A lot of people suffer chronic fatigue because sleep apnoea is preventing them from getting a good night’s sleep. Michiel Doff, trainee oral surgeon at the University Medical Center Groningen (UMCG), studied the effects of sleeping with a mouthpiece. More than half of the people with mild or moderately serious sleep apnoea reported considerable improvement after sleeping with a mouthpiece for two years. The mouthpiece shifts the lower jaw forward while the person sleeps. This prevents the lower jaw and tongue from slipping backwards and obstructing the airway in the throat. Doff will be awarded a PhD by the University of Groningen on 28 November 2012.
Doff´s research also showed that long-term use of a mouthpiece can alter the alignment and position of teeth slightly. ‘This is why it is important that the mouthpiece is made by a dentist qualified in dental sleep medicine,’ says Doff. ‘Regular check-ups are needed to monitor both the teeth and the effect of the treatment.’
People with sleep apnoea tend to snore and their upper airways become obstructed, causing them to repeatedly stop breathing for short periods. If breathing stops more than five times an hour, the condition is referred to as obstructive sleep apnoea. A sleep study is used to determine the gravity of the sleep apnoea. People with a serious form of sleep apnoea often have to sleep with a mask to provide positive pressure ventilation. This is unpleasant and people often discontinue the therapy.
Approximately 5% of men and a slightly lower percentage of women in the Netherlands suffer from sleep apnoea. They sleep badly because they wake with a shock several times a night when their breathing stops. During the day, sufferers can be very sleepy and irritable. Obstructive sleep apnoea carries an increased risk of cardiovascular disease.
Sleeping with a mouthpiece (mandibular repositioning appliance or MRA) would appear to be an effective treatment option for mild and moderately serious sleep apnoea. Healthcare insurers have been reimbursing the cost of a mouthpiece for patients with officially diagnosed obstructive sleep apnoea since 2010. ‘We have now shown that a mouthpiece can have a long-term effect on people with mild and moderately serious sleep apnoea,’ explains Doff. ‘When they start using the appliance, many people complain of too much saliva, a dry mouth, sore jaw muscles and a stiff jaw. These side effects usually disappear fairly soon.’
In the long term, using a mouthpiece can alter the alignment and position of the teeth. This can lead to a less effective bite between the lower and upper jaws. According to Doff, the best way to reduce or avoid this effect is to make sure that mouthpieces for the treatment of sleep apnoea are made to measure by specialist dentists, who will check the alignment of the teeth on a regular basis and make swift adjustments if the mouthpiece is having an adverse effect.
Michiel Doff (Groningen, 1977) studied Dentistry at the University of Groningen. He conducted his research in the Dentistry and Oral Hygiene Department of the UMCG in close collaboration with the Pulmonary Diseases and Clinical Neurophysiology Departments. The research is being run by the SHARE Research Institute. Doff’s thesis is entitled ‘Oral appliance therapy in obstructive sleep apnoea syndrome; long-term efficacy and comorbidity.’ Doff is training to become an oral surgeon at the UMCG.
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