One of the fabulous things with Absolute Sleep is that we think beyond the limit of mandibular advancement splints, that is not the only tool in our box.
So quite often the severe sleep apnoeic is really discouraged from mandible advancement splints because the research shows historically over 30 years that the severe cases don’t do as well. But we’re now seeing that by doing what we call adjunct treatments, meaning more than just putting a mandible advancement splint in, by doing adjunct treatments, we are increasing our outcomes significantly. What does adjunct treatment mean? Well, it could mean this. We make you and mandibular Advancement Splint. We use our really clever wearable technology that we use to titrate our appliances.
Titrate means adjust to optimal position. We then add in things like potentially positional therapy where we put a little vibrating collar that make sure you don’t sleep on your back. We may refer you to an ENT surgeon to have a look at the soft tissues and see that any minor trimming of the soft tissues might increase the efficacy of the splint. Or we may, which is a really touchy subject, but something that society has to grow up about is the discussion of weight.
So weight is a huge contributor to exacerbating sleep apnea. Everyone with sleep apnea has some underlying anatomical problem and fat or weight increases the problem, it exacerbates that problem.The research tells us the a 10% drop in weight can improve the severity of the obstructive sleep Apnoea by 25 to 40 %.
So based on the premise that Severe OSA patients don’t do as well as Mild to Moderate sleep apnoea patients, it is possible that weight loss may decrease the severity of a severe OSA patient to a moderate or mild OSA patient that would then make them suitable for a Mandibular Advancement Splint.
So weight is a very important component as well. So we have several ways of doing that. We use other people to give dietary advice, exercise advice. We have bariatric surgeons who will consider bariatric surgery. So basically, yes, we can expand our adjuncts to get the outcome.
The other really important point to make is that the ‘Devil is in the detail’ when it comes to interpreting Sleep Studies. Sometimes treatment is just offered on the number of the AHI, and not analysed thoroughly. To determine if things like sleep position are having a large influence on that number of choking events.
The other really important point is how well qualified the dentist is to achieve a satisfactory outcome in patients who have considered to refuse or have failed CPAP. As well as having a keen knowledge of the reading of a sleep report, they need to have a good protocol for adjusting the MAS to achieve and optimal outcome.
And that’s why we do so well with severe sleep apnoeics. And in fact, it’s a severe sleep apnoeics that have the greatest health risk long term. And they’re the ones we’re quite passionate about, because if you fail CPAP and you remain untreated, you’re on a downhill slide.