Non-surgical treatment options
Transcript of Non-surgical treatment options
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Non-surgicaltreatment options
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Miscellaneous options� Weight loss and muscle toning� Sleep on side rather than on back� Avoid heavy meals within 5 hours of bed � Avoid alcohol in the evening� Avoid smoking� Sedative effects of tranquilizers, sleeping pills,
antihistamines, etc. can also impact OSA. Check with MD to see if okay.
� Elevate head of bed� Going to bed exhausted increases risk� Nose strips
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Tennis ball T-shirt may help you sleep on your side.
Miscellaneous treatment
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Parker�s Snore Relief Cushion
- will keep you off your back
Miscellaneous treatment
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Nasal strip can help if some blockage is in noseB5
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Continuous Positive Airway Pressure (CPAP) Treatment
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Hospital sleep study - electrodes and CPAPB7
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Sleeping with CPAPB8
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How CPAP works
1 - No obstruction while patient is awake.
2 - Loss of muscle tone while asleep lets tissue fall back and block airway
3 - CPAP forces air past obstruction
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�Oral appliances present a useful alternative to continuous positive airway pressure (CPAP), especially for patients with simple snoring and patients with obstructive sleep apnea who cannot tolerate CPAP therapy.�
Wolfgang Schmidt-Nowara et al. Oral Appliances for the Treatment of Snoring and Obstructive Sleep Apnea: A Review; Sleep,1995; 18(6):501-510
In a review by the American Sleep Disorders Association, it is stated that:
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Dissection demonstrating attachment of tongue to the inside of lower jaw (no teeth present). By advancing the lower jaw with an appliance, the tongue is moved forward and hopefully opens the airway in the area of the base of the tongue.B12
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Herbst appliance on modelsB14
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Herbst appliance in the mouthB15
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Can be made in red if you are a Kansas City Chiefs fan!B16
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A hard Herbst may be needed by bruxers / clenchersB17
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Appliance developed by Dr. Peter GeorgeB18
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Close up of NAPA applianceB19
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NAPA appliance in the mouthB20
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Appliance developed by Dr. Jonathan ParkerB21
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Crossbite on both sides indicates a narrow dental archB22
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High palate and narrow arch - 1st bicuspids missingB23
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PM Positioner on modelsB24
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PM Positioner in mouthB25
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Appliance developed by Dr. Alan LoweB26
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Klearway applianceB27
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Back view of Klearway applianceB28
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Klearway appliance in mouthB29
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TAP Appliance
Appliance developed by Dr. Keith Thornton
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One of the early versions of the TAP applianceB31
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Another early TAP using 100# test fishing line.B32
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2001 version of TAP applianceB33
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CPAP inter face with TAP appliance
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Opening of airway as mandible advanced with TAPB35
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Appliance developed by Drs. Samelson & AlvarezB36
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TRD on modelsB37
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TRD with breathing tubes addedB38
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TRD in mouthB39
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TRD with air tubes blockedB40
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TRD, head gear and CPAPB41
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TRD and oxygenB42
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Ceph without TRDB43
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Improvement of airway space using TRDB44
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Pets love to chew up appliances!B45
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Appliance developed by Dr. Michael AlvarezB46
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Snor-XB47
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Snor-X in mouthB48
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Appliances are best if:
� Person is not over 125% of normal body weight.
� Apneic episodes are not over 30 per hour.
� Oxygen saturation is not less than 80%.
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Factors that reduce success:
� Obesity
� Severe OSA
� Bruxing
� TMJ symptoms
� Poor compliance / attitude
� Claustrophobia / gaggers
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Possible side effects:� Salivation
� Temporary change of bite in AM
� Change in occlusion / bite
� TMJ discomfort or dysfunction
� Gagging
� Dry mouth
� Can pull crowns and bridges off
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Possibly cannot help:
� Extremely obese individuals
� Unmotivated individuals
� Heavy drinkers
� Strong gaggers
� Individuals with psychological problems
� Individuals who have night mares
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Brian Palmer, D.D.S.Kansas City, Missouri, USA
May, 2001