How Mandibular Advancement Devices (MADs) Help You Sleep, Breathe & Live Better | Daybreak

An Oral Appliance (or mandibular advancement device, MAD treatment) looks like a set of two mouth guards connected together, most often with a strap or band. The oral appliance holds the lower jaw in place or gently pulls it to a forward position.

How Oral Appliance Therapy Works

This is an effective sleep apnea treatment because obstructive sleep apnea occurs when the upper airway muscles relax and partially or completely collapse during sleep, blocking the flow of air and leading the person to stop breathing. This loss of breath decreases blood-oxygen levels during a time when the body should be recovering.

Holding the lower jaw in place or slightly pulling the lower jaw forward keeps the airway clear, and the throat muscles do not collapse inwards. This forward positioning helps to:

1. Open the Airway: By advancing the lower jaw, oral appliances prevent the airway from collapsing, allowing for unobstructed airflow and preventing sleep apnea.
2. Reduce Snoring: The repositioning of the jaw tightens the tissues in the upper airway, reducing the vibrations that cause snoring.
3. Improve Oxygen Flow: With a clearer airway from the oral appliance, oxygen can flow more efficiently to the lungs, maintaining optimal blood oxygen levels.

Numerous studies have shown that mandibular advancement devices are highly effective in treating snoring, mild sleep apnea, moderate sleep apnea, and severe sleep apnea.

1. Snoring: Clinical research indicates that oral devices are highly effective in treating snoring and improving sleep health and daytime sleepiness.
2. Mild Sleep Apnea (mild OSA): The American Academy of Sleep Medicine considers mandibular repositioning appliances a first-line treatment for treating mild sleep apnea.
3. Moderate Sleep Apnea (moderate OSA): Oral appliances have proven highly effective in treating moderate sleep apnea, and oral appliance therapy is covered by nearly all health insurance companies for treating moderate OSA.
4. Severe Sleep Apnea (severe OSA): A recent meta-analysis confirmed that oral devices are an effective sleep medicine tool for treating severe obstructive sleep apnea.

However, oral appliance therapy is generally considered ineffective in treating central sleep apnea (vs. obstructive sleep apnea). Central sleep apnea occurs when the brain stops sending signals to the muscles that control breathing. Central sleep apnea is much rarer than obstructed sleep apnea (OSA); studies estimate only 2% of cases are central rather than obstructive.

Mandibular advancement devices are most effective when they are custom-made to fit the patient's mouth. This can be achieved through a dental impression, provided either remotely or at a Dentist's office, or by a dental professional using an intra-oral scanner.

Once a custom model of the dentition is obtained, a dental lab manufactures the custom device to exactly fit the patient's mouth.

Historically, this process has been primarily handled by a dentist's office, but now Daybreak allows you to obtain a custom-manufactured, prescription oral device 100% from the comfort of your own home.

What about "Boil-and-Bites?"

Although "boil-and-bite" appliances are available, they are bulkier, less comfortable, and lock the patient's jaw in place without any possibility of any lateral movement or mouth opening. As a result, most patients cannot use these devices for more than a few weeks.

Historically, the most common method of treating OSA has been the continuous positive airway pressure machine (CPAP machine).

CPAP therapy uses a mask, air pump, and tubing to create positive pressure in a person's airways. This steady flow of air prevents the tongue, uvula, and soft palate from moving too far into the airway, preventing snoring and sleep apnea.

While CPAP machines can be highly effective, many patients can't or won't tolerate CPAP therapy: wearing a plastic mask with connecting tubes & pump every night isn't for them. Clinical research indicates that many CPAP users quit after a year, and many others decline to even start.

The most common complaints about CPAP machines include the following:

• Discomfort: Getting the mask to fit exactly right is complex and can lead to discomfort. Many patients find it challenging to fall asleep as a result.
• Dry Mouth: Pressurized airflow from the pump can dry the inside of the mouth.
• Noise: Although there has been significant improvement, CPAP machines do still make noise. For some, this can be an issue.
• Cleaning: A CPAP machine requires regular cleaning to avoid mold, germs, and other contaminants that could otherwise enter a patient's lungs and make them sick.
• Travel Pains: The entire CPAP therapy setup is fairly bulky, and TSA requires any CPAP machine in a carry-on to be removed from its carrying case to undergo x-ray screening.
• Embarrassment: Some CPAP users report reluctance to bring out their entire PAP therapy setup early on in a new relationship.

Still, CPAP can be an effective treatment for many people.

Sleep Surgery

There are some surgical treatments that can be effective in treating sleep apnea. Hypoglossal Nerve Stimulation (commonly known as "Inspire Surgery") implants a battery in the patient's chest with a connected sensor and a nerve stimulation lead.

When the sensor notices a potential apnea, the nerve stimulation lead sends an electronic signal to the hypoglossal nerve at the base of the tongue, which can evoke a response that prevents the tongue from collapsing back onto the throat and cutting off breath.

Hypoglassol Never Stimulation and other surgeries are typically performed by an Ear Nose & Throat Specialist or maxillofacial surgeon.

Typical concerns and complaints about surgery treatments include:

• Expense: Surgeries can cost as much as $50,000. Even when insurance reimbursements are available, out-of-pocket expenses can be considerable.
• Surgery Risk: Any invasive surgery under anesthesia involves risk to the patient. It is up to the patient and their sleep physician to determine the right tradeoff with respect to any health complications.
• Recovery: Recovery times after surgery vary, but facial/jaw swelling & discomfort often lasts for several weeks, and strenuous activity is to be avoided.
• Success Rate: Not all surgeries are able to successfully treat obstructive sleep apnea. Clinical research suggests that the overall success rate of hypoglossal nerve stimulation (commonly known as "Inspire Surgery") is 79%.

A sleep specialist will typically recommend a patient try both sleep apnea oral appliances and CPAP before attempting surgery.

It's important to know that while snoring is a common symptom of obstructive sleep apnea, not everyone who snores has OSA, and not everyone with OSA snores. To find out if you or your loved one only snores or has sleep apnea, it's essential to have a sleep study.

Snoring

Snoring is often a precursor or symptom of OSA. It is a common phenomenon that occurs when air cannot move freely through the nose and throat during sleep.

This restricted airflow causes the tissues in the throat and nasal passages to vibrate, producing the familiar snoring sound. People who snore loudly often have excess tissue in the throat or “floppy” tissue that is more prone to vibration. Additionally, the position of the tongue can obstruct smooth breathing.

While snoring can be harmless (and sometimes funny), chronic snoring can also be a sign of a more serious underlying condition, such as sleep apnea, and also lead to excessive daytime sleepiness.

If you or your bed partner's snoring is exceptionally loud, or if there are gasping or choking noises that go along with the snoring, there is a good chance that the snoring is actually sleep apnea. The best way to determine whether it's sleep apnea or just snoring is to have a sleep test, conducted either in-office or using an at-home sleep test.

Obstructive Sleep Apnea (OSA)

Sleep apnea is a sleep disorder and major health concern characterized by loud snoring, pauses in breathing, and morning headaches. When a person snores, the upper airway muscles relax and partially or completely collapse during sleep, blocking the flow of air and leading the person to stop breathing. This loss of breath decreases blood-oxygen levels during a time when the body should be recovering.

In turn, this can lead to repeated awakenings throughout the night. Poor sleep, medical problems, and chronic fatigue are the result. Sleep apnea is associated with multiple health risks, including high blood pressure, cardiovascular disease, weight gain, and stroke. Research shows it can also decrease productivity and overall well-being.

Because of its disruptive effect on sleep, excessive snoring and sleep apnea can also lead to mental health issues.

Recognizing and treating this disease is crucial. Left untreated, OSA symptoms can seriously affect the overall quality of life. Luckily, the disease is treatable with long-term solutions, both through lifestyle changes and clinical sleep medicine.

Historically, testing for sleep apnea has been done in sleep labs. A patient is connected to various sensors and wires while sleep specialists observe the resulting data as the person sleeps. Although sleep labs are still recommended in certain situations, there is a much easier option available today for most cases.

An at-home sleep study is more convenient and affordable than a traditional sleep lab. Most at-home sleep tests (AHST) use Bluetooth to connect to the person's phone, and the results are uploaded the following morning. Pricing typically ranges between $100 to $300.

If you've already been diagnosed, most health insurance accepts sleep test results up to a year old when processing claims for treatments such as an oral device or CPAP. If you have an existing sleep test result and want to explore an oral device treatment from Daybreak, you can submit that existing sleep test here.

Although oral appliance treatment can be a great option for treating OSA, not everyone is a suitable candidate. Some contraindications against using oral appliance therapy include the following:

• Dentures: An oral appliance requires a suitable anchor to hold forward the lower jaw.
• TMJ Surgery: If someone has had or plans to have temporomandibular joint surgery, an oral appliance may aggravate the issue and should not be used.
• Severe Periodontal Disease: Those with severe periodontal disease should address their dental health with a professional before proceeding with oral appliance therapy.
• Ongoing Orthondic Treatment: Someone currently undergoing orthodontic treatment (i.e., braces or Invisalign) should wait until their treatment is complete before starting oral appliance therapy.

Although less well-known compared to CPAP, MAD therapy using oral appliances is a highly effective treatment for both snoring and obstructive sleep apnea. It is covered by insurance, avoids complicated equipment & cleaning, and is a discrete solution that travels easy.

Many (though not all) dentists offer their patients an oral appliance. Additionally, Daybreak offers a fully at-home process to obtain a custom, FDA-cleared, prescription oral appliance, with no need to wait in an office or to book visits to the sleep lab.