Sleep Apnea

Using oral surgery to help sleep apnea seeks to remove the excess tissue in the throat that is vibrating and blocking the upper air passages. One surgical procedure is an Uvulopalatopharyngoplasty (UPPP). This procedure involves removing the excess tissue from the upper mouth and throat. This procedure in performed in a hospital under general anesthesia. Maxillomandibular advancement is another type of procedure used to assist with sleep apnea. This procedure involves the upper and lower part of the jaw. In this procedure, the jaw is moved forward from the rest of the facial bones. This allows more room behind the soft palate, thereby reducing the obstruction. Finally a Tracheostomy is a last ditch effort when other treatments have failed. This involves the surgeon inserting a tube in your throat so you can breathe. It is covered during the day, but opens at night while you sleep. All of the aforementioned surgeries are routine and very safe.

When the face does not grow the way it should, and grows more downward and backward, the airway is often compromised. For many of us, this leads to snoring during sleep, and even a medical problem called "Obstructive Sleep Apnea" (OSA). Sleep apnea is associated with many health problems, including: strokes, heart attacks, cardiovascular disease, high blood pressure, diabetes, GERD, depression, sexual dysfunction, and many other health problems.
When undiagnosed and untreated, OSA shortens lifespan by about 20%.
How is OSA diagnosed? Signs such as frequent snoring and daytime sleepiness, or another person seeing you stop breathing or gasp for air, can point in the direction of OSA. Only a medical doctor can diagnose sleep apnea. A sleep study can be performed with a monitor you take home and wear while you're sleeping (ambulatory sleep study), or by a polysomnogram study outside of your the home. Even though polysomnogram is the most accurate way to diagnose sleep disorders, both options are available ways of diagnosis.

How is OSA treated?

1. Open the airway temporarily.
This is the option of wearing a dental appliance that holds the airway open while you're sleeping.

Advantages: An oral appliance can be as effective with mild to moderate sleep apnea for many patients. It's more comfortable than CPAP, and it's less expensive and invasive than surgery.

Disadvantages: Oral appliances will change your bite permanently, and this may or may not be easily fixable with orthodontics. In the long run, these appliances might pull the upper jaw backward, part of the original problem that led to the obstructed airway.

2. Push harder on the air through the narrow airway.
This is the option of using Continuous Positive Air Pressure (CPAP), which is considered the "gold standard' by the medical profession for the treatment of sleep apnea. It's a pump hooked up to a mask that fits on your face, covering your nostrils, nose, mouth or all of the above. The pump pushes the air harder as you inhale, and it can help you get the oxygen and restful sleep you need.

Advantages: CPAP avoids surgery or oral appliances, and medical insurance might help with it. When it's used, it can be very effective.
Disadvantages: After 6 months, most CPAP users give up. It can dry your throat (a humidifier can help), restrict your sleep position, feel claustrophobic, be a hassle to carry around, or have other disadvantages.

3. Open the airway more permanently.

There are ways that the airway can be increased more permanently. This involves orthodontics, surgery, or both.

ORTHODONTICS

The same patient, before and after opening up spaces where bicuspids had been extracted. Notice how much more room the tongue has. Why does this matter? Because the airway is more open when the tongue can come more forward.

Advantages: Orthodontics to open up more tongue space can work for some people. When permanent teeth have been taken out - or even when they haven't, opening up room for the tongue can help. Not having to depend on CPAP, or risk bite changes with an oral appliance, or undergo surgery are all advantages.
Disadvantages: Orthodontics takes time and there's always the possibility that it might not work. In that case, surgery might be the best option.

INSPIRE THERAPY

Inspire therapy is a breakthrough implantable treatment option for people with Obstructive Sleep Apnea who are unable to use or get consistent benefit from Continuous Positive Airway Pressure (CPAP). While you are sleeping, Inspire monitors every breath that you take. Based on your unique breathing patterns, the system delivers mild stimulation to the hypoglossal nerve, which controls the movement of your tongue and other key airway muscles. By stimulating these muscles, the airway remains open during sleep.

The Inspire obstructive sleep apnea device is controlled by a small handheld sleep remote. The remote allows you to turn Inspire therapy on before bed and off when you wake up, increase and decrease stimulation strength, and pause during the night if needed.

WILCKODONTICS

Wilckodontics is a surgical procedure Dr. Selleck stimulates the bone into a demineralized, more active state. This active state enables orthodontic treatment (with braces or Invisalign) to occur in about 6 months.

Wilckodontics promises to change the perception that a straight, healthy smile takes a long time to achieve. The orthodontic procedure is also known as Accelerated Osteogenic Orthodontics – AOO – and can provide the same results as traditional therapies, but in much less time. In fact, many patients discover the process takes less than a year, from start to finish, which is approximately 3-4 times faster!

Photo Credit: Wilkodontics.com

JAW SURGERY

Probably the most definitive solution for a small airway that's causing sleep apnea, is to move the jaws to the correct position in the face in order to open the airway. Like architects, jaw surgeons have many different ideas for how to "build the ideal," These photos are of results surgery done by Dr. Larry Wolford in Dallas, Texas. Notice the bigger airway. When it's done right, jaw surgery has the potential to really fix the problem. Patients can throw away the CPAP!!

Advantages: Jaw surgery deals with the structural cause of the sleep apnea. It's fixing the root of the problem. If the jaw joints have problems too, a surgeon like Dr. Wolford can treat them at the same time. If there are problems with the nasal airway, soft palate, etc., these can also be addressed.
Disadvantages: Cost and hassle of surgery, as well as risks involved for any surgery.