In the past, oral appliances were considered treatment for mild or moderate sleep apnea. Now guidelines allow for oral appliances to be used as treatment for all forms of obstructive sleep apnea , if they are intolerant of CPAP or prefer alternate therapy. This change in recommendations came after a comprehensive review of the rules for sleep apnea treatment by the two leading boards that credential sleep doctors and sleep dentists.
The Review Process
Previous rules and guidelines for oral appliances were put in place in 2006, and it was perceived that the science had changed considerably since that time. To attempt to make new rules that coincided with the science, the American Academy of Sleep Medicine (AASM) and the American Academy of Dental Sleep Medicine (AADSM) convened a seven-member task force to review the scientific research into the effectiveness of CPAP , oral appliances, and other sleep apnea treatments. The task force reviewed all relevant scientific literature to come up with its six recommendations. These recommendations were put before the AASM and the AADSM, who approved the final recommendations.
The Adopted Recommendations
Based on a review of the science, the two boards came up with the following standards and guidelines for the use of oral appliances.
- Sleep physicians should prescribe oral appliances instead of no therapy for adults who have primary snoring without sleep apnea.
- Sleep physicians should refer a patient to a dentist for the fitting of a custom appliance for snoring rather than a non-custom device, which may not be effective.
- Sleep physicians should prescribe oral appliances instead of no therapy for adults with obstructive sleep apnea and can’t tolerate sleep apnea or prefer an alternative treatment.
- Sleep dentists should follow-up with patients with oral appliances to check for dental side effects.
- Sleep physicians should perform sleep testing on people receiving treatment to make sure the treatment is effective.
- Sleep dentists and physicians should tell patients to make regular checkup visits to ensure.
Points 1 and 3 are standards–physicians are required to follow them to be incompliance with the AASM standard of care. The rest are guidelines.
Insurance Company Guidelines May Be Different
We are happy to see this change in attitudes toward oral appliances. Oral appliances are a highly effective sleep apnea treatment, and most studies show they are just as effective as CPAP. There is no reason why they should only be considered for mild to moderate sleep apnea. They may not be fully effective for people with severe sleep apnea, but they can give a considerable improvement for patients in their health and quality of life, and because of high compliance they may be as effective as CPAP.
This is the direction that the medical community is moving overall. However, not everyone is caught up with the trend. Some insurance companies may still limit your options for treating severe sleep apnea, although most will allow you to get an oral appliance if you are unable to tolerate CPAP.