Managing snoring and obstructive sleep apnoea

John O’Brien presents four case studies of patients whose lives have been transformed with the help of the mandibular snoring inhibitor

I am a dentist and a strong devotee of the mandibular snoring inhibitor (MSI) appliance for management of snoring and in carefully selected cases, obstructive sleep apnoea. The MSI is a durable snoring appliance with an outstanding track record.

I have been involved in the relatively new area of sleep medicine for 20 years, and as a clinician with experience in a dedicated dental sleep medicine practice, I constantly check for new designs of oral appliances. With the MSI, I am confident I’m using the best appliance in the field.

What does the MSI provide for patients and clinicians?

The MSI appliance combines comfort, durability and effectiveness. Its soft lining increases patient comfort and allows for continuing accuracy of fit with mild to moderate alteration of tooth shape due to placement of new fillings or other dental restorations.

Effectiveness of the MSI over other appliances is partly due to the fact the jaw is maintained in an advanced, but also importantly, a near closed position that, in my view, makes this appliance more than 95% effective.

MSI’s success is in the detail

The MSI has the following features:

• Durability: designed to withstand severe bruxism with three bar hook support and robust construction
• Predictable first time fit: in most cases, even without a fully protruded bite, the 11mm of adjustment will compensate
• Outstanding performance: considerable amount of additional adjustment available, built to last, all parts individually replaceable and a two-year warranty
• Hygiene: simple to clean – all parts are accessible; gold-plated, anti-plaque surfaces
• Comfort: lateral/excursive movement provision, separable upper and lower while in the mouth, dry mouth compatible, low/slim profile, no cheek irritation from linkage arms and soft inner lining
• Ease of use: the patient is able to adjust the MSI safely, to maximise performance and comfort
• Uncomplicated design: less production time and predictable quality
• Dedicated bite register: minimal returns and reworks.

Case studies

Here are four heart-warming stories of patients whose lives have been transformed by wearing the MSI.

Mary: the woman who no longer went to the theatre or cinema

Mary was a 55-year-old woman referred to me by her dentist after she had fallen asleep and snored during root treatment. Mary had been evaluated by a sleep physician and found to have moderate to severe obstructive sleep apnoea.

She loved going to the theatre and cinema, but would no longer go as she was guaranteed to fall asleep and, worse still, start snoring loudly.

She had been given a C-PAP unit, but could sleep for no more than two hours with it, and would always remove it in the early hours of the morning.

She reported that falling asleep at the dentist was nothing new for her and she constantly felt exhausted. For fear of falling asleep at the wheel, she avoided driving in the late afternoon or later. She would also occasionally fall asleep in the middle of a conversation.

Having had a mandibular advancement device fitted, she called one week later to tell me she had been to the theatre on three separate nights and had never even thought about sleep. She felt she had her life back.

Mary had a review with her sleep physician and her sleep study showed that the appliance, as well as controlling her snoring, had virtually eliminated her obstructive sleep apnoea.

Andrew and Maeve: the couple who had not shared a bedroom in 12 years

Andrew and his wife of 15 years, Maeve, attended one of my practices having read an article I had written in a local newspaper about treating snoring with oral appliances.

Andrew was an extremely loud snorer, but did not have obstructive sleep apnoea. As his wife could not sleep with the very loud snoring, Andrew and Maeve slept in separate bedrooms.

When they went on holidays, they had to book separate hotel rooms and rarely went away; partly due to the added expense, but more due to the fact that being on holiday in separate rooms did not appeal to them.

Andrew had tried every snoring remedy on the market with very little benefit. Both were very frustrated with the situation and stated it had seriously affected their marriage.

Their marriage was on the verge of collapse, but agreed having read about oral devices on the internet that maybe I had the answer, although after so long they were sceptical anything could help them.

Andrew said if I could stop his snoring, he would book a holiday for the two of them. I said this was a good idea, but to wait for one month after the appliance was fitted to allow him time to fully adjust.

Andrew’s appliance was fitted, and a month later they went away for a week’s holiday. They were able to share a room for the first time in years as the appliance was, as Maeve put it, a miracle. Although he had always considered himself to be a good sleeper and did not feel he had daytime sleepiness, Andrew noted that his sleep was much improved with his appliance and now woke much more refreshed than previously.

John: too embarrassed to sleep on transcontinental flights

John, a 42-year-old company executive, did a lot of flying as part of his job. On average, he made 10 long-haul flights per year. As he needed to attend meetings often within hours of touching down after an overnight flight, his company paid for him to have a first-class sleeper where available.

He had only used a sleeper once because when he did, he was woken by the flight attendant and the other passengers – nobody else could sleep with his snoring.

He was checked for obstructive sleep apnoea and was found to be simply a snorer with no apnoea.

The day after I fit an appliance, John departed for a week’s holiday with his wife.

They had booked separate hotel rooms as a precaution, but he texted me to say he was able to cancel the booking for the second room after the first night because his wife told him there was no snoring whatsoever.

As John said at his review appointment, being able to cancel the second room paid for his appliance. He looked forward to returning to first-class flights thereafter and attending his business meetings refreshed.

Tony: the man who no one wanted to share a room with

Tony was a very fit 36-year-old, yet had always snored very loudly. He did not have obstructive sleep apnoea.

Once a year, he went away with a group of friends on a week’s golfing holiday. There was a standing joke that none of the others would share with Tony or Gerry – another regular on the annual trip – as both were extreme snorers. Tony and Gerry were always expected to share a room due to their snoring.

Tony had an appliance fitted by me a few months before their trip and, during his appointment, mentioned he did not want to share a room with Gerry.

During the trip, Gerry was intrigued to find that Tony could sleep soundly even after a few drinks, with no more than a very faint snoring noise.

A week after his return, and on the urging of his wife, Gerry attended my clinic to have an oral appliance made for himself – another marriage improved thanks to the MSI!

About the author

John O’Brien has practices confined to oral and facial pain management, and management of snoring and sleep apnoea in Dublin, Galway and Portlaoise. He also practises general dentistry at the Novara Dental Clinic in Bray.

Designed by product developer and dental technician Phil Chapman, the MSI is available from DB Orthodontics. For more information on the benefits of becoming a provider of the appliance, contact DB Orthodontics on +44 (0) 1535 656 999, email sales@dbortho.com or visit www.dbortho.com.