mask are supposed to keep your mask in place. If you find this is not happening, it may be time to look for a better fitting mask. When you wear your mask, your jaw should be relaxed when it’s resting, your teeth shouldn’t be touching, and your lips should be lightly together. Keeping these things in mind should reduce jaw pain when wearing a face mask.

2. Be aware of ear loops and look for alternatives.

Earloops can pull and tug on your ears, leading to headaches and jaw pain. When your mask’s ear loops are constantly tugging, the trigeminal nerve is triggered. This can lead to pain and tension in your jaw.

If you feel this pain, you may want to try ear savers. These fit around your head, eliminated ear loops and the pulling they cause. If you’re crafty, you can try to make one yourself. If not, there are plenty that are already made and available online.

3. Be aware of your breathing pattern.

Face mask-wearing might prompt us to breathe through our mouths instead of our noses. When we breathe through our mouth, our jaw is held open slightly, leading to tension around the jaw. Try to still breathe through your nose when you’re wearing a face covering. When you breathe through your nose, it allows the jaw to stay in a better resting position.

4. Keep your neck muscles loose.

When you wear a mask, it can change your normal head position. This can hurt your neck muscles and lead to jaw aches. If you can try to keep your neck muscles loose, you can eliminate the strain and keep TMJ symptoms at bay.

5. Ensure masks fit properly.

Your mask should fit snug across the nose and not slip up toward the eyes. This will prevent you from clenching or protruding your jaw.  Ear savers can also help keep your mask in place and reduce tension on the jaw.

It’s important to find a face mask that fits properly and doesn’t cause unnecessary problems. In the end, proper face mask-wearing should not only protect you from the coronavirus but also be comfortable and not lead to TMJ pain.

Resources for TMJ Pain

http://tmj.org/

http://www.tmj.org/Page/36/18

https://www.painnewsnetwork.org/stories/2020/8/3/what-if-you-cant-wear-a-face-mask#.XyhRL4mbgBA.facebook

https://www.msn.com/en-sg/health/medical/9-side-effects-of-wearing-face-masks/ss-BB13ZHW7#image=11

https://askthedentist.com/tmd-treatment/

Columbus Ranked 6th Most Sleep Deprived Large City in US

Columbus Ranked 6th Most Sleep Deprived Large City in US

If you’re reading this article through blurry eyes, you’re not alone. Columbus was recently ranked one of the most sleep deprived cities in the United States by a study from RetailMeNot.

The study looked at data from the Centers for Disease Control (CDC) in which adults reported getting less than seven hours of sleep per night. Additional metrics include statistics on poor mental health and physical health, as a lack of sleep can have a drastic impact on both.

Columbus ended up in 6th place on the list of large cities with a whopping 41.8% of adults reporting getting less than seven hours of sleep per night. The only large cities to rank higher include Detroit (#1 with 51.4% of adults reporting less than seven hours of sleep per night) followed by Cleveland, Memphis, Philadelphia and Baltimore.

“Many facets of modern life contribute to the lack of sleep,” states the RetailMeNot blog post that features the results of the study. “One example is technology, as people spend more time in front of brightly-lit devices that disrupt the body’s natural circadian rhythms. But more fundamental patterns of working and living are also at play. Factors like longer commutes and longer working hours in the U.S. workforce may be key reasons why a good night’s rest is harder to come by.”

As a whole, the CDC reports that the United States has a national rate of 36.2% of adults getting less than 7 hours of sleep per night, which means that Columbus isn’t that much higher than the national average.

To view the full results of the study, visit www.retailmenot.com.

RELATED: The Future of Sleep

Source: https://www.columbusunderground.com/columbus-ranked-6th-most-sleep-deprived-large-city-in-us-we1

Sleep Apnea as a COVID-19 Risk

Sleep Apnea as a COVID-19 Risk

With almost 15 million cases of coronavirus and over 280,000 deaths in the U.S., we have fortunately learned much about COVID-19 prevention measures and treatments since the early days of the pandemic, and a vaccine is now in sight. Most of our knowledge regarding  risk factors for worse outcomes, include immunocompromised status, diabetes, older age and high blood pressure.

One risk factor remains hidden in plain sight: obstructive sleep apnea.

Read more