Sleep apnoea and snoring: how can a mandibular advancement device help?
Obstructive sleep apnoea, also known as obstructive sleep apnoea syndrome (OSAS), is a breathing disorder that causes repeated interruptions in breathing during sleep. These episodes are caused by narrowing or blockage of the upper airways and can affect both sleep quality and daytime alertness.
Loud snoring, persistent fatigue, unrefreshing sleep or excessive daytime sleepiness can be signs that should be discussed with a healthcare professional. After a medical diagnosis, several treatment options may be considered depending on the severity of the sleep apnoea and the individual patient’s situation. One of these is a mandibular advancement device (MAD), a dental appliance worn during sleep.
What is obstructive sleep apnoea?
Obstructive sleep apnoea is characterised by repeated episodes during which the airways narrow or close while a person is asleep. Breathing is then reduced or temporarily interrupted.
These episodes can cause repeated brief awakenings that disturb sleep quality, sometimes without the person being aware of them.
Possible signs of sleep apnoea include:
- regular or loud snoring;
- observed pauses in breathing during sleep;
- tiredness on waking despite sufficient sleep;
- daytime sleepiness;
- difficulty concentrating;
- headaches on waking.
Snoring does not necessarily mean that a person has sleep apnoea. However, it may be a warning sign, especially when it is associated with breathing pauses or significant daytime fatigue.
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Everything you need to know about lower jaw advancement trays
How is sleep apnoea diagnosed?
Sleep apnoea is diagnosed medically. If symptoms suggest the condition, a general practitioner may refer the patient to a specialist or a sleep medicine centre.
Specific tests such as respiratory polygraphy or polysomnography can record different parameters during sleep and help determine whether sleep-related breathing disorders are present and how severe they are.
Treatment is then selected according to the diagnosis, the severity of the sleep apnoea, the symptoms and the patient’s individual situation.
What treatments are available for sleep apnoea?
Several approaches can be used to treat obstructive sleep apnoea. The choice of treatment depends in particular on its severity and underlying causes.
Continuous positive airway pressure (CPAP) is an established treatment, particularly for more severe forms. In some situations, positional therapy, lifestyle measures, ENT or maxillofacial surgery, or a mandibular advancement device may also be considered.
For mild to moderate obstructive sleep apnoea, a mandibular advancement device is a recognised treatment option. It may also be considered in certain situations when CPAP is not suitable or is not tolerated.
What is a mandibular advancement device?
A mandibular advancement device, commonly abbreviated as MAD, is a custom-made intraoral appliance worn during sleep.
It works by holding the lower jaw in a slightly forward position. This can increase the space available in the airways behind the tongue and help reduce obstruction while sleeping.
The aim is to facilitate airflow and reduce sleep-related breathing problems in patients for whom this treatment is indicated.
MADs may be used in particular to treat certain forms of mild to moderate obstructive sleep apnoea and some cases of snoring.
How does treatment with a mandibular advancement device work?
Before a MAD is made, the dentist checks whether the condition of the teeth, gums and jaw joints is compatible with this type of treatment.
Once the medical indication has been established and no dental contraindications have been identified, several steps are required:
- oral examination and assessment of the jaw;
- conventional or digital impressions;
- recording the measurements required to manufacture the device;
- custom fabrication by a specialised laboratory;
- fitting and progressive adjustment of the appliance;
- dental and medical follow-up to assess comfort and effectiveness.
The appliance is individually adapted to the patient’s dentition and anatomy.
Is a mandibular advancement device effective against snoring?
Advancing the lower jaw can help create more space in the airways during sleep. In some patients, this can also reduce snoring.
However, chronic snoring should be assessed before treatment begins, as it can sometimes be associated with obstructive sleep apnoea.
When a person has snoring without diagnosed sleep apnoea, the treatment approach and reimbursement conditions may differ.
I snore or think I may have sleep apnoea: what should I do?
If you experience loud snoring, observed breathing pauses during the night, persistent fatigue or excessive daytime sleepiness, the first step is to speak with a doctor.
If necessary, a specialised sleep assessment can determine whether obstructive sleep apnoea is present and identify the most appropriate treatment.
When a mandibular advancement device is indicated, a dentist trained in this type of treatment can then assess the patient’s oral health and provide support with the fabrication, adjustment and follow-up of the appliance.
