Oral Appliances as Treatments for Obstructive Sleep Apnea

There are many options today to treat sinus conditions, from snoring to chronic respiratory infections to sleep apnea to sinus polyps. In some cases, external oral appliances such as sleep apnea CPAP machines may be the right approach.

However, many patients are seeking a more permanent solution to sinus, respiratory and sleep disturbance issues that doesn’t require continual use of external devices. For these patients, oral appliances can give a new level of freedom to enjoy good health and high quality, comfortable sleep that doesn’t disturb a partner.

However, for these patients, achieving a high degree of comfort with oral appliances is often a major concern. Here, having the expertise and experience of a board certified ENT surgeon can ensure the most comfortable, permanent fit for oral appliances.

Types of Oral Appliances

Treating sleep disturbances in adults and children is no longer limited to prescription of external CPAP and similar devices. Two cutting edge treatments that can free patients from dependence on external sleep management devices include pillar implants and lower jaw repositioning appliances.

It is important to know that CPAP is generally the first approach for treating serious sleep disturbance such as that caused by sleep apnea. For patients who do not tolerate CPAP, however, pillar implants, repositioning appliances and additional surgical interventions are available and may provide a better long-term outcome.

CPAP

The continuous positive airway pressure (CPAP) device is considered the first-line treatment of choice for full-spectrum sleep apnea. There are different models of CPAP oral appliances that may work better for patients and sleep partners.

Pillar implants

Stiffening rods implanted into the soft (upper) palate can lessen the tendency of the soft palate to relax during sleep and block your airway. The pillar implant procedure is considered a minor surgery that can typically be done under local anesthetic in your surgeon’s office.

Dr. Rubinstein will administer a local anesthetic to the soft palate area before inserting each rod and positioning it for your comfort. The entire procedure can usually be completed within one-half hour.

The risks of the pillar implants procedure are considered to be minor: mild swelling, bruising and bleeding at the insertion site and difficulty swallowing (due to temporary swelling) are the most commonly reported after-effects.

It can take up to three months or longer for the full impact of the pillar implants procedure to be felt, since the soft palate will continue to stiffen around the rods as the tissues heal. Patients generally report less snoring following the procedure. The pillar implants procedure is sometimes prescribed to treat mild to moderate sleep apnea, but is not considered appropriate for severe sleep apnea.

Lower jaw repositioning appliances

Obstructive type sleep apnea can be effectively treated by repositioning the lower jaw. There are two types of oral appliances that can be used for jaw repositioning: ready-made and custom-fitted appliances.

Not surprisingly, custom-fitted oral appliances have been shown to deliver better as well as more comfortable patient results. Custom-fitted oral appliances ensure the best fit for the patient’s unique jaw size and shape and provide for a greater range of adjustment to reposition the jaw and, over time, train the patient’s jaw to hold the new alignment.

Over time, some devices can also reshape the patient’s jaw to further improve treatment results. However, these devices must provide a comfortable fit if the patient is to tolerate and continue treatment.

Pursuing Treatment with Oral Appliances

For patients who do not tolerate CPAP-based treatment or who wish to pursue other options besides CPAP, oral appliances represent a less invasive, semi-permanent treatment approach as an alternative to surgery.

The first step is to schedule your consultation with Dr. Rubinstein. During the initial one-to-one consultation, Dr. Rubinstein will do a full examination of the affected area, which typically includes the nose, mouth, neck, palate, throat and respiratory passages. This examination may include palpitation and/or X-rays as needed.

Dr. Rubinstein will also take a full individual and family medical history. This is important to ensure you are a good candidate for certain treatments with oral appliances and to avoid medication interactions.

During your consultation you can discuss all the options to treat your condition, including the pros and cons of each. If you want to pursue treatment with oral appliances, Dr. Rubinstein can talk with you about your options, take any necessary measurements and/or molds that may be necessary and talk with you about how best to prepare for your treatment.

Ensuring the Most Comfortable Fit

It can be important to have realistic expectations for the outcome of your treatment. Many oral appliances are designed to improve treatment results over time. For example, pillar implants will help to stiffen and shape your soft palate as the tissues heal after implantation. Lower jaw repositioning appliances, as well, will reposition and reshape your jaw over time. Both treatments require discipline and dedication to deliver the desired treatment results.

There may be an initial period of mild discomfort, which is typically fully manageable until your tissues have healed and/or adjusted to the presence of your new oral appliances.

Beginning your treatment journey with the most customized fit provided by a highly trained and experienced board certified surgeon such as Dr. Rubinstein will give you the best chances of experiencing optimal treatment outcomes.

If you’re seeking for sleep apnea treatments in the Hudson Valley area, you may visit or contact Hudson Valley Sinus Center. Hudson Valley Sinus Center is both the first and the sole Ear/Nose/Throat specialty clinic for allergy, sinus and respiratory patients. Dr. Rubinstein is a double board certified ENT and facial plastic surgeon. He has more than 15 years of expertise in performing reconstructive and cosmetic surgery for the face, nose and surrounding areas.