Sleep apnea therapy

What is sleep apnoea?

More than 150,000 people in Switzerland experience pauses in breathing while they sleep. Snoring is not just a nuisance; it can also be a sign of a serious condition called obstructive sleep apnoea (OSA). An apnoea is defined as an interruption of airflow lasting at least 10 seconds. People with sleep apnoea sometimes have hundreds of these pauses a night, often lasting a minute or longer.

During sleep all muscles relax, including the tongue. It falls back and can narrow the throat; the uvula and the palatal arch can fall back too. Air has to pass the narrowed area under increased pressure, the soft palate vibrates – and the typical snoring sound results.

• Being overweight and having a large neck circumference
• Narrowing in the nasopharynx
• Frequent alcohol consumption and smoking
• Sleeping pills or sedatives, which can make snoring worse
• Men are generally affected more often than women

Symptoms and consequences

Loud snoring and pauses in breathing are typical. A bed partner notices that breathing stops without any snoring sound, followed by sudden attempts to breathe, often with gasping or rattling. Sometimes the person wakes up completely. Sleep is fragmented and unrefreshing, which can lead to severe daytime sleepiness. The resulting lack of oxygen in the blood is linked to various medical problems.

Signs include heavy snoring, pauses in breathing, rattling and wheezing during sleep, memory problems, tiredness during the day and while driving, and low mood as a result of lack of sleep. Possible medical consequences:

• Increased risk of stroke due to higher stress levels in the body
• High blood pressure (hypertension)
• Erectile dysfunction
• Coronary artery disease

How the splint works

The mandibular advancement splint – also called a protrusion, snoring or anti-snoring splint, TAP® or Narval® splint – is one of several alternatives to CPAP (continuous positive airway pressure). Many patients cannot cope with the CPAP mask and its side effects in the long run; this is known as mask intolerance.

The term protrusion splint comes from the Latin protrusio, «to push forward». A metal joint moves the lower jaw slightly forward, and jaw distance and position can be adjusted individually. This keeps the throat open, more air reaches the lungs, the blood is sufficiently oxygenated and snoring at the base of the tongue is prevented. The splint resembles an orthodontic retainer or a sports mouthguard, is non-invasive and is worn only at night.

Sleep splints vary greatly in quality. A poorly fitting splint can overload the teeth and cause pain, tooth movement and TMD. We therefore work primarily with biblock splints from Somnomed, tailored in our dental laboratory to your teeth, jaw and jaw joints. TMD diagnostics with a three-dimensional view of the jaw position help us fit the splint optimally. Snoring mouthpieces and snoring clips are something different and are not suitable for treating sleep apnoea.

Advantages over CPAP

CPAP is an effective treatment, but it has drawbacks. For mild to moderate sleep apnoea and snoring, splint therapy (Continuous Open Airway Therapy, COAT) can be an effective alternative:

• Comfort: smaller and less bulky than a mask, better adapted to your anatomy
• Silent: no machine and no air supply – quieter nights for your partner too
• Easy to use with no hoses, cables or equipment; simple to clean
• Small and light, ideal for travel
• No feeling of confinement, even with claustrophobia
• No dried-out or irritated nasal membranes
• Effective in any sleeping position; no pressure marks on the face, which suits stomach sleepers

Procedure

Whether splint therapy is suitable is determined, after a careful examination, by a specialist qualified in sleep-related breathing disorders, who then prescribes it. We then assess the dental requirements: jaw joint function, the condition of the teeth and gums, any existing dentures and other underlying conditions. We define the position of the lower jaw and the most suitable splint model.

We take impressions and use X-rays to determine the possible jaw position. The dental technician makes the splint from plastic, and we fit it in your mouth. The advancement is set so that it works without changing your bite, tooth position or jaw joints. The sleep physician assesses the result and coordinates any adjustments with us. Regular follow-up with both is advisable.

Getting used to it

Temporary discomfort can occur at first. Most people get used to the splint within three to four weeks. If problems or pain persist, a readjustment may help.

• Jaw muscle tension, similar to sore muscles – chewing gum during the day trains the muscles
• A foreign-body sensation – completely normal; try the splint for more than one night
• Dry mouth, possibly with coughing – keep a glass of water by the bed
• Increased saliva, which subsides after a few nights
• Sore gums – a pain-relieving gel from the pharmacy helps; this should pass within a few days

Care, durability and costs

Clean the splint after every use with a manual toothbrush and cold or lukewarm water; water that is too hot can deform it. At least once a week, soak it for about 10 minutes in a mild denture-cleaning solution – we are happy to advise you on which one. Brush your teeth thoroughly before putting it in, as food remains under the splint encourage decay.

With careful care, a splint lasts about 5 years. Use it only as long as there is no visible damage; if it has been damaged by grinding or no longer fits properly, we make a new one.

The sleep apnoea splint is fully covered by health insurance. As no spare parts or filters are needed, long-term costs are lower than with CPAP.