Sleep Apnea

DNA Oral Appliance

DNA stands for “Daytime Nighttime Appliance”. It is an FDA-regulated method of treating and even curing obstructive sleep apnea. The DNA oral appliance is an innovative dental health solution to this sleep/breathing disorder. A DNA looks very similar to a retainer. It is adjustable, so your healthcare provider can slowly adjust it to reshape your arches (the crescent of your teeth) to allow more room for your tongue, so it doesn’t block your upper airway. The American Academy of Sleep Medicine supports oral appliances as an effective therapy for sleep apnea. Though these manage symptoms, they do not address the root cause of your sleep apnea. DNA is not like normal “oral appliances” that temporarily reposition your tongue and lower jaw for a night. DNA is an oral appliance that gets at the root cause. A DNA stimulates steady arch redevelopment, activating stem cells for bone growth. This is not cranking the jaw back open. It painlessly expands the arch in every direction. Also, many patients and practitioners report that a DNA makes your smile look better, on top of curing sleep apnea. DNA is a holistic dental solution because it is focused on whole-person health — treating health problems in one part of the body to treat a health problem in another part of the body. Other devices, such as an MAD (mandibular advancement device), may be used. However, we do not recommend these, as they place the jaw in an unnatural position.
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APAP or CPAP Therapy

APAP stands for “automatic positive airway pressure.” CPAP stands for “continuous positive airway pressure”.

About half of all sleep apnea-diagnosed patients are prescribed APAP or CPAP therapy. It is the most popular treatment option for sleep apnea sufferers — even it only treats the symptoms, not the underlying cause, of your sleep apnea. Patients on APAP or CPAP wear a facial or nasal mask while they’re sleeping. This mask is connected to a pump device. This machine maintains a positive flow of air that keeps the airway open during sleep. The primary difference between the CPAP and APAP machines is that a CPAP uses consistent pressure, while an APAP adjusts air pressure depending on what air pressure you need at any given time. Fortunately, almost all insurance plans cover these therapies as treatments for obstructive sleep apnea. APAP/CPAP machines have been linked to increased quality of life for both patients and their bed partners. However, there is some debate in the sleep medicine world about the potential for these machines to lead to reduced muscle strength and development in the throat over long periods of use.

BiPAP Therapy

BiPAP stands for “bilevel positive airway pressure”. Also called BPAP, this works similarly to CPAP.

The difference? BiPAP machines have two pressures:

1. A standard inhalation pressure level
2. A lower exhalation pressure level

Where CPAP only uses one pressure level, BiPAP utilized two pressure settings to make it easier for patients to breathe. The most common complaint of CPAP is probably trouble breathing out when at higher pressure settings.

Because CPAP is less patient-friendly at higher pressure settings, and higher pressure is needed for more severe sleep apnea, BiPAP machines are good for patients with more severe cases of sleep apnea.

Medications

If your sleep apnea is caused by nasal congestion or allergies, ask your doctor about taking nasal decongestants or allergy medications. This may help you breathe better at night.

Don’t use sleeping pills. These pills often relax the soft tissues in the back of your throat, worsening your sleep apnea symptoms. Sleeping pills are bad for your airway health.

If your sleep apnea is caused by opioids, ask your doctor about stopping your use of opioid medications.

Surgery

In rare cases, you may require surgery to correct a physiological issue that is triggering your sleep apnea.

Examples of surgery for sleep apnea:

• Uvulopalatopharyngoplasty (UPPP) is when the surgeon removes and/or repositions excess soft tissue in the back of your throat. This is the most common sleep apnea surgery.
• Genioglossus advancement moves the bone in the lower jaw (where the tongue is attached) further from your throat. This opens up the airway.
• Maxillomandibular osteotomy/advancement is a highly invasive surgery where your jaw is cut into and brought forward, giving your throat more room for breathing.
• Midline glossectomy means the surgeon will remove part of the back of your tongue.
• Palatal implants involve the placing of small rods into your soft palate to prevent airway blockage.
• Radiofrequency volumetric tissue reduction uses cauterization to shrink the tissues of the throat, soft palate, tonsils, and/or tongue.
• Septoplasty is when the surgeon adjusts a deviated septum — an effective treatment option if your sleep apnea is caused by a deviated septum. (Some doctors claim a deviated septum is never the cause of sleep apnea.)
• Tracheostomy is a procedure in which a surgeon inserts a hollow breathing tube into your windpipe that can be plugged during the day for normal breathing and speaking.

Lifestyle Changes

There are several simple lifestyle changes you can make to improve your sleep apnea. Some of these changes may help manage symptoms; other changes may get rid of the underlying cause of your sleep apnea.

Consider these lifestyle changes to address sleep apnea:

• Weight loss and exercise go hand in hand, and both fight sleep apnea. Not only is weight loss the most common risk factor for sleep apnea, but exercise can improve your peak oxygen consumption and daytime sleepiness, regardless of weight loss.
• Don’t sleep on your back. When you sleep on your back, gravity pulls your tongue towards your throat, making it harder to breathe.
• Quit smoking. Smoking tobacco seems to make sleep apnea worse, though it’s difficult to say conclusively that smoking can cause sleep apnea. Quitting smoking should improve symptoms, potentially so much that you won’t even notice your apnea even more. (Note: The first couple days of nicotine withdrawal symptoms may mimic OSA.)
• Avoid excess alcohol. A little alcohol shouldn’t hurt, but excess alcohol has been linked to sleep apnea. Don’t drink alcohol 2-3 hours before bedtime.
• Use a humidifier, since dry air makes it difficult to breathe normally when you’re asleep. More humid air will not cure sleep apnea, but it makes it easier for you to get the oxygen you need and helps prevent allergens from getting to your lungs.
• Reduce opioid use. Opioid medications are a leading cause of central sleep apnea.