It is a well known fact that snoring, although annoying, can be serious both socially and medically.

Ask any qualified marriage counselor, snoring can be a major factor in causing divorce! Why, because causes sleepless nights for bed partners. Thus, both the snorer and bed partner don’t get needed rest, which effects their mood and attitude during their waking hours.

The medical community is well aware that snoring can be the precursor of obstructive sleep apnea. And obstructive sleep apnea has been linked to heart failure, high blood pressure and stroke. Also, snoring has been linked to Type II Diabetes.

Sleep apnea usually interrupts loud snoring with a period of silence in which no air passes into the lungs. Listen carefully to a snorer and you will oftentimes recognize this pattern. This the lack of oxygen and the increase carbon dioxide that occurs at these silent times will awaken the snorer, finally forcing the airway to open with a loud gasp.

You may not be aware of your snoring but it is highly likely that your bed partner is! Seeking professional advice can help you both because snoring not only causes disruption in sleep it can also be a sign of obstructive sleep apnea.

Dr. Norman Huefner, Orange County Dentist, Laguna Niguel, CA

First, all snorers and those with sleep apnea should first incorporate several lifestyle changes, such as good sleep hygiene, exercise, reducing alcohol consumption (especially in the evening) and weight loss.

Then, there are three primary ways to treat snoring and sleep apnea.

The most common way is with therapy delivered through a Continuous Positive Air Pressure machine or CPAP machine. CPAP is usually applied through a tube to a mask that covers the nose. The air pressure that is generated splints the structures in the back of the throat, holding the airway open during sleep. Unfortunately, there are many patients who cannot tolerate sleeping with the CPAP.

Treatment can also be accomplished with surgery to the soft palate, uvula, and tongue to eliminate the tissue that collapses during sleep. Most commonly are the Pillar Procedure and the modified UPPP procedure.  By the way, I have had both these procedures done to reduce my snoring and treat my obstructive sleep apnea, but neither procedure helped much.

More complex surgery can reposition the anatomic structure of your mouth and facial bones. Many of these procedures can be performed by an AADSM member trained as an oral and maxillofacial surgeon.

However, the patient and practitioner need to weigh the advantages and disadvantages, risks and complications of the surgical procedures.

As a general rule, the CPAP is the best treatment for patients with severe obstructive sleep apnea.  Also, dental oral appliances are highly ranked for those with only snoring, those with mild to moderate sleep apnea and those with severe sleep apnea who cannot tolerate utilizing the CPAP.

Dr. Norman Huefner, Orange County General Dentist

With so many different oral appliances available, selection of a specific appliance may appear somewhat overwhelming. Nearly all appliances fall into one of two categories. The diverse variety is simply a variation of a few major themes. Oral appliances can be classified by mode of action or design variation.

One type of appliance used is a Tongue Retaining Appliances.  It works by holding the tongue in a forward position by means of a suction bulb. When the tongue is in a forward position, it serves to keep the back of the tongue from collapsing during sleep and obstructing the airway in the throat.  This is probably the least used appliance, but is still effective in many situations.

The most common dental appliance used for snoring and sleep apnea is one of the variations of the Mandibular Repositioning Appliances.

Mandibular Repositioning Appliances (or MADs) function to reposition and maintain the lower jaw (mandible) in a protruded position during sleep. This serves to open the airway by indirectly pulling the tongue forward, stimulating activity of the muscles in the tongue and making it more rigid. It also holds the lower jaw and other structures in a stable position to prevent opening of the mouth.  They also repositioning the lower jaw, tongue, soft palate and uvula, which stabilizes the lower jaw and tongue, increasing the muscle tone of the tongue

Dentists with training in oral appliance therapy are familiar with the various designs of appliances. They can determine which one is best suited for your specific needs. The dentist will work with your physician as part of the medical team in your diagnosis, treatment, and on-going care. Determination of effective treatment can only be made by joint consultation of your dentist and physician. The initial evaluation phase of oral appliance therapy can take from several weeks to several months to complete. This includes examination, evaluation to determine the most appropriate oral appliance, fitting, maximizing adaptation of the appliance, and the function.

Oral appliances are worn in the mouth to treat snoring and sleep apnea. These devices are similar to orthodontic retainers or sports mouth guards. Oral appliance therapy involves the selection, design, fitting and use of a custom designed oral appliance that is worn during sleep. This appliance then attempts to maintain an opened, unobstructed airway in the throat. There are many different oral appliances available. Approximately 40 appliances have been approved through the FDA for treatment of snoring and/or sleep apnea. Oral appliances may be used alone or in combination with other means of treating sleep apnea. These means include general health, weight management, surgery, or CPAP. Oral appliances work in several ways:

• Repositioning the lower jaw, tongue, soft palate and uvula
• Stabilizing the lower jaw and tongue
• Increasing the muscle tone of the tongue

Dentists with training in oral appliance therapy are familiar with the various designs of appliances. They can determine which one is best suited for your specific needs. Your dentist (if he/she is trained in treating sleep breathing disorders, snoring and sleep apnea) will work with your physician as part of the medical team in your diagnosis, treatment, and on-going care. Determination of proper therapy can only be made by joint consultation of your dentist and physician. Initiation of oral appliance therapy can take from several weeks to several months to complete. Your dentist will continue to monitor your treatment and evaluate the response of your teeth and jaws.

How do they work?  These stop snoring and sleep apnea appliances help prevent the collapse of the tongue and soft tissues in the back of the throat, keeping the airway open during sleep and promoting adequate air intake. There are approximately 70 different oral appliances available today, each having a different construction, size and method of adjustment.  The appliance utilized most often in our practice is the SmonomedMAS.

Oral appliances may be used alone or in combination with other means of treating OSA, including general health and weight management, surgery, or CPAP.

Snoring can be harmless, or one of the signs and symptoms of an oftentimes dangerous condition called obstructive sleep apnea.

Obstructive Sleep Apnea (OSA) occurs when the tongue and soft palate collapse onto the back of the throat. This blocks the upper airway, causing air flow to stop. When the oxygen level drops low enough, the brain moves out of deep sleep and the individual partially awakens. The airway then contracts and opens, causing the obstruction in the throat to clear. The flow of air starts again, usually with a loud gasp. When the air flow starts again, you then move back into a deep sleep. The airway muscles collapse, as you awaken with a gasp. The airway clears once again as the process repeats itself. This scenario may occur many times during the night. The combination of low oxygen levels and fragmented sleep are the major contributors to most of the ill effects that the sleep apnea patient suffers.

In addition to excessive daytime sleepiness, studies show that sleep apnea patients are much more likely to suffer from heart problems (heart attack, congestive heart failure, hypertension), strokes, as well as having a higher incidence of work related and driving related accidents.