There are three forms of sleep apnea: central (CSA), obstructive (OSA), and complex or mixed sleep apnea (i.e. a combination of central and obstructive) . In CSA, breathing is interrupted by a lack of respiratory effort; in OSA, breathing is interrupted by a physical block to airflow despite respiratory effort, and snoring is common.
Regardless of type, an individual with sleep apnea is rarely aware of having difficulty breathing, even upon awakening. Sleep apnea is recognized as a problem by others witnessing the individual during episodes or is suspected because of its effects on the body. Symptoms may be present for years (or even decades) without identification, during which time the sufferer may become conditioned to the daytime sleepiness and fatigue associated with significant levels of sleep disturbance
For moderate to severe sleep apnea, the most common treatment is the use of a continuous positive airway pressure (CPAP) or Automatic Positive Airway Pressure (APAP) device, which ‘splints’ the patient’s airway open during sleep by means of a flow of pressurized air into the throat. The patient typically wears a plastic facial mask, which is connected by a flexible tube to a small bedside CPAP machine. The CPAP machine generates the required air pressure to keep the patient’s airways open during sleep. Advanced models may warm or humidify the air and monitor the patient’s breathing to ensure proper treatment.
Although CPAP therapy is extremely effective in reducing apneas and less expensive than other treatments, some patients find it extremely uncomfortable. Many patients refuse to continue the therapy or fail to use their CPAP machines on a nightly basis, especially in the long term.
For mild to moderate cases, an inra-oral dental appliance is fabricated that positions the lower jaw in a comfortable way to open up the airway flow.
In certain cases, a combination of a CPAP machine AND an oral appliance are worn.