SNORING & SLEEP APNOEA SERVICE

Do you wake up tired?
Do you wake up more than once during the night?

Snoring and Sleep Apnoea is a medical condition and occurs when the airway is is either constricted or obstructed while a person is asleep.  Sleep Apnoea events occur less frequently in moderate cases but when you stop breathing up to 30 times per hour this is severe. Not only can it keep your partner up at night. It also may leave you with daytime sleepiness, feeling sleepy at the wheel, struggling to stay awake at work and being constantly tired even after 7-8 hours of sleep each night!

Improving your quality of life!

The Snoring and Sleep Apnoea Service at MDC is lead by practitoners in the treatment of snoring and sleep apnoea through a full range of medically proven, custom-made oral appliances.

Patient Information

Oral Appliances

Oral Appliance Therapy for Snoring and Obstructive Sleep Apnoea

Custom made adjustable oral appliances, commonly known as mandibular advancement splints or sleep apnoea/snoring mouth guards, are now regarded by sleep physicians, and experts in the field, as the best available treatment for overcoming snoring and, along with the CPAP machine, one of the two main treatments for sleep apnoea. The main difference to CPAP is that oral appliances are far more comfortable, easy to use and travel with. Oral appliances are customised to allow the dentist, and importantly the patient, to slowly bring the lower jaw forward to the ideal most comfortable position that opens the airway and overcomes snoring, tiredness and sleep apnoea.

Your initial appointment

• Sleep study results and referral letter: It’s important we have all the information from your specialist Sleep Physician, ENT Surgeon or GP prior to your first appointment. We are happy to request this information on your behalf.
• If you are a new patient to our practice, we need to know when your last dental exam was, last visit with the dental hygienist and date of last full mouth x-ray (OPG).

At your first visit:  Please allow 1-hour appointment duration. Our team will confirm that a sleep device is suitable for you based on your history, examination, and sleep study results.  During the consultation, we will assess your teeth, gums and jaws, as it is important that these are in optimal health prior to fitting the custom-made device. To ensure accurate fit of the device, any minor or major dental treatment required should be completed prior to taking the impressions/scans for the appliance. We want to ensure that the appliance fits well and requires minimal adjustment.

Description	Item Number	Estimate Fee
Consultation + report	017	$ 95

If you wish to proceed and your teeth and gums are healthy – Impressions/3D scan of your upper and lower teeth including a specific bite, that is based on your sleep study results will be taken. Insert appliance Appointment (3 weeks after taking impressions): Please allow 30-minute appointment duration. A complimentary review and adjustment appointment will be scheduled 2 weeks later or longer where the dentist feels appropriate. Please note: The device needs to be checked once a year by our sleep appliance trained dentists to ensure proper fit and effectiveness.

The Review Visit

Approximately four weeks after the fitting of your oral appliance we will arrange for a follow-up visit. In most instances you will be using your appliance comfortably each night and your snoring will have reduced along with tiredness and other symptoms. Any adjustments needed will be made at this visit. Depending on the severity of your sleep apnoea, we will either check in with you again in 12 months time or earlier, to ensure your appliance does not need any further adjustments. All review and follow up visits within the first 12 months are included in the initial cost of treatment. A written report and referral will be sent to your referring medical practitioner for a follow review with them.  The only sure way to know that the oral appliance is working is to have a treatment sleep study – where you wear it during the sleep study so the results can be analysed to assess its effectiveness.

Ongoing Support

You will receive a reminder every 12 months for a review to ensure the appliance is still functioning optimally. Please do not hesitate to contact us should you have any concerns or questions during this time and remember to take your oral appliance with you to any regular dental appointments. Information for Medical Professionals Download the Melbourne Dental Clinic Referral Form – (PDF Form)

Other Treatments

There are several treatments available for snoring and obstructive sleep apnoea and should be directed by your sleep physician or medical GP based on your diagnosis and clinical presentation.  Choosing the best treatment option will increase the likelihood for success. The Melbourne Dental Clinic specialises only in Oral Appliance Therapy and you will require a referral to visit our clinic.

Surgery

This is not common in the treatment for snoring and sleep apnoea but  it can be very effective in a select group of patients and a consultaion with an ENT Surgeon can help you decide if this is an option for you. It involves trimming and tightening of soft tissues in the throat, opening up the nasal passages or moving the upper and lower jaws.

CPAP machine

The CPAP machine works extremely well by delivering air under pressure to keep the airway open during sleep.  The machine is attached to a mask by a hose which the patient wears during sleep. Those using the machine are required to wear the attached mask throughout the night – which for some people can be challenging . If CPAP is working well for you, you should continue using it. Oral appliances are an excellent alternative for people who elect not to use CPAP or cannot tolerate CPAP  or for patients who have been diagnosed with a mild to moderate level of obstructive sleep apnoea.

Things that Might Help…

Sleeping on your back can be a key contributing factor to sleep apnoea. Your sleep study will show if sleep position affects your reported level of sleep apnoea. Elevating the head of your bed and avoiding sleeping on your back can be very helpful. There are a number of  strategies that you can try to help you sleep on your side and these can be discussed with your referring sleep physician

Weight Loss

If you are overweight, weight reduction may improve your sleep apnoea. Weight gain deposits fat into and around the soft palate, tongue and neck structures consequently reducing the size of the airway. Weight loss can reduce these fat deposits and enlarge the airway size thereby reducing snoring. Although weight loss can be beneficial on many levels, it is usually insufficient as a treatment option to overcome all problematic sleep apnoea and snoring.

Substances to avoid

Alcohol and most sleeping pills relax the muscles of the throat and can worsen snoring and sleep apnoea. You should avoid alcohol for at least three hours prior to bedtime. Smoking and caffeine can also worsen snoring and sleep apnoea, due to swelling of the nasal and throat tissues.

Clear nasal airway

Any form of nasal obstruction can worsen sleep apnoea and snoring. There are simple strategies for improving the nasal airway which can include the use of sprays, nasal cones or strips. While perhaps not offering a cure, these methods have the potential to enhance the effectiveness of the established treatments.

FAQs

How common is snoring?

Snoring is very common, with approximately 40% of men and 30% of women affected. Snoring occurs in all age groups but is most common in the middle- aged population. What contributes to snoring?

• Obesity
• Alcohol, sedative and tranquilliser use
• Nasal Congestion
• Breathing through the mouth
• Sleeping on your back
• Allergies and hayfever
• Smoking
• Abnormalities of the upper airway or the oral and facial structures

What are the best treatments for snoring?

The first thing to know is that most ‘over the counter’ treatments for snoring such as medications, nasal sprays, and sleep pillows are generally unproven and ineffective.

There is scientific evidence that oral appliances are an effective treatment for snoring, and it widely regarded as the least invasive available treatment.

While lifestyle changes such as weight loss and alternative sleep positioning can be very helpful, oral appliances are the front line treatment for snoring.

How common is Obstructive Sleep Apnoea?

OSA affects 9% of males and 5% of females. It is commonly associated with snoring and obesity. Many individuals with OSA are aware they snore and feel tired during the day but are unaware of the potential medical problems that may exists. Therefore, many individuals with OSA remain undiagnosed.

How serious is Obstructive Sleep Apnoea?

Individuals with untreated obstructive sleep apnoea have an increased risk of developing a number of medical conditions:

• High blood pressure
• Heart disease
• Heart attack
• Irregular heart beats
• Stroke
• Diabetes
• Depression

OSA may contribute to driving and work related accidents due to excessive daytime sleepiness, which affects concentration, cognition, memory and the ability to work effectively.

How is Obstructive Sleep Apnoea diagnosed?

If you believe you have symptoms of OSA, consult with your medical GP. Your GP will carry out a physical exam and ask you about your symptoms. If your history and examination suggest you have obstructive sleep apnoea, your GP will refer you for a sleep study under the care of a specialist sleep physician. The sleep study is necessary to confirm the presence and severity of OSA in order to establish a diagnosis which is important in determining the best treatment option for you.

Are oral appliances effective and how do they work?

There is scientific evidence that these oral appliances are affective and are suitable for treating:

• snoring,
• mild to moderate obstructive sleep apnoea,
• severe obstructive sleep apnoea cases who are intolerant to CPAP
• As a combination therapy with CPAP and/or upper airway surgery.

A combination of thorough history, examination and sleep study will determine if you are suitable candidate for a mandibular advancement splint.

Oral appliances work by holding the lower jaw slightly forward during sleep, thereby opening the airway at the back of the throat. The tongue is attached to the lower jaw and, with the jaw held forward, the tongue is prevented from collapsing back.

Are all oral appliances the same?

No… they are not! There are numerous appliances available in Australia, some of which are effective and others which have not passed scientific studies proving effectiveness. Mandibular Advancement Splints are customised and fitted to meet your individual situation and are titratable (adjustable) to find the best protrusive position for your lower jaw while you sleep.

Over the counter appliances (such as “boil and bite” ones) Wh can be less expensive, they are not as effective or comfortable. They are not recommended and for best treatment outcome, it is recommended that you seek the care of a clinician who is experinecd in the field of Dental Sleep Medicine.

The MDC Snoring and Sleep Apnoea Clinic utilises a number of commercially available, scientifically tested oral appliances, each carefully chosen for their comfort, effectiveness, and features. The ideal appliance for each person depends on factors such as the size, position and number of teeth as well as the size and position of the jaw.

Are oral appliances comfortable?

Mandibular advancement appliances are worn in the mouth during sleep and are somewhat similar to orthodontic retainers or sports mouthgurds. Experience indicates that the majority of people adapt within a week and find the appliance comfortable.

How long does an oral appliance last?

Generally, our experience indicates that our appliances last for between three to five years. However, appliances can last much longer than this depending on how you take care of it. Replacing your device several years down the track is usually done at a discount off the original price.

Are oral appliances covered on Extras of your Private Health Insurance?

Generally through your Private Health Insurance Extras cover rebates may be available, please note that a diagnosis and referral from your medical physician is required. It is best to check with your insurer first to identify what diagnosis tools and limits apply.

When you book your initial consultation at our clinic you will be sent a full list of the applicable item numbers for treatment, which you can use to determine the full amount rebatable through your private health insurance.

Do missing teeth, dentures or a bridge mean I can’t wear an oral appliance?

There are new appliances which can be successfully used in many different situations – even if all the upper teeth are missing. You would need to have at least a total of four teeth to be able to utilise a dental sleep appliance. It is important to have a thorough assessment of the teeth, gums and jaw to ensure predictable, successful results with minimal long-term problems.

Are there any side effects?

Most people have little or no side effects with a custom made appliance that is fabricated and fitted correctly, it is generally well tolerated. There is a short period of adjustment during which the mouth will adapt to the sensation of an appliance and a small percentage may experience initial minor side-effects such as excessive saliva, jaw tenderness, pressure on teeth and bite changes. As the appliance pushes the jaw forward, some patients feel discomfort early, which typically resolves with continued use. When this occurs, discomfort is usually felt in the jaw joint (in front of the ear) or jaw muscles.

Most of these side-effects are temporary and transient and disappear on their own or with minor adjustment of the appliance.. In the long term these devices can lead to changes to the bite, so please discuss with the dentist to understand this. Given the potential for side effects and complications, it is recommended that regular monitoring continue while using the appliance.