November-December 2014 | TIRED OF THIS?

David and Diane Howard at their residence in PocomokeSteve Huston at his home in SeafordTIRED OF THIS?TIRED OF THIS?Dr. James Crouse of The Brace Place



The success stories of two patients treated for sleep-related breathing disorders with the latest in oral appliance therapy

Written By: Nick Brandi | Photographer: Grant L. Gursky

The eight-year marriage of Steve and Donna Huston has been one of uninterrupted happiness in virtually every important respect — save one. For as long as he can remember, Steve has been a chronic snorer. Donna, a ninth-grade English teacher, had always soldiered on commendably, but the continual interruptions to her sleep cycle were having a detrimental impact not only on her mood but even on her performance at work.

“Eventually, Donna told me I could come back home only after I got this taken care of,” laughed Steve in recalling his wife’s mock threat. But the fact that Donna was only joking didn’t make Steve feel much better. Besides, his snoring was affecting his sleep cycle, too, having to adjust positions throughout the night in the vain attempt to escape his unwelcome nocturnal serenades.

“I tried the sleep strips; didn’t work. I even had deviated septum surgery (not the most pleasant experience of my life), and while that did help my breathing, it didn’t cure my snoring,” said Steve, who works for Huston Appraisal Co. in Seaford as a real estate appraiser and consultant. “Finally, I went to The Brace Place and saw Dr. Crouse, who created a custom oral appliance for me — and that did the trick!”

Recently, oral appliance therapy (OAT) has exploded on the scene as an effective frontline treatment for patients with sleep-related breathing disorders such as chronic snoring or mild-to-moderate obstructive sleep apnea (OSA). For many, it represents a very welcome alternative to the bulky and restrictive continuous positive airway pressure (CPAP) machine, which increases the air pressure in the patient’s throat through a mask that is usually attached to the nose during sleep. By contrast, the small, plastic oral appliance is custom fit by a dental professional into the mouth of that specific patient — similar to a sports mouth guard or orthodontic retainer — and is worn during sleep. Oral appliances basically reposition the jaw in order to help prevent the collapse of the tongue and soft tissues in the back of the throat, thereby keeping the airway open during sleep and promoting adequate air intake.

“It took me about a week to get used to,” Steve reported, “but at no point did it ever cause me any discomfort, and now I’m barely even aware of it. Best of all, the days of my chronic snoring are over, and Donna and I are sleeping like babies.”

David Howard, meanwhile, adapted to his oral appliance the very first night. A recently retired builder, David couldn’t remember a good night’s sleep in over 30 years. And, just as with the Huston household, David’s spouse, Diane, couldn’t either. David has obstructive sleep apnea (OSA), and for the more than 18 million Americans who have it, OSA is no joke. It is, however, an extremely disruptive and potentially life-threatening condition. 

Sleep apnea occurs when tissue in the back of the throat collapses and blocks the airway, reducing the amount of oxygen delivered to all the organs, including the heart and brain. People with sleep apnea may snore loudly and stop breathing for short periods of time. When the blood-oxygen level drops low enough, the body momentarily wakes up.

This can happen hundreds of times a night, and the effects are substantial. In addition to snoring and excessive daytime sleepiness, sleep apnea can cause memory loss, morning headaches, irritability, depression, decreased sex drive and impaired concentration. Sleep apnea sufferers also have a much higher risk of stroke and heart problems, such as heart attack, congestive heart failure and hypertension. They are also more likely to be involved in an accident at the workplace or while driving.

“Sleep apnea definitely took a heavy toll on my life and my family’s lives,” David admitted. “I would never achieve REM sleep, so I never dreamed, which left me chronically fatigued and sluggish, both physically and mentally. As a result, I was less inclined to engage in productive activities with my wife, kids and grandkids. It also affected my mood and probably made me a less pleasant person to be around sometimes, which wasn’t fair to my family.”

In his desperation to get relief, David tried the CPAP machine. But for him, the clumsy apparatus just made matters worse.

“One hour is the longest consecutive period I ever slept with the CPAP on. It was so awkward and uncomfortable for me that I preferred to just put up with the sleep apnea,” said David, who used to stop breathing hundreds of times a night. “Dr. Crouse custom-made upper and lower trays for me that are connected by adjustable stainless steel rods that gently push my jaw forward, which in turn keeps my airway open while I sleep.”

And sleep he does. As a direct result of the appliance Dr. Crouse created for him, David is proud to report that he is now dreaming for the first time in three decades.

“This little device is truly amazing — as is Dr. Crouse’s entire staff, who are the nicest and most professional I’ve yet encountered,” praised David. “Diane and I are sleeping through the night, and I have more energy now than I’ve had in the last 25 years. I just wish this technology was available sooner.”

“Believe it or not, children sometimes suffer from sleep apnea, too,” advised Dr. Crouse, who is not only a member of the American Academy of Dental Sleep Medicine but also gives lectures periodically to local pediatricians on the subject. “Expanding the upper jaw creates more room for the tongue and widens the floor of the nose, which facilitates respiration and therefore uninterrupted sleep. It’s an important subject, as recent studies indicate that children who suffer from sleep apnea experience higher rates of ADHD, poorer performance on standardized IQ tests and other school-related issues. In fact, palatal expansion has been shown to have a positive or beneficial effect on bedwetting, as well.”


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