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Sleep Apnea Therapy
Sleep Medicine

Our focus in sleep medicine is on effective therapies against sleep apnea and snoring. With individual solutions, we sustainably improve the quality of sleep of our patients.

Competencies

Sleep Apnea Therapy

Healthy sleep despite sleep apnea – potrusion splints

If you constantly feel tired, drained and exhausted, you need one thing above all: a good night's sleep. For many, however, this is not easy. More than 150,000 people in Switzerland suffer from breathing interruptions while sleeping.

The snoring splint is a therapy option for sleep apnea, which is offered by our practice in Baar as part of dental sleep medicine. It is an effective alternative to CPAP therapy for mild to moderate OSAS.

Whether it's a husband, wife, bedfellow, or boyfriend, we all have someone in our lives who snores. Not only can snoring be annoying, but it can also be a sign of a serious condition called obstructive sleep apnea (OSA).

Apnea goes beyond healthy snoring and short pauses in breathing. It is defined as "an interruption of the flow of air for a duration of at least 10 seconds". People with sleep apnea sometimes have hundreds of these breathing interruptions during sleep, often for a minute or more.

Causes of sleep apnea and associated snoring

During sleep, all the muscles of the human body relax. This is also the case of the tongue, which falls backwards when flaccid and can block the palatal arch in the throat. When the outgoing air hits the resulting obstacle, it has to pass through this area under increased pressure - this leads to a strong vibration of the soft palate and thus to the typical snoring sound.

Not only the slackening of the tongue muscle can lead to snoring, but also the uvula and palatal arch, which fall back during sleep and narrow the airways. This cause also leads to the side effect of snoring.

Risk factors for sleep apnea:

  • Being overweight and having a large neck circumference are risk factors
  • Constriction in the nasopharynx
  • Frequent alcohol consumption and smoking
  • Sleeping pills or sedatives can increase snoring
  • Men are usually more likely to be affected by sleep apnea than women

Patients suffering from a mild form of sleep apnea can be helped with a dental sleep apnea splint. These splints have many names and are often also called mandibular protrusion splint, UKPS, protrusion splint, TAPP® splint, Narval® splint, snoring splint or anti-snoring splint - they all mean the same thing! However, snoring mouthpieces and snoring clips are something else. They are not suitable for the treatment of OSAS.

However, the differences in quality of the sleeping splints offered on the market are enormous. The different models differ only slightly in terms of their functionality. It is important that the splint fits perfectly, otherwise it can lead to incorrect loading of the teeth, pain, tooth displacement and TMD can be the result. Therefore, we always recommend a snoring splint from the dentist that is perfectly adapted to you. In our practice in Baar, we primarily work with biblock rails from the market leader Somnomed, which are perfectly tailored to you.

Symptoms of sleep apnea

Typical for a person with obstructive sleep apnea is loud snoring and stopping breathing. The bed partner will notice that the person has difficulty breathing, but no snoring sounds can be heard. These pauses in breathing are followed by sudden attempts to breathe. These are often accompanied by a rattle or panting. Occasionally, the affected person wakes up completely. The sickening sleep is interrupted and not restful, which can lead to excessive daytime sleepiness. The resulting lack of oxygen in the blood is also associated with various medical problems.

  • Heavy snoring
  • Breathing interruptions
  • Rattling and wheezing in sleep
  • Disturbances of memory
  • Fatigue during the day
  • depressive mood as a result of lack of sleep
  • Fatigue while driving

Possible medical consequences associated with sleep apnea:

  • Increased risk of stroke due to higher stress levels of the body
  • Hypertension (high blood pressure)
  • Erectile dysfunction
  • Diseases of the coronary arteries

Treatment of sleep apnea with the mandibular protrusion splint

The mandibular protrusion splint is one of several treatment alternatives to CPAP (Continuous Positive Airway Pressure) therapy. It is suitable for patients with mild to moderate obstructive sleep apnea. The splint is comparable to a retainer in orthodontics or a mouthguard worn during sports. It is comfortable to wear, low-risk and non-invasive, as no surgical procedures are required.

Positive pressure ventilation with a CPAP mask is often the standard therapy for sleep apnea. However, many patients are unable to cope with this treatment and the side effects of CPAP therapy in the long run. In these cases, it is called mask intolerance.

The protrusion splint takes its name from the Latin word protrusio, which means "to push forward". The splint is connected to a metal joint and pushes the lower jaw slightly forward. This counteracts the narrowing of the airways and the associated reduced airflow. By moving the lower jaw forward with the help of the bite splint (snoring splint), mouth breathing is optimized and tongue base snoring is prevented during sleep. The splint is very comfortable and has no side effects. It must only be worn at night.

Due to the joint connection, jaw distance and jaw position can be individually adjusted. The splint thus keeps the lower jaw in an optimal position. The pharynx remains wide open, more air enters the lungs and the blood is sufficiently saturated with oxygen.

The principle is similar to removable braces. TMD diagnostics is a valuable therapeutic tool in the production of these splints and in the treatment of sleep disorders caused by snoring. It enables a three-dimensional representation of the position of the mouth and jaw and thus the production of an optimally adapted protrusion splint.

Advantages of splint therapy over CPAP treatment

CPAP therapy is an effective treatment for obstructive sleep apnea. However, it comes with some serious criticisms and disadvantages. For mild to moderate sleep apnea and snoring, Continuous Open Airway Therapy (COAT) with the mandibular protrusion splint can be an effective alternative to CPAP therapy. The following are some of the benefits of splint therapy:

  • Wearing comfort: Many patients find the splint more comfortable and less disturbing than the CPAP mask. The splint can be better adapted to the patient's individual anatomy because it is smaller and less bulky than the CPAP mask.
  • Silence: Since the splint does not require a machine or air supply, it is silent during use, resulting in a more peaceful sleep for both the patient and the sleeping partner.
  • Easy to use: The rail is easy to use as there is no need for additional hoses, cables, or equipment. This makes it easier to use, clean and maintain.
  • Portability: Because the splint is smaller and lighter than a CPAP machine, it is ideal for travel and gives the patient more flexibility.
  • No claustrophobia: Patients who suffer from claustrophobia may feel less restricted in a splint than in a CPAP mask, which can lead to better acceptance of the therapy.
  • No dehydration or irritation: Since there is no need for continuous air supply, the nasal mucous membranes do not dry out or irritate, as can be the case with CPAP therapy.
  • Regardless of the sleeping position: The splint can be effective regardless of the sleeping position, as it is worn directly in the mouth. In contrast, a CPAP mask can slip when sleeping on your stomach, losing the effectiveness of the therapy.
  • No pressure points: The splint is worn in the mouth. There are no pressure points on the face. This can be especially beneficial for stomach sleepers.

Due to the drawbacks of CPAP therapy, treatment is stopped sooner or later in almost half of all sleep apnea patients. UKPS therapy has a success rate of > 90%.

Why do we recommend a splint from the dental laboratory?

Mandibular protrusion splints are custom-made in our dental laboratory. They are therefore tailored to the patient's dental, temporomandibular and temporomandibular joint situation. This is important in order to achieve sufficient forward displacement of the lower jaw.

This is the only way to achieve the desired success in treating obstructive sleep apnea syndrome. It is important to adjust the advance shift in such a way that the desired success is achieved. At the same time, the risk of undesirable side effects such as changes in occlusion, tooth position or temporomandibular joints must be avoided. For regular use by the patient, the wearing comfort of the splint is of crucial importance.

Procedure and production of the mandibular protrusion splint

Whether splint therapy is an option for a patient is determined after careful examination and consultation with a specialist who is qualified to diagnose and treat sleep-disordered breathing.

Determined and prescribed by the doctor, it is up to the dentist to clarify the dental requirements for the use of a mandibular protrusion splint.

In this regard, the dentist determines the position of the lower jaw and the most suitable splint model for the patient. As part of these investigations, other factors are the subject of the investigation. In particular, the function of the temporomandibular joints must be examined, the condition of the teeth and periodontium must be assessed, any existing dentures must be taken into account or other underlying diseases must be ruled out.

After deciding on a protrusion splint, the dentist takes impressions of the position of the teeth and determines the possible position of the jaws in relation to each other based on the necessary X-rays.

The individual splint is made of plastic by the dental technician according to these specifications. The finished splint is then fitted in the patient's mouth by the dentist. The sleep physician assesses the success of the therapy and, together with the dentist, coordinates any necessary adjustments to the mandibular protrusion splint.

In order to avoid undesirable side effects or necessary corrections, regular follow-up care by both the sleep physician and the dentist is advisable in any case.

Durability and care of snoring splints

In order for the splint to be effective against snoring, it must be in good condition. Therefore, the protrusion splint should only be used as long as no damage is visible.

With careful care, a protrusion splint lasts about 5 years. A new splint should be made by the dentist if the splint has been damaged by grinding or no longer fits optimally to the teeth.

It is best to clean them after each use. To do this, remove the snoring tray and clean it thoroughly with a manual toothbrush. As a rule, water is sufficient, making sure to use only cold or lukewarm water. Water that is too hot can cause them to deform and need to be readjusted.

To clean hard-to-reach areas, we recommend placing the splints in a denture cleaning solution for a few minutes at least once a week. In general, 10 minutes is sufficient. To prevent the material from being attacked, you should use a mild solution. We would be happy to advise you on suitable cleaning solutions in our practice.

Before inserting the snoring splint, the teeth should be thoroughly cleaned. Remaining food residues can form an ideal bacterial environment under the splint and promote the development of caries.

Side effects of treating sleep apnea with the help of UKPS

Since wearing a snoring splint is an unfamiliar experience for many people, there may be side effects at first. The temporary side effects are listed below:

  • Muscle pain: Since the snoring splint initially represents a change and strain on the jaw, muscle pain and tension in the jaw area can occur. This tension can be painful and feel like sore muscles. With a few tricks in everyday life, such as chewing gum during the day, you can quickly overcome this pain. By chewing the chewing gum, the muscles are trained and after a short time the first successes can be felt.
  • An unfamiliar foreign body sensation that can occur when wearing a snoring splint for the first time is completely normal. However, this feeling quickly disappears, as many users report. It is advisable to take your time and try the splint for more than one night.
  • When wearing the splint for the first time, a dry mouth may set in. The dryness can lead to irritation of the mucous membranes. Coughing can be the result. A bottle of water should be placed next to the bed at night to counteract this.
  • Increased salivation is a relatively common problem. The body produces more saliva through the splint. However, adapting saliva production to the splint is a matter of getting used to. After just a few uses, the symptoms subside.
  • Pain of the gums can often occur during the habituation phase. In case of severe pain, a pain-relieving gel from the pharmacy can be applied to the affected areas to help with the healing process. The pain should go away within a few days.

Within three to four weeks, most people get used to the splint. A readjustment of the splint can be useful if problems or pain continue to occur when worn.

A snoring mouthpiece is not a snoring splint

A snoring mouthpiece, also known as an oral atrial plate, is fundamentally different from a snoring splint or protrusion splint. While the snoring splint shifts the lower jaw forward to prevent snoring at the base of the tongue, the snoring mouthpiece has a different approach to combating snoring.

The mouthpiece is inserted into the oral cavity between the lips and teeth. It is not firmly anchored to the teeth. It loosely encloses the row of teeth of the upper jaw and allows the lower jaw to move freely. Its main function is to prevent mouth breathing at night and to keep the mouth closed. As a result, mouth snoring is reduced.

By preventing mouth breathing, the snoring mouthpiece promotes natural nasal breathing and thus improves the regeneration of the body. Snoring mouthpieces are primarily designed to treat mouth snoring and cannot be used to treat other causes such as base of tongue snoring or sleep apnea.

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