Intra-oral appliances - Mandibular advancement splints (MAS)
The MAS is by far the most common form of intra-oral appliance used in the management of SBD (sleep breathing disorder). There is considerable variation in the design of MAS, but all posture the mandible forwards, to a varying extent, with a degree of vertical opening. Sleepwell ™ is the most clinically proven and effective.
Elimination of aggravating factors
Regardless of the severity of the SBD, it is prudent to eliminate co-existent conditions that either predispose to or worsen upper airway dysfunction during sleep. Subjects should therefore abstain from alcohol and caffeine during the evening, avoid the use of central nervous system depressants and ensure adequate control of any co-existing chronic obstructive airway disease, asthma or hypothyroidism. Furthermore, in subjects with a BMI above 25, research has demonstrated a weak correlation between the amount of weight loss and the clinical response.
Changing sleeping posture
Research has demonstrated that, in a proportion of subjects, the frequency of SBD is substantially greater during sleep in the supine position compared with the lateral recumbent position. That author proposed that the effect of gravity on the tongue and enlarged soft palate collectively could lead to upper airway occlusion. Methods used to help subjects to sleep in the lateral recumbent position include the use of a tennis ball sewn into the back of their sleeping garment.
Removal of nasal obstruction and nasal dilating devices
The presence of any nasal obstructions will lead to an increase in nasal airway resistance, which in turn will further promote collapse of the upper airway during inspiration. Despite the unpredictable direct effects of relieving nasal obstruction on SBD, it has been suggested the removal of any obstructions as first line care in facilitating other treatments regimes. The use of external nasal dilating devices to reduce nasal resistance has been shown to have beneficial effects in reducing the severity of snoring.
In addition a range of surgical procedures address snoring however success varies. Short term results using surgical procedures have shown limited success, the long term results show that the snoring can return.
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Normal airflow. The soft pallet relaxes and restricts the airflow, the soft pallet vibrates, causing the 'snore'. The epiglotis may also restrict the airflow and may even cause 'Sleep Apnia'. The Silensor is introduced which when positioned and adjusted brings the lower soft tissue forward, improving the airflow and eliminating the vibration.