MADs are the most common dental sleep devices used when treating sleep apnea and snoring. Also known as oral appliances, they open the airway by 1 — keeping the lower jaw from falling down and back and 2 — holding the lower jaw slightly open and forward. Because the tongue is attached to the jaw, as the jaw moves forward your airway is made larger by the forward movement of the tongue. At Dr. Drake’s Sleep Solutions, we ONLY use custom made, titratable Mandibular Advancement Devices. We don’t recommend non-custom or boil and bite devices or any device that cannot be adjusted.
Tongue Stabilizing Devices (TSD) and Tongue Retaining Devices (TRD) work by holding the tongue in a forward position while you sleep. They require a “getting used to” period and are a bit of a challenge, but some patients have found them to be very successful.
There are hundreds of reasons that keep someone from wearing CPAP (Continuous Positive Airway Pressure). The mask is too tight; it’s too loose; I feel claustrophobic; it keeps me from being able to move around; the air makes me feel like I’m drowning; it makes me feel bloated; it dries out my mouth, throat, etc. You get the picture and understand exactly what we’re saying if you’ve tried it yourself. So sometimes CPAP doesn’t work for you. And sometimes, our dental device doesn’t get your numbers low enough either. THANK goodness! We have a hybrid therapy option. When neither therapy works by itself, sometimes we can combine PAP and a dental device via a custom mask. NOW we have a therapy that works and seems to give our patients the best of both worlds. Our team can work directly with your sleep physician to create a combination dental sleep device that will pair with your PAP delivery system. This custom-made device or oral appliance will attach to your CPAP machine. Combining your machine with this device will allow you to set your CPAP at a much lower pressure setting.
Cleaning your appliance should be done each morning, with a soft toothbrush and toothpaste, brushing all surfaces inside and out. You can also use any denture or orthodontic retainer cleansers; many are available commercially; consider doing this every couple of weeks. You can also wash them gently in your hands with any anti-bacterial soft soap. Be sure to store your device as we directed you (some dry, some wet). Avoid anything that has alcohol in it! Be careful that you do not leave your appliance anywhere that a pet can reach it! Dogs and cats find them wonderful chew toys and replacement of the appliance is costly and is not covered by insurance.
The AM bite positioner which was made at your delivery appointment is a record of how your teeth came together before you started your dental sleep therapy. It is an effective tool we use to recapture your bite each morning. This is worn for several minutes – usually while you are getting dressed in the morning. Do not place the AM Positioner in warm or hot water or it will warp or melt.
Each appliance requires a different technique to adjust. As a general rule, we start you at a position where your lower jaw is only slightly forward. If you get a nudge that first night or two and a “How much did you pay for that thing?! You’re still snoring” do NOT fret. Devices require adjustment; and even small adjustments can make a big difference. We are trying to find the “sweet spot” where you sleep quieter, oxygenate better, and live healthier and longer.