In January we spent some timeused for treating Sleep Apnoea, the Fisher & Paykel Icon. Though we love using this machine it did have us wondering what alternatives were available. CPAP machines do a great job of restoring a good night's sleep to apnoea suffers, but they can be cumbersome, especially if you travel regularly, and some patients find the constant air pressure hard to tolerate. So what other options are available?
Let's begin with a layman's description of what obstructive sleep apnoea (OSA) is. OSA refers to when a person's breathing is obstructed during sleep by a blockage in their airway. This blockage is caused when muscles, including the tongue, relax and collapse into the airway. Everyone's muscle will lose tone during deep sleep; however, this won't cause a breathing issue in most people. When it does (as it does in 20% of the population), the obstruction needs to be overcome to reduce significant fatigue and other serious health issues, including stress on the heart. Constant positive airway pressure (CPAP) can push past a physical obstruction and reopen the airway, but there is another way.
How does it work?
SomnoDent is one version of a treatment referred to as Mandibular Advancement — any device that moves the mandible or lower jawbone forward, bringing the tongue with it. The SomnoDent splint is worn like a mouthguard during sleep and features an ingenious adjustment mechanism on each side that can advance the lower jaw further forward if the treatment isn't immediately successful.
The advantages are obvious; a splint is a much smaller and quieter solution to sleep apnoea than CPAP. Any night I plan not to sleep in my own bed I'm forced to pack up my CPAP machine, lug it to my destination and reinstall it. When I'm overseas I have to make sure I have a compatible power adapter, I'm too shy to use it on long-haul flights and there have been times when I've had to move the bed in hotel rooms just to have the machine close to a power point. Others would say that a treatment like SomnoDent would be helpful for people who can't tolerate CPAP, though I'd argue that wearing a device like this takes as much tolerance as wearing a CPAP mask.
Why it might not work
As with much of medical science, the success of any treatment will depend on the patient. The severity of OSA varies greatly from person to person, with unique physical attributes and external factors, like weight and build, impacting how serious the obstruction is during sleep and what is required to overcome it. With CPAP, a sleep specialist can increase the air pressure to find the level required to restore uninterrupted sleep, but with mandibular advancement a person's condition may not be significantly improved because of a combination of these unique attributes. The lower jaw may be advanced, but the tongue may be so relaxed it still collapses into the airway and the obstruction may persist.
In fact, I have been cautioned by the SomnoDent team that I am not the perfect candidate for this particular type of treatment. That I'm younger than most Sleep Apnoea sufferers is to my advantage, in that my muscle tone might be better during deep sleep, but my build and other previously known physical attributes might mean that the splint offers little benefit. SomnoDent is designed to assist people with low to moderate Sleep Apnoea, while mine is classed between moderate and high.
Still, this won't deter me from spending six weeks or so trialling the SomnoDent. Its compact size would be a fantastic advantage when I'm travelling, so I've got my fingers crossed that I'll see a comparable benefit to when I'm using CPAP. My plan is to use both the SomnoDent splint and the Fisher & Paykel Icon for a week or two, to acclimatise myself to the mouthguard before I use it alone. Thereafter, I'm hoping to use my CPAP machine to collect data while relying on the SomnoDent solely to prevent my OSA.
If you're using a CPAP machine and you're curious about this alternative, or if you snore like an angry Rhino and you're considering having a sleep test, drop me a line. I'd be happy to let you know how this is going at any time.