Most published research into anti-snoring devices for treating mild sleep apnea comes to the same conclusion. Mandibular Advancement Devices (MAD) can play a part in treating mild sleep apnea, and possibly help with moderate sleep apnea cases, too. But does it compare well with CPAP machines, long considered the gold standard for sleep apnea treatment?
Again, most researchers agree with the authors of a 2015 Australian study that comes to the conclusion that MADs might not work quite as well (efficacy) as Continuous Positive Airway Pressure machines in bringing down sleep apnea scores, but they are just about as effective in terms of treatment.
In the study “Efficacy versus Effectiveness in The Treatment of Obstructive Sleep Apnea: CPAP and Oral Appliances”, three doctors from the University of Sydney in Australia came to the conclusion (in more scientific terms) that the reason why the two devices were basically equally as effective when it came to the health effects of treatment, was because the human factor intervened. People preferred the oral appliance to the machine, so they used it more often and for longer periods! By contrast, patients had a tendency to use the CPAP machines less than they should.
Classifying the severity of sleep apnea
Determining the severity of sleep apnea is done by calculating the Apnea-hypopnea index, or AHI of patients, which is based on the number of times the person’s breathing pauses (apnea) for at least 10 seconds, and the periods of shallow or partially obstructed breathing (hypopnea) that occur in the space of one hour. Sleep apnea is the classified into mild, moderate or severe according to the frequency of events. Results of fewer than five incidents per hour are considered normal, with 5 to 15 events per hour taken as mild cases, 15 to 30 as being moderate and 30 to 40 is classified as severe. Bringing sleep apnea sufferers scores down through the scale to as close to normal as possible, is the aim of sleep apnea treatment.
The importance of the levels is in that along with the increase in severity goes a similar upward curve in the chances of suffering some of the serious health situations which are linked to the disorder, like high blood pressure, strokes, heart attacks and arrhythmia, as well as mental health problems which include severe depression. Daytime sleepiness and headaches are also linked to sleep apnea on all levels.
CPAP machines and how they work
According to the Harvard Medical School Blog, CPAP was the first device to be used in treating sleep apnea, which operates by creating pressurized air to send through the airways to keep them open. However the machine, while successful, is cumbersome, uncomfortable and noisy. It consists of a pump which pressurizes the air and a tube connected to a mask which then fits over the nose. Around 40% of those that try it don’t keep on using it. Explanations offered by users are that the pipe can be a nuisance in the bed, and the mask makes them feel claustrophobic.
MADS enter the picture
MADs entered the arena some time ago, offering sleep apnea sufferers a real alternative. The device, sometimes called a night guard, is a step or two up from other mouth guards like the gum guard used in sports, and the one used to stop people grinding their teeth. The MAD is anchored on the teeth and is adjustable for comfort. There are no wires, pipes and masks. They are portable and they make no noise.
And, while some researchers are still cautious regarding the relative benefits of MADs versus CPAP machines, many studies, and research programmes acknowledge its place in the fight against sleep apnea.
Further results on MADs
The results of a clinical trial published in the peer-reviewed Journal of the American Medical Association came to the conclusion that “A custom-made, adjustable oral appliance reduces obstructive sleep apnea, snoring, and possibly restless legs without effects on daytime sleepiness and quality of life among patients with daytime sleepiness and snoring or mild to moderate sleep apnea.”
But perhaps one of the most telling results are in the “Ten-year follow-up of mandibular advancement devices for the management of snoring and sleep apnea”, a study conducted to check on how well 180 patients who were given a mandibular advancement device back in 1996, complied 10 years down the line. About 40 percent responded to questionnaires sent out to all the patients. Out of the 72 that replied, 34 were still wearing it every night, and a further 13 still used it up to six nights a week.
As more and more oral anti-snoring devices are designed (and there are lots of them being made) these alternatives to the cumbersome CPAP machines might take an even bigger role in the battle against snoring and sleep apnea. In the interim, these devices have been acknowledged as definite players in that regard.
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