In his 40s and with a slender build, John Wachowiak, Stevens Point, didn’t fit a typical profile of someone who has sleep apnea.
Yet, he stopped breathing 61 times an hour, according to a sleep study done at Marshfield Clinic Sleep Lab. Both he and his father had lower jaws that constricted air passage.
Wachowiak estimates that he had this condition for 15 years. “I was notorious for falling asleep. Every time I sat down, I dozed off,” he said.
He is among 30 million Americans with obstructive sleep apnea. It occurs when the throat narrows while a person is sleeping, and he or she stops breathing for a few seconds. A gasp, choke or snore awakens the brain to open the throat.
Those who stop breathing more than 30 times hourly during sleep are considered to have moderate to severe obstructive sleep apnea. Those who stop breathing 15 to 30 times an hour during sleep have moderate sleep apnea, while stopping five to 15 times hourly is considered mild sleep apnea.
Most people with obstructive sleep apnea are treated with CPAP, or continuous positive airway pressure. A CPAP machine delivers air through a mask that increases air pressure in the throat. It is considered the most effective treatment.
Wachowiak tried the CPAP machine. “I just had a hard time getting used to it.”
He was then referred to Oral and Maxillofacial Surgeon Ajit Pillai, D.M.D., who fitted him with a mouthpiece that moves the jaw and tongue forward to open the airway, reducing sleep apnea. A sleep study after wearing this oral sleep appliance for three months showed Wachowiak’s stop-breathing episodes dropped significantly to five per hour.
“I feel like my sleep is better. Now when I wake up, I feel rested,” Wachowiak said, adding that the appliance was easy to get used to.
Oral appliances are recommended for patients who have mild to moderate obstructive sleep apnea and are unable to tolerate CPAP therapy. Oral appliances may be considered as initial treatment in cases of mild obstructive sleep apnea.
“A majority of my patients cannot tolerate the CPAP or BiPAP,” Dr. Pillai said. The latter is bilevel positive airway pressure. He is one of three dentists in Wisconsin who are certified in dental sleep medicine by the American Academy of Dental Sleep Medicine. Oral and maxillofacial surgeons, along with ear, nose and throat (ENT) specialists, also provide surgical options for sleep apnea but not as first line therapy.
After a sleep study, patients are referred to Oral Surgery if they are good candidates for an oral appliance, said Jessica Geiger, Marshfield Clinic Sleep Medicine nurse practitioner. Dr. Pillai or another Marshfield Clinic oral surgeon conducts an exam, and if appropriate, has the sleep appliance custom-made. Generally six appointments over four to five months are needed to fit and adjust the appliance and make sure the patient is comfortable placing and removing the device, Dr. Pillai said.
“It’s painless, and no surgery is involved,” he said. “Most people are really happy with it, and it’s a life-changing event.” He has fitted an estimated 120 patients with sleep devices in the last four years.
Having oral and maxillofacial surgeons specially trained in the use of oral appliances allows Sleep Medicine staff to offer an additional treatment option for patients, Geiger said. “We work closely as a team to ensure patients with sleep apnea are adequately treated to reduce the health risks associated with the disorder.”
The multidisciplinary approach to sleep medicine may also include an ENT specialist, or otolaryngologist. These physicians perform soft tissue work to open the airway. This integrated approach helps effectively manage the condition.
Sleep appliances generally are covered by public and private insurers.
In a few cases, patients with sleep apnea may benefit from both CPAP or BiPAP therapy and an oral appliance.
For Wachowiak, life and his overall health are better. “I can actually do things, sit down and read a book without falling asleep. If I don’t put it in at night, I can really tell the difference.”
