Health Column: Game gear: Tips for winning at the game of sleep

Sometimes sleep-related ills simply come down to one thing - oral concerns. Having an abnormal face and facial bone structure can increase the likelihood and severity of obstructive sleep apnea, a problem that can appear when the airway in the back of the throat becomes totally blocked, usually by the tongue and the soft palate coming into contact.

It makes it seem as if the person is trying to breathe, yet the blocked airway won’t allow air to enter or leave the lungs.

People with a small or receding chin or a significant overbite are more likely to have obstructive sleep apnea, but these structural woes - as well as some others - sometimes can be treated through the use of oral appliances, which also can be especially helpful in treating sleep-related problems. The goal surrounding the use of oral appliances - along with other treatments for sleep-disordered breathing -- is to maintain as-close-to-normal breathing by maintaining the potency of the upper airway, as well as rate and volume of respired air.

Oral appliances are especially helpful in treating snoring, the upper airway resistance syndrome and sometimes moderate sleep apnea. They provide another non-surgical option for those patients who can’t tolerate a PAP machine, which detects the abnormalities in an individual’s breathing rate, along with the amounts of inhaled and exhaled air, and adjusts the breathing rate and volume or air delivered to compensate for it.

In some ways, an oral appliance is similar to the mouth guard an athlete wears. It’s molded to the upper and lower teeth and stays in place because of that.

The purposes of the oral appliance, also called a mandibular (or lower jaw) advancement device - or simply a splint, is to open the posterior upper airway by moving the lower jaw slightly forward and sometimes downward. It also moves the tongue at the same time, as it’s attached to the lower jaw. This helps to open the airway from the front.

There are some advantages to using an oral appliance as opposed to other non-surgical treatment options including the fact they have a lower cost than the PAP, they are easier to use, they are easier to transport and they don’t require a power source. It’s also a lot quieter. In some cases, too, the oral appliances are adjustable, which allows for more-optimal treatment of the sleep-disordered breathing. Adjustable options often are more expensive, but may be worth it, depending on individual cases.

But, oral appliances aren’t the fix for everyone, unfortunately. They can’t be used for patients that have too severe of an obstructive sleep apnea, and especially not with those who have severe oxygen desaturations; with those who have too few teeth to hold the appliance in place; with those who experience pain or temporomandibular joint disease; or with those who have diseases of the gums called periodontal disease.

Patients experiencing central sleep apnea and central hypoventilation also shouldn’t use oral appliances for treatment as these conditions don’t respond to them.

Dr. Fredric M. Radoff is a neurologist specializing in sleep disorders medicine at The Center for Sleep Medicine, a partnership of Blount Memorial Hospital and East Tennessee Medical Group.

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