orthodontics Sleep apnea Bellevue

Sleep Apnea & Orthodontics

BY Dr. Rooz Khosravi

Orthodontic Treatments for Obstructive Sleep Apnea in Adults

Do you suspect that you or a loved one has obstructive sleep apnea

OSA is a serious problem that poses several risks to your health and wellbeing if it stays untreated. Daytime sleepiness, increase blood pressure, hypertension, and reduced quality of life are examples of OSA consequences.

So what are your options for treating OSA? Since OSA is caused by a pharyngeal physical obstruction, treatment involves removing or preventing the blockage.

Let’s review the most common and effective treatments for obstructive sleep apnea.

What is obstructive sleep apnea?

Sleep apnea is a condition in which your breathing is interrupted while you are asleep – hypopnea. Sleep-disordered breathing is a larger umbrella of sleep abnormalities.

There are two main kinds of sleep apnea: central sleep apnea and obstructive sleep apnea.

Central sleep apnea – when breathing is interrupted by a miscommunication between your brain and the muscles that control breathing.

Obstructive sleep apnea – when a physical obstruction temporarily blocks your airway while you sleep. The blockage happens when soft tissues in the throat collapse together.

Both types of sleep apnea cut down on your body’s oxygen supply during sleep. Obstructive sleep apnea (often abbreviated OSA) is the most common type, however, and it’s the easier one to treat.

CPAP Therapy for OSA

CPAP is an abbreviation for “continuous positive airway pressure.” A CPAP machine is a device that administers a steady stream of filtered and pressurized air through a mask that either fits over your nose, or that covers both your nose and mouth. The constant airstream presses on the tissues in your mouth and throat to keep them from collapsing while you sleep.

A CPAP device may not look very comfortable because of the mask, tubes, and straps. But CPAP therapy is actually quite effective in treating OSA when used properly. If a sleep disorder specialist prescribes CPAP therapy to help you manage OSA, then they will help you find a device that suits your needs.

CPAP Therapy: What to Expect

Your prescribing physician will teach you how to set up and wear your CPAP device.

To use, simply plug your machine into a power source near your bed and then put on the mask with the straps loose. Once the mask feels like it’s in the right place, tighten the straps. Switch the machine on before falling asleep.

Give yourself a little extra time in the evenings before going to bed so you can set up your CPAP machine. It may feel a little uncomfortable or even claustrophobic, at first, but you will probably get used to the sensation within a few nights of use.

The pressurized air from a CPAP machine is naturally cold and dry, so most models come with built-in heated humidifiers. These allow you to make the airflow more comfortable.

Pros of CPAP Therapy

  • Can help you enjoy a better quality of sleep
  • Ensures that your body is receiving a steady supply of oxygen

Cons of CPAP Therapy

  • May require changes in your sleeping position and routine
  • It can take some time to get used to wearing the mask
  • Dry mouth, congestion, skin sores, and nosebleeds can occur as a result of use
  • Depending on your lifestyle, type of CPAP device, and sleep disorder treatment needs, traveling with the machine could be inconvenient

CPAP, APAP, BiPAP—What’s the Difference?

All CPAP machines have essentially the same hardware, but some have different programming to address different sleep disorder needs.

For example, an APAP machine (“automatic positive airway pressure”) is simply a CPAP device that monitors your breathing condition and automatically adjusts the airflow as needed. It administers the steady stream of pressurized air only when it detects that your natural breathing pattern is being actively obstructed.

What about CPAP versus BiPAP? A BiPAP machine (“bi-level positive airway pressure”) is mostly used for cases of central sleep apnea which is when there’s a lack of communication between the brain and the breathing muscles. BiPAP therapy administers the air at regular intervals to ensure the individual keeps getting oxygen.

Orthodontic treatment for sleep disorders

Orthodontists along with sleep doctors can help patients with sleep disorders of all ages. The interdisciplinary team should work together to address this condition.

The prevalence of patient with sleep apnea various from 5-14% in adults (2X in males) and 2-5% in kids. It is essential that sleep apnea is diagnosed through ideally more than one sleep study.

The American association of orthodontists had an exclusive meeting on sleep apnea syndrome and how orthodontic and dentofacial orthopedics can offer sleep apnea treatment. Here is a white paper by the association clarifying the facts on a few of the following questions:

1) Can jaw surgery help with symptoms of sleep apnea?

2) Can palatal expander prevent or treat sleep apnea?

3) What are the treatment options for sleep apnea that an orthodontist can offer?

4) How does facial growth impact mouth breathing? How to address sleep apnea in children? Does rapid maxillary expansion in kids change sleep disorder?

5) Does extraction of teeth cause sleep-related breathing disorders or sleep apnea?

6) How does an orthodontist work with sleep specialist of sleep medicine?

7) Can adenoid or tonsils removal in pediatric patients can improve sleep apnea?

8) Does expansion of upper arch and soft palate improve the upper airway resistance and prevent sleep apnoea?

Orthognathic (Jaw) Surgery for Obstructive Sleep Apnea

In some cases of obstructive sleep apnea, an unobstructed airway is created by adjusting the position of the upper jaw and lower jaw in a procedure called orthognathic surgery – maxillomandibular advancement. Orthognathic surgery is quite drastic, so it’s normally only needed in cases of moderate-to-severe OSA as a last-resort. 

Orthognathic Surgery—What to Expect

Jaw surgery is usually an in-patient procedure at a hospital. You will be given general anesthesia so that you are not awake during the surgery. 

The surgeon will access your jaw from inside your mouth to avoid leaving scars on the outside of your face. Your jawbone will be cut, moved forward, and then fastened into a new position with plates, screws, or even a bone graft.

You won’t feel anything during the surgery, but you will experience some swelling and discomfort while you start healing. It will take several weeks for your jaw to start feeling back to normal, and it may take up to three months for it to completely heal.

After your jaw has been realigned, you may need to follow up with orthodontic treatment to make your teeth all line up properly.

Pros of Jaw Surgery for OSA

  • Results of treatment are permanent and effective for OSA sufferers
  • No need to wear an appliance or use a PAP (“positive airway pressure”) device

Cons of Jaw Surgery for OSA

  • An major procedure that requires a lot of time for recovery
  • Not suitable for those with certain medical conditions

OSA Oral Appliance therapy

An oral appliance is a convenient and non-invasive way to open up your airway when you sleep. Oral appliance therapy helps the mandible to position forward. There are two main kinds of OSA appliances: tongue retainers and mandibular advancement devices.

A tongue retainer, or stabilizer, looks a bit like a pacifier and it holds your tongue in place so that it can’t flop backwards in your mouth and close off your airway. This appliance could work well if you learn that your tongue is the cause of your OSA, but some people find that tongue stabilizers are uncomfortable.

Mandibular advancement devices look similar to athletic mouth guards or clear aligners, except that the upper and lower trays are connected by a spring mechanism. The spring applies tension which pulls your lower jaw forward. This prevents your jaw from relaxing and sliding back when you sleep, something that is a common cause of OSA.

What to Expect from an Oral Appliance

If your sleep physician prescribes an oral appliance to treat OSA, then you will need to get one custom-made to fit your mouth precisely. Otherwise, the appliance won’t work well and you could even experience jaw pain.

To use, you’ll simply place the device over your teeth or tongue as your doctor demonstrated before going to sleep. You’ll have to carefully clean your appliance daily to prevent infections and bad breath.

Like PAP therapy, an oral appliance will not permanently cure obstructive sleep apnea. Instead, it just helps to temporarily open up your airways when you sleep.

Pros of an Oral Appliance for OSA

  • No need for invasive surgery
  • More convenient and discreet than PAP therapy
  • Easy for travel

Cons of an Oral Appliance for OSA

  • Can be an annoyance if the device is not properly fitted
  • Not a permanent solution for OSA

Oral appliances, surgery, and PAP therapy are the main ways physicians treat obstructive sleep apnea, but they aren’t your only options.

Let’s consider a couple more.

Other Surgery for Obstructive Sleep Apnea

Your sleep disorder specialist might recommend either repositioning your tongue, removing your tonsils, or reshaping your sinuses to create an unobstructed airway.

Although minor soft tissue surgery is not the same thing as jaw surgery, it’s still a drastic measure that may not work for all OSA-sufferers. It should be prescribed by a sleep physician if other non-invasive treatment methods don’t work.

Other OSA Therapies

In addition to first-line treatments that remove the physical obstruction, there are a few other steps you can take to lower your risk of experiencing obstructive sleep apnea.

Weight Management

The American Thoracic Society recommends taking this step in addition to other OSA management techniques. Obesity is a known risk factor for sleep disorders. The weight of excess fat tissue around your neck can contribute to airway obstruction, so a healthy weight loss program could help you breathe easier at night.

Change Sleep Position

Getting relief from OSA could be as simple as switching your sleeping position from your back to your side. You can experiment with this method on your own, but a sleep disorder specialist will give you more helpful insights.

Diet and/or Medication Changes

Certain foods including alcohol and some medications can cause your throat and neck muscles to deeply relax and collapse, leading to airway obstruction.

Do not attempt to change your medications without approval from your primary care physician. Even making big changes to your diet should be done with direction from your doctor. Cutting back on alcohol consumption, however, is always advisable and you don’t need a doctor’s permission to do that.

Which OSA Treatment Is Right for You?

After reading this article about treatments for obstructive sleep apnea, you probably have an idea of which option interests you the most.

However, it’s not as simple as just picking an option that sounds good to you. You’ll have to get a diagnosis from a sleep doctor who can recommend treatments based upon your unique needs. It’s possible that you will have to try out more than one non-invasive therapy before trying something more complex like jaw surgery.

At this point, you might be wondering: “how could an orthodontist help me treat OSA?”

You’ll notice that this list of medically proven treatments for obstructive sleep apnea doesn’t include braces. Treatment for OSA requires a multidisciplinary approach to address the cause of the obstruction and simply straightening your teeth isn’t enough.

But your orthodontist can still help.

In another post, we’ll address some common myths about orthodontic treatment and OSA and explain the facts. You’ll also learn about the important role that your orthodontist can play in your OSA treatment journey.

To start getting relief from obstructive sleep apnea, contact a sleep doctor near you to arrange a consultation.

Dr. Rooz Khosravi is an associate professor of orthodontics at the University of Washington. He offers specific orthodontic treatments to patients with sleep disorders including jaw surgery and oral appliances.