3. Obstructive Sleep Apnea(OSA) - Treatment

It is important to distinguish between mild, moderate and severe OSA. For patients diagnosed with severe OSA, a CPAP device is considered the gold standard for treatment. A CPAP device delivers air to the patient through a mask which fits over the nose, or over the nose and mouth via an air compressor and a humidifier. A follow-up sleep study with the CPAP device is performed, gradually increasing the air pressure to determine the amount of pressure required to effectively open the airway. The air pressure has to be high enough to displace the tongue, uvula and soft palate and allow an adequate amount of oxygen to reach the lungs. When the patient wears the CPAP device and the air pressure is correct, it is effective in eliminating OSA. Patients who are happy with their CPAP devices should not be encouraged to replace them with oral appliance therapy. As current guidelines stand, oral appliances are mainly to be used for those who have tried and cannot tolerate a CPAP device and for those with mild to moderate OSA.

A study in the journal Sleep and Breathing (November 2010) found that combined therapy of oral appliance and nasal CPAP device is effective is treating OSA and had the benefit of reducing the effective CPAP pressure by 29%.

Treatment for mild to moderate Sleep Apnea and CPAP device intolerance

Dr. Kang only treats with a sleep(oral) appliance once the patient has been diagnosed by a sleep physician and the patient presents a prescription for a sleep appliance from the sleep physician. He uses a 7 appointment protocol. The patient is asked to fill out a very detailed OSA questionnaire (please look for Sleep Apnea New Patient Questionnaire in Contact Us Section) before presenting for their first appointment. The first appointment takes over an hour to do a thorough examination and to take records. The second appointment is to take impressions for the sleep appliance and a bite is taken at the most comfortable position for the patient. This is to make the transition to appliance wear as easy as possible for the patient. It does take a couple of weeks just to get use to having the appliance in the mouth. When the appliance is delivered, Dr. Kang will check for good fit and demonstrate how to use the appliance and discuss what to expect from appliance wear. Once the patient is comfortable with wearing the appliance then they are encouraged to advance the screws on the appliance to activate it. The patient has full control over the rate of advancement, if the position becomes uncomfortable then, they can back off and resume advancement when they are comfortable. The patient is seen every 5-6 weeks for 3 to 4 visits to assess progress of treatment and to make any adjustments required to the appliance. This amount of time also allows the soft tissues of the airway to heal. Once the patient feels that they have found their best position then they will be sent home with a take home portable sleep study to obtain an objective measure of treatment outcome. The patient's sleep physician will be kept abreast of treatment outcome. The patient will be followed up annually. As their health and circumstance changes the appliance may have to be adjusted to maintain an optimum therapeutic position.

We currently provide 2 options for a sleep appliance:
1. The SomnoDent Appliance
2. The Herbst Appliance

When the patient comes in for their impressions, they can examine the two types of appliances and decide which one would work best for them.