DNA Sleep Apnea
Appliance
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CPAP No More! Dental Oral Appliance Obstructive Sleep Apnea Therapy that Cures.
What is Obstructive Sleep Apnea (“OSA”)?
Obstructive sleep apnea (OSA) is a sleep disorder that involves cessation or significant decrease in airflow while breathing during the sleeping.
There are various degrees of OSA including mild, modrate to severe sleep apnea.
Additiona to OSA, there is also a more dangerous version of sleep apnea known as Central Sleep Apnea (CSA) which is a nervous system disorder.
Commonly, long term therapy, such as continuous positive airway pressure (CPAP) and/or oral appliance therapy, such as mandibular advancement appliances (MAD), have been utilized as treatment.
However, a recent form of treatment, biomimetic oral appliance therapy (BOAT), offers and alternative non-surgical method, which can putatively resolve OSA by combined maxilla-mandibular correction, and addressing craniofacial deficiencies.
Multiple studies have determined that BOAT induced craniofacial and airway changes produce a more favorable result, resulting in an optimally reshaped upper airway, which results in a reduction in the severity of sleep disordered breathing, thereby effectively resolving the disorder of sleep apnea.
What is the DNA Sleep Appliance Device?
Typically, dental oral appliances used to manage snoring and obstructive sleep apnea are mandibular advancement devices that simply protrude the lower jaw. These devices are worn over a lifetime, and do not address the underlying etiology of the condition. In contrast, Dr. May advocates that treating the underlying cause of OSA is a superior approach that improves not just the symptoms of OSA, but resolves the OSA itself. Dr. May’s FDA approved, superior treatment option is the DNA Appliance know as mRNA(T) which works through upper airway remodeling or Pneumopedics® to re-develop the airway so that underlying sleep apnea can be resolved in some mild and moderate cases.
The biomimetic technique of the DNA is significantly different from standard dental MAD because instead of simply repositioning the mandible, the patented, FDA-registered Daytime-Nighttime Appliance® system (or DNA appliance®), which is worn during the evening and at night, allows the body to gently increase the size of the upper jaw and increase the volume of the nasal airway, sometimes to the extent that the underlying issues are completely eliminated. In addition, the FDA-cleared, patented, mandibular Repositioning-Nighttime Appliance® (or mRNA appliance®) is a biomimetic oral appliance that provides combined maxillo-mandibular correction. The mRNA appliance is worn at night, and this allows the body to reposition the mandible while gently redeveloping the midface, as well as remodeling the upper airway in adults, while correcting the positions of the teeth into a more natural position.
Perfect Fit – Neuromuscular Dentistry Expert – Dr. Yuriy May
Our Obstructive Sleep Apnea Appliances utilize the advanced scientific principles and technology of Neuromuscular dentistry.
This means that Dr. May plans, observes and measures exactly how the sleep apnea appliance will affect the TMJ joint and the surrounding muscles of the jaw. As the Connecticut Sleep Apnea expert, he takes considerable time to ensure that every patients’ appliance is fabricated while the patient is able to maintain the most relaxed position for their jaw joint and facial muscles.
This muscular relaxation process takes about an hour and a half and is achieved through the use of TENS therapy (Transcutaneous Electrical Nerural Stimulation).
The relaxed and comfortable position for the patients’ lower jaw is then extensively verified through the use of computer Electomyography (EMG’s) and Jaw Tracking technology to ensure the mDNA appliance will be clinically effective and extremely comfortable each and every night of wear.
Why is the expert fitting of the oral sleep appliance critical?
Setting the mRNA Oral Appliance to keep the lower jaw in the most relaxed position will virtually eliminate any morning jaw or facial soreness that most often occurs with many other “arbitrarily” made dental sleep appliances. These “arbitrary” starting positions also promote further torquing of the lower jaw which leads to torquing of the spine’s C1 and C2 around the brain stem which is also the location of the respiratory center within the brain.
This can lead to a possible Central Sleep Apnea (CSA) condition that takes place in the central nervous system. Overall, if the prescribed dental appliance is not comfortable and causes the patient facial, muscle, and TMJ pain, the patient will most likely not wear it. This results in non-compliance of OSA treatment, leaving OSA untreated which can lead to a wide array of other serious medical conditions.
Added Benefits for Nighttime CLENCHERS and GRINDERS
For patients who are habitually plagued by clenching, grinding and waking up with sore TMJ joints and migraines, there are tremendous benefits. By maintaining the jaw’s most relaxed muscular position, mDNA will virtually eliminate all of these symptoms.
This means, that Dr. May is able to effectively treat not only the OSA itself, but also any pathological clenching / grinding habits a patient may have, alleviating debilitating TMJ discomfrot and migraine pain! How great would that be to not clench or grind one’s teeth anymore at night time, all while effectively treating the obstructive sleep apnea while getting a mini facelift!
Enhanced aesthetics using Pneumonics(R)
Patients have been extraordinarily increasing interest in facial macro aesthetics and micro aesthetics, which has significantly increased the use of facial fillers in the lower face to reduce aging effects, wrinkles and improve upper lip fullness. Indeed, cosmetic injection around the lips and perioral area is thought to be a way to provide aesthetic improvement of age changes around the mouth as well as lip augmentation.2 It has also been suggested that intramuscular injection of Botulinum toxin type A (Botox) is an effective way of preventing damage to dental hard tissues and restorations by deprogramming the muscles responsible for the destructive forces.3 But, despite the invasive nature of these procedures, injection of dermal fillers has also been deployed for facial soft-tissue augmentation.4
Unfortunately, there have been some adverse reports on injectable, nonbiodegradable fillers.5 Therefore, noninvasive, natural methods of craniofacial enhancement are preferred by Dr. Yuriy May. In additional, Dr. May has observed positive results in clinical changes that are consistent with increased craniofacial symmetry and volume, consistent with numerous publications documenting the improve facial aesthetic phenomenon as a substitute to potentially dangerous facial fillers.
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What is a dental device and how does it work?
There are many FDA approved dental sleep devices. These devices can generally be divided into the 3 categories listed below:
Mandibular Advancement Devices (MAD)
Mandibular advancement devices are by far the most common type of dental sleep device available for the treatment of snoring and Obstructive Sleep Apnea (OSA). They are also sometimes called oral appliances, or dental sleep devices. Mandibular Advancement Devices (MADs) open the airway by moving the mandible (the lower jaw) forward. The tongue is attached to the lower jaw behind the chin. As the jaw is moved forward, the collapsible part of your airway is held open by the forward movement of the tongue and other airway muscles.Mandibular Advancement Devices (MADs) also improve the strength and rigidity of the airway by increasing the muscle activity of the tongue and other muscles of the airway.
Tongue Retaining Devices (TRD)
Like MADs, Tongue Retaining Devices (TRDs) also work by holding the tongue in a forward position. These devices pull the tongue forward, but instead of moving the jaw forward like a Mandibular Advancement Device (MAD), TRDs directly control the tongue itself. In some cases Tongue Retaining Devices (TRDs) have decreased therapeutic complications compared to MADs, but TRDs can also be less comfortable and generally take several weeks or months to be worn comfortably.
Combination CPAP/Dental Sleep Device Therapy
Often the problems associated with Continuous Positive Airway Pressure (CPAP) therapy are due to high pressures and uncomfortable fit of the nose or face mask. Your Dental Sleep Solutions® dentist can work directly with your sleep physician to make a combination dental sleep device that is worn in combination with your CPAP. This custom-made dental sleep device or oral appliance will attach directly to your CPAP machine. When CPAP is combined with jaw advancement from a mandibular advancement device, the CPAP can often be used at a much lower pressure setting.
Other Invasive and High Risk Therapies
What other treatments for snoring and Obstructive Sleep Apnea (OSA) are available?
Treatment options for a patient suffering from sleep apnea include Dental Device Therapy (learn about dental device therapy here), CPAP, Surgery, Positional Therapy, and Weight Loss.
CPAP (Continuous Positive Airway Pressure)
CPAP was developed in the early 1980’s and was the first viable solution for treating the CPAP examples for treating obstructive sleep apnea insidious disease of Obstructive Sleep Apnea (OSA). Most physicians prescribe CPAP as a first treatment option, though many physicians now utilize dental devices as a first line of therapy for mild to moderate disease OSA. CPAP treatment consists of a pump that delivers positive air pressure to a mask that is fitted over the nose and/or the mouth. The air pressure is adjusted until the airway is forced open, much like blowing up a balloon.
CPAP is a very effective therapy WHEN it is used. If you’ve been diagnosed with sleep apnea and were prescribed a CPAP by your physician, you know exactly what we mean when we say WHEN it is used; compliance is the biggest challenge with this therapy. Most people find that wearing a mask and having air pushed down their throat is a challenge. The problems patients complain about from CPAP therapy are very real and often difficult, if not impossible, to overcome.
A partial list of the most common patient complaints from CPAP:
- Mask leaks
- An inability to get the mask to fit properly
- Discomfort or interrupted sleep caused by the presence of the device
- Noise from the device disturbing sleep or bed partner’s sleep
- CPAP restricted movements during sleep
- CPAP does not seem to be effective
- Pressure on the upper lip causes tooth related problems
- Latex allergy
- Claustrophobic associations
- An unconscious need to remove the CPAP apparatus at night
Do you currently use CPAP and have problems?
Here are some tips that may help you sleep more effectively while using CPAP:
Try a different CPAP mask
Masks come in many shapes and sizes. Some go over just your nose; some your nose and mouth; others simply have a small tube that fits into your nose. Sometimes switching masks can help you.
- Call the company where you purchased your CPAP
- Work with the DME (Durable Medical Equipment) company where you got your CPAP. They are experts at helping people adapt to the therapy.
- Consider adding heat / humidification
- The constant air moving through your airway and across your mucous membranes tends to dry you out; so adding humidification to your CPAP can help. Heat can also be added and can make a significant difference, especially in Northern climates and the winter time.
Ask about BiPAP
If your pressure seems to be just too much, you may want to ask your physician if a BiPAP is a possible solution. BiPAP machines have a sensor in them that adjust the pressure based on whether you are trying to inhale or exhale. The sensor lowers the pressure when you are trying to exhale and makes it easier to get air out.
Surgery
Surgery may also be a treatment option for Obstructive Sleep Apnea (OSA). The upper airway goes from your nose and mouth to the middle of your throat. The upper airway is dynamic and complex. Here is a partial list of surgeries that may be utilized to treat sleep apnea.
Surgery examples to treat obstructive sleep apnea
- Nasal septal surgery
- Turbinate reduction surgery
- Somnoplasty turbinate reduction
- Uvulopalatopharyngoplasty (UPPP)
- Partial uvulectomy/ Pillar Procedure
- CO2 laser palatoplasty (LAUP)
- Uvulopalatal flap
- Woodson Procedure (transpalatal palatopharyngoplasty)
- Somnoplasty
- Turbinate reduction
- Tongue base reduction – soft palate for snoring
- Tonsillectomy (total/ partial)
- Lingual tonsillectomy
- Tongue base reduction
- Epiglottectomy
- Epiglottoplasty
- Glossectomy (anterior vs. posterior)
- Linguoplasty (CO2)
- Tongue-base suspension sutures (Repose procedure)
- Hyoid suspension and advancement to mandible
- Hyoid myotomy and suspension to thyroid cartilage
- Expansion hyoidplasty
- Geniotubercle/genioglossus skeletal advancement (with multiple variants)
- Jaw advancement (telegnathic) surgery (LeFort I,
- Bilateral Sagittal split Advancement)
- Distraction Osteogenesis
- Maxillary transverse expansion
- Tracheostomy
- Hyoepiglottoplasty
Most surgeries are performed by Ear Nose and Throat (ENT) physicians, though Oral and Maxillofacial (OMS)surgeons are also generally able to perform surgeries to treat Obstructive Sleep Apnea. Surgery is appealing to many patients because if it works, you are usually cured. However, Surgery carries many severe and potentially life-threatening risks that should be discussed in detail with your physician so that you can evaluate the risk and reward for this treatment option. Dental devices can often be used as an initial treatment, and surgery used later if desired.
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About Dr. Yuriy May
Widely sought after for his precision and leadership in biological oral surgery and zirconia implantology, Dr. Yuriy May is recognized as an accomplished leader in metal-free, biologically driven dentistry. With over 12 years of clinical experience, his work is defined by uncompromising standards, refined surgical execution, and outcomes that support both oral and systemic health.
Dr. May holds advanced certifications and training in zirconia implantology from programs ranging from IAOCI and Tufts University, is Board Certified as a Naturopathic Dentist by the ANMCB, and is a distinguished Ceramic Implant Ambassador for SDS—an honor reserved for clinicians shaping the future of ceramic implant science.
A respected educator and international lecturer, Dr. May has presented extraordinary ceramic implant cases to dentists worldwide, including the JCCI in Switzerland, and has served as an instructor in the Ceramic Implant Program at ACIMD. He lectures nationally, publishes complex metal-free surgical cases, and serves as a Board Member of the IAOCI (International Academy of Oral Ceramic Implantology). Dr. May has recently become an Associate Fellow of the AAID (American Academy of Implant Dentistry), one of the few focusing solely on zirconia dental implants, and has been and an Accredited S.M.A.R.T. Certified member of the IAOMT for many years. He is also a Certified Biological Dentist with the IABDM, reflecting his commitment to removing root canal infections and to mercury-safe, evidence-based biological protocols.
Dr. May’s reputation, results, and excellence in ceramic implant dentistry have made him a destination provider for patients and referring clinicians seeking the highest level of ceramic implant surgery and biological dental care.
DMD, IBDM, AIAOMT, CIABDM
Associate Fellow, American Academy of Implant Dentistry
ANMCB Board Certified Naturopathic Dentist