I have written extensively on this blog and my main website that there is no single surgery for sleep apnea and snoring.  The recurring theme is that different treatments work differently in different patients, meaning that a cookie-cutter approach to sleep apnea surgery is doomed to failure.  Even with our best efforts to apply this personalized medicine philosophy, surgery is by no means universally successful.  Because of my focus in surgery for sleep apnea and snoring, I see a large number of patients that have not achieved the desired results after surgery–whether performed by other surgeons or me.

While many physicians tend to shy away from those with bad results because they make us feel bad, a long time ago I saw that my mentors had patients with suboptimal outcomes returning to their office more often than the happiest patients.  If I want to do everything possible to help patients, I want to understand why some do not have success with sleep apnea surgery so that I can improve results in those patients and others that I will treat in the future.  My evaluation for patients with poor results after previous surgery often includes drug-induced sleep endoscopy, and I have performed research showing that it can be a valuable technique to evaluate patients who have not responded to previous surgery for sleep apnea.

DISE: not just for sleep apnea surgery

In the August 2015 issue of the medical journal Otolaryngology–Head and Neck Surgery, an article describes the role of drug-induced sleep endoscopy in patients who have not achieved success with the use of oral appliances (the type known as mandibular repositioning appliances or mandibular advancement devices).  The study was performed at the University of Pittsburgh and written by Drs. David Kent, Ryan Soose, and Robert Rogers.  I am particularly proud that Dr. Kent wrote such an interesting study, as he is one of our current fellows in Sleep Medicine at the Keck School of Medicine of USC.

In short, there are many reasons that oral appliances for sleep apnea may not work well for a patient, and drug-induced sleep endoscopy is one technique that can be useful in the search for an explanation why.  This study showed that the most common reasons that patients did not achieve success include blockage of breathing related to the soft palate and epiglottis.  In some cases, the sleep endoscopy led to adjustment of the oral appliance.  Overall, drug-induced sleep endoscopy led to recommendations that improved the treatment of sleep apnea in these patients.  This certainly agrees with my experience, in that I can combine a variety of interventions–for example, surgery and an oral appliance–to achieve success in treating sleep apnea.

The bottom line: if your oral appliance for sleep apnea is not working, find someone who can help

The most important conclusion is that if an oral appliance for sleep apnea or snoring is not working, do not give up.  The same is true for patients who have received positive airway pressure therapy (like CPAP or BiPAP) and for those who have undergone surgery.  Find someone who can evaluate you (whether with drug-induced sleep endoscopy or some other approach) and who does not accept suboptimal results.  I have been drawn to this field because good sleep is important for your health and getting the most out of life.  If you suffer from sleep apnea, don’t settle for anything less.


0 thoughts on “Is your oral appliance for sleep apnea not working?

  • Anita McMillen says:

    I suffer from severe claustrophobia from a childhood event, and can not tolerate my face being touched. Crap proved to be intolerable, and my mandibular repositioning device fails to stay in place during sleep. I have bounced back and forth from ENT to allergist and back, with frustrating conflicting options and failed results. My sleep doctor thinks I need sinus surgery. My ENT feels I would not have good results. I am petrified of even considering it. I am obese (5’4”), but watching my weight and slowly losing. Is there a procedure that does not involve surgery of the sinuses or soft palate?

    • Dr. Kezirian says:

      There is a wide range of procedures, but the key is what would be best for you (and how well it would work). Likely weight loss would be important if you are truly obese, but you should discuss these with a surgeon who fouses in sleep surgery. I would be happy to schedule a telemedicine visit (covered by medical insurance if you are in California) to discuss your options.

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