treatment option for sleep apnea and snoring ent expertsThere is good news for people who snore or have mild to moderate sleep apnea but who haven’t been able to find relief using a CPAP machine, either because they find it noisy or uncomfortable. While CPAP devices may be the standard treatment for sleep apnea, mandibular advancement devices (MADs) have proven to be equally or more effective in boosting patients’ overall quality of life. MADs are smaller, less invasive, and easier to use than a CPAP machine.

Snoring can be a lifelong issue for many people, affecting themselves as well as their partner, family, and colleagues. Not only can snoring be a disruption in the bedroom but it can also result in poor sleep which can impact your energy levels, health, lifestyle, and productivity at work.

Continuous positive airway pressure (CPAP) has been the gold standard treatment for obstructive sleep apnea. However, not all patients do well on the machine either because they can’t tolerate it or just don’t like using it, leading to poor compliance and decreased effectiveness.

The good news is that mandibular advancement devices are providing an answer for many patients looking to prevent loud snoring and alleviate mild to moderate sleep apnea.

“A mandibular advancement device is a tool for people who have mild to moderate sleep apnea or snoring that they haven’t been able to treat in other ways,” says Kiran Tipirneni, M.D., F.A.C.S., a board-certified otolaryngologist at the Ear, Nose, Throat & Plastic Surgery Associates.

Why Do We Snore?

There are many reasons why people snore, many of which are connected to the partial obstruction of airflow to and from the lungs at sites such as the tongue base or throat tissues. Snoring can result from a narrowing of the airways that causes the air passing through the throat to vibrate within its soft tissues, not unlike air flowing through a whistle.

When you sleep, sometimes the airways relax when you breathe in. As a result, those tissues collapse and fall backward, like the palate falling back and vibrating, or the tongue or the epiglottis dropping down and causing a vibratory noise. Anything that causes the soft tissue in the mouth and throat to expand or relax too much can bring about snoring — like when one drinks alcohol or takes certain sedatives.

What Is Sleep Apnea?

Sleep apnea is a common disorder in which you have one or more pauses in breathing or shallow breaths while you sleep. Breathing pauses can last from a few seconds to minutes. They often occur 5 to 30 times or more an hour. Typically, normal breathing then starts again, sometimes with a loud snort or choking sound.

Sleep apnea usually is a chronic (ongoing) condition that disrupts your sleep and if left untreated, may place individuals at higher risk of developing other serious medical conditions such as hypertension, heart disease or stroke. Sleep apnea also causes poor sleep quality which makes you tired during the day. Sleep apnea is one of the leading causes of excessive daytime sleepiness and affects as many as 18 million people. Although it occurs most often in adults aged 40-60, sleep apnea can affect people of all ages.

How Does a Mandibular Advancement Device Work?

A mandibular advancement device (MAD) helps to diminish restriction that may occur in the back of the throat by advancing the jaw (and by extension the tongue) forward and away from the back of your throat. This increases the area of the upper airway, thus reducing the air resistance that leads to snoring.

“A mandibular advancement device allows your lower jaw to be pulled forward while you sleep,” says Dr. Tipirneni. “When your lower jaw gets pulled forward, it increases breathing space in the back of the throat. The device keeps your tongue from falling backward, and it can also keep the soft palate from falling back and making the snoring sound.”

Typically, MAD’s fit within the mouth and are molded to your teeth to provide a stable platform through which the upper jaw acts a fixed frame, and the lower jaw is pushed forward. The best MAD’s provide a support mechanism that allows incremental advancement of the jaw until the ideal balance between the back of the tongue and the soft tissue of the throat is achieved, and snoring and apnea stops.

According to Dr. Tipirneni, patients should not get fooled by low prices advertised for online “one size fits all,” devices. It is important for patients to buy quality MADs and have them equipped by a certified professional.

​”Mandibular advancement devices need to be custom fitted properly,” he says. “You may see a lot of them advertised on the internet, and they can be relatively inexpensive. Unfortunately, you get what you pay for. Many of my patients will come in saying they tried them and they don’t function well. The problem is that when mandibular advancement devices aren’t fitted correctly, at the very least, they don’t work as intended, but at the worst, they can (negatively) affect the jaw joints.”

“Mandibular advancement devices should be fitted professionally,” Dr. Tipirneni continues. “This is something we do here in the office. ​We employ the Thornton Adjustable Positioner (TAP) device. They’re relatively low profile so that when you wear them in your mouth, they are not bulky or cumbersome.”

TAP is a patented lower jaw advancement device specifically designed to keep your airway open during sleep. What makes the TAP so innovative is its single, midline tension mechanism.

“You can get your lips around the TAP and close your mouth,” says Dr. Tipirneni. “What the TAP does is it advances the jaw and tongue base forward while you sleep, keeping them from falling back and narrowing the airway.”

“​If this is something you think you might be interested in, you can come to see us in the office, and we can see if this might be right for you.”

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