An increasingly popular sleep solution, mandibular advancement devices (MAD) have become a focal point of discussion and research. MAD has emerged not merely as a remedy for snoring but as a transformative tool for those grappling with sleep apnoea and respiratory-related sleep disorders. Moreover, the role of MAD in addressing positional Obstructive Sleep Apnoea (OSA), a subtype of sleep apnoea, has garnered particular attention. The versatility of MAD in adapting to various sleep positions provides a flexible and effective solution for a diverse range of sleep apnoea presentations. This extensive exploration delves deeper into the multifaceted components of MAD, providing a comprehensive understanding of its significance, intricate functionality, and the myriad of benefits it brings to the elusive quest for a peaceful night’s sleep.
Why choose MAD?
The rising prevalence of sleep apnoea brings hindrance over the quality of sleep for many, making Mandibular Advancement Devices a beacon of hope. Offering simplicity and efficacy, MAD is the preferred choice for its non-invasive nature. The device subtly repositions the lower jaw and tongue forward, creating additional airspace in the throat. This not only mitigates snoring but also significantly improves airflow, promising not just better sleep but also potential enhancements to overall health.
Studies have shown the five-year treatment success rates of MAD at 52% overall, with the greatest benefit seen in patients suffering with moderate-severe sleep apnoea. However, the effectiveness of MAD seems to decrease over time, for example from 79% at 3-6 months to 68% after 2 years. The study concluded that long term MAD remained effective in the majority of patients, with good levels of patient satisfaction and adherence. Additionally, research shows that using MAD can result in significant reduction in the Apnoea-Hypopnea Index (AHI), a key metric in diagnosing sleep apnoea.
How does MAD work?
Consider a device resembling a mouthguard yet possessing the potential to revolutionise your sleep quality. MAD creates gentle adjustments of the lower jaw and tongue, ensuring the airway remains open during sleep, addressing the root causes of snoring and sleep apnoea. Research shows that MAD improves upper airway collapsibility during sleep, reducing the likelihood of apnoea’s (periods when your breathing stops) and hypopneas (periods when your breathing is reduced). It also enlarges the pharyngeal airway, leading to improved respiratory function during sleep. Far from a one-dimensional solution, this subtle alteration has far reaching implications for sleep quality, presenting a gateway to a myriad of health benefits.
Using MAD at night
Ease of use contributes significantly to MAD’s allure. Inserted into the mouth before bedtime, the device secures a snug, comfortable fit. With adjustable features, users tailor the device to find the optimal jaw position, ensuring maximum effectiveness. Throughout the night, MAD works diligently, enabling an undisturbed sleep experience free from the disruptive sounds associated with sleep apnoea.
Clinical trials have demonstrated that patients using MAD experienced a significant reduction in snoring intensity, leading to improved sleep quality for both the individual and their sleep partner. This highlights not only the individual benefits of MAD but also its positive impact on the sleep environment.
Determining the need for MAD
Recognition of the need for a Mandibular Advancement Device often starts with understanding one’s sleep patterns. Loud snoring, choking, or gasping sounds, coupled with excessive daytime sleepiness, are all tell-tale signs of sleep apnoea. The next crucial step is a comprehensive sleep study, which can be conducted in sleep clinics or using portable devices at home. These studies diagnose sleep disorders, guiding individuals towards the most suitable treatment, potentially including the adoption of MAD.
According to the Sleep Apnoea Trust, as many as 10 million people in the UK suffer from the most common form of sleep-apnoea called Obstructive Sleep Apnoea (OSA) – with up to four million of these suffering either severely or moderately. Despite this, many cases of sleep apnoea remain undiagnosed. Incorporating MAD into diagnostic and treatment strategies can significantly help impact the management of sleep apnoea on a broader scale.
Alternative options to MAD
While MAD stands out as a popular choice, alternative options cater to different preferences and needs. Tongue retainers, for example, work by securing the tongue in place, preventing it from falling back and obstructing the airway. This can be particularly beneficial for individuals whose tongue position significantly contributes to their sleep apnoea. Choosing between a tongue retainer and a Mandibular Advancement Device involves weighing up pros and cons based on individual needs. Tongue retainers are non-invasive, easy to maintain, and less bulky but may be less effective for complex sleep apnoea cases. MADs, while potentially more effective for most sleep apnoeas, may require an adjustment period and regular cleaning. Personal preferences and the severity of the sleep disorder play a pivotal role in deciding the most suitable option, underlining the importance of consulting with a healthcare professional before coming to a decision.
Another alternative is a Continuous Positive Airway Pressure (CPAP) machine. CPAP is a simple machine that blows air through a mask you wear at night. It’s designed to hold your airway open while you’re asleep. It sends air at pressure into your upper airway to stop it collapsing. CPAP machines, though effective, can be bulky and uncomfortable for some users. MAD, with its unobstructive design and ease of use, presents a more favourable choice for those seeking comfort without compromising effectiveness. Whilst CPAP has shown to be more effective at reducing sleep apnoea, an increasing number of studies suggest fairly similar outcomes in terms of symptoms and cardiovascular health as a result of these treatments. These findings, coupled with the higher compliance seen with MAD, positions it as a viable and more tolerable alternative for those seeking effective yet user-friendly interventions.
Benefits of MAD: Beyond Sleep Improvement
Mandibular Advancement Devices are revered not only for their effectiveness in addressing sleep-related issues but also for their extensive range of benefits they bestow upon users. Beyond ushering patients into a restful night’s sleep, MAD contributes to holistic well-being and elevates various aspects of physical and mental health.
- Cardiovascular Health: Research underscores the positive impact of MAD on cardiovascular health. This is because Obstructive Sleep Apnoea is associated with high blood pressure. Therefore, by addressing sleep apnoea with MAD, studies show that patients experience reduced nocturnal blood pressure, consequently reducing the risk of hypertension and related cardiovascular disease.
- Improved Respiratory Function: Beyond its primary role in addressing sleep apnoea, MAD has been observed to improve overall respiratory function, having positive implications for individuals with respiratory conditions beyond just sleep apnoea.
- Daytime Alertness and Cognitive Function: The unobstructed flow of oxygen by MAD during sleep not only promotes night-time alertness but extends its benefits into waking hours. Users commonly report increased daytime alertness and cognitive function. Improved oxygenation of the brain leads to enhanced mental clarity, concentration, and overall cognitive performance. This can be of particular importance to patients who need to be fully alert for work, such as heavy goods vehicle operators.
- Mental and Emotional Well-Being: The profound impact of consistent, quality sleep on mental and emotional well-being is well documented. By mitigating sleep apnoea symptoms, MAD positively influences emotional resilience and mental health. Research suggests that addressing sleep disturbances can contribute to a reduction in symptoms of anxiety and depression, promoting an emotionally balanced and resilient state.
- Enhanced Intimacy and Relationships: Sleep apnoea can strain intimate relationships due to disruptive snoring and sleep disturbances. MAD therapy not only improves the sleep quality of the individual but also contributes to a more harmonious sleep environment. The resulting reduction in disruptive snoring can lead to improved sleep for both the individual and their sleep partner, fostering a positive impact on relationships.
Choosing the right MAD
In conclusion, Mandibular Advancement Devices provide an effective alternative to CPAP and other traditional methods of treatment for sleep apnoea and snoring; they represent a gateway to a healthier, more rejuvenated self. However, it is important to note that there is a diverse landscape of sleeping aids, apart from MAD, from tongue retainers to CPAP machines. The simplicity, comfort, and proven efficacy of Mandibular Advancement Devices stand as a compelling choice though it is important to recognise that the journey to better sleep is unique for each individual and the variety of options available encourages patients to explore different solutions to see what works best for them and their needs. As sleep science continues to unravel the mysteries of our nightly rest, Mandibular Advancement Devices stand as a testament to the potential of merging technological innovation with holistic health approaches. The future promises further refinements and advancements in MAD technology, ensuring a personalised and effective solution for each individual’s unique sleep needs.
I advise all readers to consult with a qualified healthcare professional to discuss their options before diving into the world of Mandibular Advancement Devices. MADs are not a one-size-fits all, and a personalised approach ensures optimal comfort and efficacy. Healthcare providers may recommend custom-fitted devices to meet individual needs, to optimise effectiveness and minimise side effects.
Do you think you need a MAD?
Sleep apnoea can profoundly affect physical and mental well-being in many ways. It is important to contact your GP and the right specialists if you are struggling with your sleep or breathing. In severe cases, sleep apnoea can also lead to life-threatening conditions. It is important to ensure that the correct type is diagnosed as soon as possible to start the right treatment.
As a leading sleep and respiratory physician specialising in sleep apnoea and sleep-related breathing disorders, I offer consultations to diagnose and treat these conditions including providing CPAP and MADs. Please contact me if you have any further queries about MADs or want further advice on the potential treatments available.
