Advanced Sleep Apnea Therapy:
Sleep apnea therapy as presented by most of the dental community involves the use of oral appliances at night time. This is well and good, but it often fails to look at the whole person and all of their past and present medical issues. Sleep apnea is often caused by a complex set of conditions and the cure for sleep apnea will not be found in treating just part of a patient’s multifactoral causation. Advanced sleep apnea therapy is designed to treat the patient comprehensively and address not only apnea, but the whole individual and all of their associated medical disorders.
What is sleep apnea:
Sleep apnea presents in two primary forms: central and obstructive. What is common to them both is that the underlying cause is often a jaw misalignment. Recent developments in movement disorders is shedding light on our understanding of the cause of central sleep apnea. Evolving information is showing that the cause of central sleep apnea may be do in large part to the affect of jaw alignment sensors on breathing pattern generation in the brain stem.
The primary cause of obstructive sleep apnea in most patients is the restricted airway near the rear of the tongue. The cause of sleep apnea is the lower jaw being postured excessively in a retruded position in most cases due to inherited and developmental jaw positioning. This is often the cause of sleep apnea even in individuals that present with what appears to be a good bite. Jaw retrusion (misalignment) is most often inherited and causes a continuum of disorders throughout the persons lifetime, hence the need to take a complete medical history with knowledge of dental orthopedic symptoms. Sleep apnea is often just another symptom in a long complex medical history. The ideal treatment then is to not just treat the apnea at night, but to reposition the jaw 24 hours a day. This will not only help the night time apnea, but often address the broad medical issues (see Associated Medical Disorders). This is the essence of advanced sleep apnea therapy.
Traditional sleep apnea therapy with the use of CPAP may correct the apnea, but with the lower jaw misaligned, leave the trigeminal nerve hypertonic with continued sympathetic over stimulation, decreased cerebral blood flow, and elevated neurogenic inflammatory propensity to name but a few of the consequences. With the jaw misaligned (retruded), the air pressure will have to be unnecessarily elevated in order to force the air past the narrow airway space at the back of the tongue. Advanced sleep apnea therapy considers more factors and tries to address all of them.
There are many types of sleep apnea appliances that can be used to align the jaw, but seldom are they adjusted properly by dentists. It is critical that they be adjusted such that the posterior teeth touch first so as to decompress the TMJ and calm the trigeminal nerve. And it must be recognized that in time, this relationship can change with use and should be monitored at minimum 6 month intervals (more frequent if unstable). This adjustment is done in our office with polyvinyl siloxane bite registration material that gives us precise objective analysis.