Do you have snoring problem?
Sleep apnoea (or more correctly obstructive sleep apnoea) is a condition that affects about 5% of adults. In sleep apnoea the airway in your throat that leads from the nose and mouth to the lungs collapses when you fall asleep and muscles relax.If the collapse is severe enough it causes an apnoea (absence of breath). If it is a partial collapse it usually causes snoring. A person with severe sleep apnoea may have hundreds of these events each night which results in lack of oxygen to the body’s vital organs and disrupted sleep. Long term consequences are high blood pressure and an increased risk of heart attack or stroke and, of course, sleepiness.
Treatment of sleep-disordered breathing (i.e. snoring, upper airway resistance syndrome, sleep apnea syndrome) can be divided into four general categories. These include:
- Lifestyle modification,
- weight loss, cessation of evening alcohol ingestion, sleep position training
- upper airway surgery
- Oral appliances
- CPAP.
There are many treatments that have been tried for sleep apnoea but the treatment that is most effective, controlling the symptoms in almost everyone who uses it effectively, is CPAP (Continuous Positive Airway Pressure). Unfortunately a number of people with sleep apnoea do not tolerate CPAP and turn to other treatments such as surgery to the airway or an oral appliance.
What is Oral appliances?
Is it comfortable?
A properly fitted oral appliance should not cause lasting discomfort to your teeth or gums. Pushing the bottom jaw forward is inevitably a little uncomfortable and around 40% of people report some discomfort. The main problems experienced are in the area where the jaw pivots, called the temporomandibular joint. This is a bony structure in front of your ear. Prolonged protrusion of the jaw may cause this to ache but if the device is fitted correctly, any ache should soon disappear when you take the appliance out in the morning. Other problems reported by some people are tooth tenderness and excessive saliva formation.
A properly fitted oral appliance should not cause lasting discomfort to your teeth or gums. Pushing the bottom jaw forward is inevitably a little uncomfortable and around 40% of people report some discomfort. The main problems experienced are in the area where the jaw pivots, called the temporomandibular joint. This is a bony structure in front of your ear. Prolonged protrusion of the jaw may cause this to ache but if the device is fitted correctly, any ache should soon disappear when you take the appliance out in the morning. Other problems reported by some people are tooth tenderness and excessive saliva formation.
Is it work for everyone?
Everyone is different with shape of faces and airways. Although oral appliances will work to some extent for most people, their success is variable and the fitting and subsequent assessment of success should always be undertaken with the guidance of a sleep physician or a dentist who specializes in the use of oral appliances to treat sleep apnoea. It may be necessary to have another sleep study with your oral appliance in place to check on its success. Although your sleep specialist cannot be certain, there are a number of pointers to when an oral appliance has a good or bad chance of success.
Everyone is different with shape of faces and airways. Although oral appliances will work to some extent for most people, their success is variable and the fitting and subsequent assessment of success should always be undertaken with the guidance of a sleep physician or a dentist who specializes in the use of oral appliances to treat sleep apnoea. It may be necessary to have another sleep study with your oral appliance in place to check on its success. Although your sleep specialist cannot be certain, there are a number of pointers to when an oral appliance has a good or bad chance of success.
Bad pointers to treatment success:
- If you have no teeth or very poor dental structure
- If you have a very stiff jaw joint
- If you are very overweight
- If you have very severe sleep apnoea
- If you have a more complicated form of sleep apnoea, such as central sleep apnoea which can occur more commonly in people with heart failure or a stroke
Good pointers to treatment success:
- If your sleep apnoea is mild or moderate in severity,.
- If your sleep apnoea is a lot better when you lie on your side rather than your back
How to get it?
Obtain a referral from your GP to a sleep specialist. Most sleep specialists will advise a trial of CPAP because it is very effective, but if you cannot use CPAP they will consider a referral to a dentist who specializes in oral appliances. Some people are referred directly to dentists from their GP or another specialist. Most dentists prefer that you have tried CPAP before committing to an oral appliance.
Obtain a referral from your GP to a sleep specialist. Most sleep specialists will advise a trial of CPAP because it is very effective, but if you cannot use CPAP they will consider a referral to a dentist who specializes in oral appliances. Some people are referred directly to dentists from their GP or another specialist. Most dentists prefer that you have tried CPAP before committing to an oral appliance.
Oral appliances from the Internet or Pharmacist: A number of cheaper appliances are available for purchase over the counter or from the internet but these are not recommended.
If your problem is not sleep apnoea but just that you snore and snoring is causing distress to you or your family, an oral appliance may be a solution. An oral appliance, properly fitted, is usually quite effective in stopping or reducing snoring. Whilst snoring may seem like a less important medical condition it is still important to have it managed properly because it may be a pointer to more serious sleep apnoea.
If your problem is not sleep apnoea but just that you snore and snoring is causing distress to you or your family, an oral appliance may be a solution. An oral appliance, properly fitted, is usually quite effective in stopping or reducing snoring. Whilst snoring may seem like a less important medical condition it is still important to have it managed properly because it may be a pointer to more serious sleep apnoea.
What's next?
After you get your appliance, it is important to look after you oral appliance to get the maximum life out of the device and ensure that it works effectively. Just like your teeth, plaque can accumulate on an oral appliance overnight. Brushing and flossing of your teeth before bed should help to minimize this. Careful cleaning the oral appliance should also be carried out daily. Leave it out to dry completely.
If you think you appliance is not working so well, either because you are starting to snore again or you feel tired in the daytime, it is important to go an get it checked out. Depending on the type of appliance, your dentist may simply be able to adjust it. Some people find that the oral appliance comes out during the night. This may be a sign that it does not fit properly and a trip to your dentist is required.
After you get your appliance, it is important to look after you oral appliance to get the maximum life out of the device and ensure that it works effectively. Just like your teeth, plaque can accumulate on an oral appliance overnight. Brushing and flossing of your teeth before bed should help to minimize this. Careful cleaning the oral appliance should also be carried out daily. Leave it out to dry completely.
If you think you appliance is not working so well, either because you are starting to snore again or you feel tired in the daytime, it is important to go an get it checked out. Depending on the type of appliance, your dentist may simply be able to adjust it. Some people find that the oral appliance comes out during the night. This may be a sign that it does not fit properly and a trip to your dentist is required.
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你有打鼾的问题吗？
睡眠呼吸暂停（或更正确为阻塞性睡眠呼吸暂停）这种影响约大约5 ％的成年人。当你睡着了，肌肉放松导致从鼻子和嘴到肺的气道塌陷暂停你的呼吸。如果它塌陷的严重程度足以导致呼吸暂停（无呼吸），我们称之为阻塞性睡眠呼吸暂停
。如果它是一个局部坍塌，它通常会导致打鼾。一个人患有严重的睡眠呼吸暂停，而可能影响赢氧气输送到身体的重要器官会，并导致每天晚上因为扰乱而睡眠不足。长期后果是高血压和心脏病发作或中风的风险增加，及造成嗜睡的情况。
治疗睡眠呼吸紊乱，可分为四大类。这些措施包括：
- 改变生活方式上
- 减肥
- 停止晚上的酒精摄入
- 睡眠姿势训练
- 呼吸道手术
- 口腔矫治器
- CPAP
持续正压通气（
Continuous Positive Airway Pressure-CPAP ）对睡眠呼吸暂停治疗是最有效的，几乎每个人使用它后都能有效地控制症状。但是，一些人不能使用CPAP和其他治疗方法，那么口腔矫治器是另一选择。
口腔矫治器是什么？
口腔矫治器也被称为下颌前移夹板（ Mandibular Advancement Splint-MAS ）或下颌前移装置（ Mandibular Advancement Devive-MAD）。睡眠期间口腔矫治器直接作用于口腔内部，将下颌前移，影响口颌系统与上气道的解剖和功能关系，从而间接增大咽气道，缓解呼吸暂停和低通气，消除鼾声，属于保守治疗，风险性相对较小。
它穿戴起来会舒服吗？
正确佩戴口腔矫治器应该不会造成你的牙齿或牙龈的不适。下颌向前推必然是会有点不舒服，约40％的人报告说穿戴时会有一些不适。其主要问题是发生在爪枢转的区或被称为颞下颌关节
（Temporomandibular joint）。这是一个在你的耳朵前面的关节。长时间前移的下巴可能会导致这种疼痛，但如果设备安装正确，并把设备在早晨拿出来，任何疼痛都能很快消失。也有一些人报告的问题是齿压痛及唾液过多问题。
它对所有人都有效吗？
每个人都是不同的面孔和呼吸道的形状。虽然口腔矫治器一定程度上对大多数人来说有效，他们也不是完美的，定期进行维修和后续评估，遵循睡眠呼吸暂停睡眠医生或对口腔矫治器有专业经验的牙医指导，应该能提升此治疗睡眠障碍的成功率。
治疗成功率低的情况：
- 如果您没有牙齿或牙齿结构非常差，有可能不足够的好牙齿结构
- 如果你有一个非常僵硬的下颌关节
- 如果你是严重的体重超重，那么口腔矫治器是不太可能获得成功而CPAP将是更好的选择
- 如果你有非常严重的睡眠呼吸暂停问题
治疗成功率高的情况：
- 如果你的睡眠呼吸暂停的严重程度为轻度或中度，每小时20或30次。
- 如果当你睡眠呼吸暂停情况在侧躺睡时比起你卧着背躺时好许多
如何能拥有口腔矫治器？
你能从您的家庭医生转介到睡眠专家。大部分的睡眠专家将建议CPAP试用，因为它是非常有效的，但如果你不能使用CPAP ，他们会考虑转介到对口腔矫治器的专业牙医。有些人会直接从他们的家庭医生转介给牙医。但大多数牙医比较喜欢你在开始口腔矫治器前先尝试CPAP治疗。
一些便宜的口腔矫治器能从互联网或药剂房买到，但这些都是不建议的。如果您的睡眠问题没有睡眠呼吸暂停，而只是打呼噜，打鼾对您或您的家人造成困扰，那么口腔矫治器可能是一个解决办法。一个装配正确的口腔矫治器，通常能有效的停止或减少打鼾。虽然打鼾可能看起来像一个不太重要的医疗条件，但是它仍然需要妥善处理，因为它可能更严重的睡眠呼吸暂停的预兆。
有了口腔矫治器后该做什么？
当你得到你的口腔矫治器后，重要的是要照顾你的口腔矫治器，以让它能保持长久，并确保它能发挥疗效。它就像你的牙齿一样，牙菌斑会积聚在口腔矫治器过夜。睡前刷牙和使用牙线清洁你的牙齿，有助于减少这种情况发生。你也应每天仔细的清洁口腔矫治器。
如果你认为你口腔矫治器不能用了，比如你开始再次打鼾，或者你在白天感到疲倦，那么记得去检查。您的牙医会根据设备类型的不同，加以调整及修复。而如果您发现口腔矫治器在您睡觉时掉出来，那可能您需要再次拜访您的牙医了！
