Treatment of Sleep Apnea, UARS and Sleep-Related Bruxism

TREATMENT OF OBSTRUCTIVE SLEEP APNEA AND UARS

Treatment of OSA depends upon the degree of severity of the condition. In mild to moderate OSA, mandibular advancement appliances such as the Luco Hybrid OSA Appliance, are the treatment of choice. In severe OSA, a CPAP or forced air machine is the treatment of choice. In some cases of moderate OSA, a CPAP May be recommended (if you do not have enough teeth or they are not healthy enough to support an oral appliance).

CPAPs however, have problems. Recent studies have shown that less than half the patients given CPAPs actually use them! In these cases, oral appliance are recommended for even severe OSA. The first CPAP was made by adapting the air compressor for a fish aquarium, a plastic hose and a make shift mask!

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CPAP

CPAPs, as above, force air into the lungs and help to maintain an airway while sleeping. Problems can occur if the face mask get pushed to one side allowing for an air leak. Not everyone has the same shape of face and often many different masks must be used to find one that. Fits well.  Some patients will remove the masks in their sleep. Claustrophobic patients cannot tolerate the masks.  In recent years, due to the epidemic of obesity being seen, masks have been developed for children, as obese children can develop OSA at a young age, affecting their brain development and triggering diseases such as type 2 diabetes at a very young age.

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Pediatric CPAP

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Nasal type CPAPs cannot be used on patients who are mouth breathers.

Treatment with oral appliances has a much higher success rate (over 90%) and can be worn by claustrophobic patients easily. They do not require electrical connections, are much more portable, and can be used on airplanes, camping, etc. where use of a CPAP would not be realistic.

In 2015 the American Academy of Sleep Medicine and American Academy of Dental Sleep Medicine published guidelines for OSA therapy. In it they removed the classification of mild, moderate and severe and recommended oral appliances be considered in all cases of OSA when CPAPs cannot be used. This moved oral appliances into the realm of severe OSA therapy as a verified treatment option. They also found that when QOL (quality of life) surveys were done, even in severe OSA, CPAP therapy and oral appliance therapy were equal.

TREATMENT OF UPPER AIRWAY RESISTANCE SYNDROME

The treatment of UARS is very similar to sleep apnea. Because  of the collapsibility of the wind pipe in UARS, by decreasing the resistance of the airflow in the upper airway, there is less negative pressure buildup  and the weak trachea (wind pipe) does not collapse. CPAPs work well for severe cases and, as with sleep apnea, oral appliances are also quite effective. The Luco Hybrid OSA Appliance has been successfully used on hundreds of patients with UARS with excellent results. Quality of life improvements were also equal for UARS when comparing CPAP vs oral appliance therapy.

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The Luco Hybrid OSA Appliance

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The Luco Hybrid OSA Appliance

 

TREATMENT OF SLEEP BRUXISM ( SB)

The treatment of SB depends upon the severity. Mild cases, with no underlying sleep related disorder, may be treated with a single arch bruxism appliance such as the Luco Splint. To prevent the tongue from being forced into an abnormal position, lower appliances such as this promote normal tongue positioning. The Luco Splint can be constructed with or without lower incisal coverage creating excellent tongue space.

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Front View Luco splint

View from Above

View from Above

Back View

View from Inside

 

For the treatment of severe SRB, the treatment a much different. Severe SRB has the TMJ or jaw joints involved, as well as the muscles used for chewing and the neck and shoulder muscles. There is usually a long standing history for this condition and quite often, a history of a head or neck injury.

For chronic long standing sleep-related bruxism, a single arch appliance will actually worsen the condition and should be avoided. A dual each appliance, such as the Luco Hybrid OSA Appliance, work far better. With the Luco Hybrid’s bite set into a forward position, and the mandible set as well, into a forward position, the patient cannot clench and grind. The painful muscles are maintained in a stretched position which relaxes them and stimulates blood flow into them clearing away the painful chemicals that build up in a spasmed muscle. Within a few weeks, the condition is stabilized and the patient no longer has headaches.

The original prototypes of the Luco Hybrid were used to treat severe TMD cases, mostly severe car accidents and severe head injuries. The design is inherently friendly to the TMJ and makes it ideal for treating SRB. Seven prototypes were tested over a ten year period before the final design of the Luco Hybrid OSA Appliance was completed. With the cast framework of the Luco Hybrid, the appliance is well suited for the most severe bruxer.

The patented forward bite of the Luco Hybrid appliance was originally conceptualized for the treatment of TMD patients, as it inactivates most of the main clenching muscles that are affected in TMD patients. By using this position in the treatment of OSA and UARS, there are minimal TMD concerns and, in most cases, pre-existing TMD symptoms resolve within a short period of time. Dr. Luco currently uses this is the treatment of TMD patients, for night support. UARS has associated with it chronic muscle conditions and this device is very effective at treating this condition as well. The Luco Hybrid OSA Appliance is the first FDA market cleared treatment for sleep bruxism (K160477).  It is the only OSA appliance with this distinction.

There are a number of over-the-counter OSA Appliances that the patient fit themselves. The current research has clearly shown that these are not effective in this type of treatment and can actually harm the patient. None are FDA cleared.  Custom made appliances are more comfortable, much smaller and fit by a trained professional. The FDA has stringent guidelines for OSA appliances that must be met before it is cleared for use in The USA. The Luco Hybrid has met these standards and is registered in the USA as well as in Canada, the European Union and other regions.

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