There is no doubt that Sleep Apnoea exists and is a valid and extremely debilitating condition. The actual statistics on the successful patient compliance with CPAP are difficult to obtain as it is in the interests of the industry to overstate the effectiveness. They ‘fail’ to take into account those machines that have been prescribed, purchased, trialled and then left lying about in a cupboard because the user just cannot tolerate the device. According to our in-house records less than 16% of the people that we see are able to use CPAP effectively.
There are two major factors which trigger the breathing response:
-The pH of the blood, more specifically the movement towards pH7.8 and alkalosis.
-The hypoxic drive to breathe created by reduction of oxygen to the brain.
What appears to be totally ignored, relative to the above, is the fact that both of these mechanisms are controlled and regulated by the levels of CO2 in the body. ANY mechanism that regulates breathing and increases CO2 levels will automatically reduce the incidence of apnoeas using the following well known facts:
- CO2 combines with water to produce Carbonic Acid which is used to buffer the alkaline blood back to the correct pH.
- The return to pH 7.35 then allows the oxy-haemoglobin bond to dissolve and release O2 to the body’s cells.
Thousands of patients have regained normal sleeping patterns, stopped snoring, no longer have sleep apnoea and/or restless leg syndrome or periodic limb movement, by learning this simple way of retraining breathing back to the way it was designed to be.
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Oral appliances (OA) have emerged as an alternative to continuous positive airway pressure (CPAP) for obstructive sleep apnea (OSA) treatment. The most commonly used OA reduces upper airway collapse by advancing the mandible (OAm). OAm are an effective treatment for OSA, not only improving AHI but also a variety of physiologic and behavioral outcomes.
OAm are an effective treatment for OSA, not only improving AHI but also a variety of physiologic and behavioral outcomes. Recent comparative effectiveness trials have shown health outcomes between CPAP and OAm treatments are equivalent, even in severe OSA, despite greater efficacy of CPAP in reducing AHI. This likely reflects greater nightly adherence to OAm compared to CPAP therapy. Recent advances in technologies related to OAm treatment have the potential to further improve their efficacy and effectiveness in clinical practice. Selection of appropriate patients who will respond to OAm treatment is an ongoing barrier to use.
The now commercially available remotely controlled mandibular positioner offers a means to predict response from a single-night mandibular titration study and has shown good positive predictive value in initial testing. The advent of new adherence monitoring technology that can be routinely incorporated into OAm devices to objectively monitor treatment usage represents another advance in OSA treatment, which will be beneficial in practice and research. This will further help clarify the role of OAm in OSA treatment next to CPAP. Establishing best quality devices that are objectively validated in terms of both efficacy and durability in combination with recent advances in patient selection and treatment monitoring, will continue to optimize OAm as an effective and even first-line treatment for OSA.
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Current treatments for sleep bruxism include dental nightguards or occlusal splints, which are often provided without upper airway or sleep assessments. In this case report, they used biomimetic oral appliance therapy by redeveloping the maxilla and repositioning the mandible. This particular case report represents a patient who followed all treatment recommendations conscientiously, and her progress and results appear to reflect her pursuit of health. It is thought that preventive therapy cannot effectively cure sleep bruxism but various treatment protocols for its management are available.
This particular case report tracks a patient who followed all treatment recommendations conscientiously, and her progress and results appear to reflect her pursuit of health. However, a major limitation of this case report is the lack of a PSG study to document bruxism and OSA at both the baseline and post-treatment phases. However, psychometric measures, such as an Epworth Sleepiness Scale questionnaire were used to confirm the presence of bruxism, its severity and daytime sleepiness. In addition, the patient admitted to grinding her teeth, had worn holes through her night-guard, and the flattened cusps of her posterior teeth were indicative of sleep bruxism. As a result of biomimetic oral appliance therapy, her upper airway was developed so that mouth breathing was corrected and she could revert back to nasal breathing. This change in function appears to have resolved her chief concern of sleep bruxism. In addition, the nasal mode of breathing allowed her lips to contact gently while at rest.
A multi-disciplinary approach may be appropriate for patients that present to a dental office with issues relating to sleep bruxism. The protocol described in this article may also be applicable to cases of posterior open bite associated with mandibular advancement appliance therapy for the management of OSA. That premise remains as the basis for future studies. We conclude that dentists and orthodontists can help in the recognition and treatment of both sleep bruxism and malocclusion, thereby preventing systemic co-morbidities associated with obstructive sleep apnea.
For more information regarding the case study and sleep bruxism please refer to the following link: