Obstructive Sleep Apnea (OSA) is the Rodney Dangerfield of medical conditions. It gets no respect, and it gets mistreated more often than it gets appropriately treated.
It's no wonder that 80% of Americans who suffer with OSA aren't being diagnosed. And the 20% who are diagnosed are more likely than not to be shoved in a one-size-fits-all box they're not meant to fit in.
The current standard of care for OSA patients is a one-size-fits-none approach. There is typically three different scenarios that someone with OSA experiences.
- Someone who potentially has OSA walks into a sleep center, they will be walking out with a CPAP machine...guaranteed.
- Someone who potentially has OSA walks into a dental sleep practice, there is a high probability they will be walking out with an oral appliance.
- Someone who potentially has OSA walks into a typical ENT practice, they will be walking out with a head buzzing full of information, and a body still suffering with a broken airway.
The reality for all these patients is that their throats are too narrow for their bodies. 70-80% of these same patients have noses that aren't adequately patent during sleep.
No oral appliance or CPAP machine can work properly and efficiently without a well-functioning nose. Yet, how many dental sleep and sleep med docs properly evaluate and correct nasal airway obstruction prior to placing a patient into a treatment modality?
I think we all know the true answer...
None!
Why is this?
OSA is an ENT issue that is almost never adequately addressed by an ENT. For reasons having to do with medical turf battles and ENT apathy, OSA has been almost abandoned by the ENT community at large.
Who suffers because of this? The patients who are being sent down a one-way street to frustration and failure.
Sleep Apnea: A Ticking Time Bomb
To put it bluntly: if a patient is tossed an oral appliance or CPAP machine and wished, "good luck," they either learn to live with the frustration of the device or the misery of their OSA. With a malfunctioning nasal airway, they are destined to fail. This is a band-aid approach, not a root cause solution. What's worse, patients are left feeling dismissed and hopeless. Like they're the failure.
But there's something even bigger at play here. Bigger than quality of life issues - I'm talking about years of life left to live. Every time you brush off another patient by providing them a remedy not primed for success, you're nudging them one step closer to detonation. Because as we all know, OSA is like a ticking time bomb.
Every mistreated case is one more daughter who loses her father to a heart attack before he gets to walk her down the aisle.
It's one more grandchild who will never know his grandmother because she died from a stroke before he was born.
It's one more parent who loses their battle with diabetes before their kids even graduate from high school.
Tick. We're failing our patients.
Tick. They're paying the price.
Tick. Because the solution is all too often doomed to fail.
Millions of people are suffering and dying from OSA and its comorbidities, but dental sleep, sleep med, and ENTs are so caught up in their own ways of thinking that they've got blinders on. They're unwilling to give up a little ground in order to bring to light a better way.
Opening Up The ENT Toolbox
At ADVENT, a practice I founded in 2004, we've pioneered a much different model than the typical ENT practice that you grew up with. In fact, throat surgery is what we do the least. Our paradigm starts with getting the nose working properly first, most often with simple, in-office procedures. Only then do we clear a patient to move into an oral appliance or other OSA treatment.
We've made a shift. We approach OSA more holistically on behalf of our patients, together. Rather than treating a singular part of the issue - the collapsing airway - with our limited resources, we instead focus on solving the upstream issue, the obstructed nose, prior to treating the throat issue. It really is simple, we focus on healing our patients.
Until sleep centers, sleep dentists, and typical ENTs acknowledge the limitations of the tools in their toolboxes, they will continue to fail…and the patients will continue to feel the brunt of it.
This is not to say that oral appliances and CPAPs never work - don't write them off at all. It's just that they're working against an issue that remains often unidentified and massively untreated. You cannot address an airway problem downstream with an oral appliance or CPAP if upstream the airway is restricted.
The bottom line is this: oral appliances cannot work adequately if nasal airway obstruction is not addressed first. Solutions must be built around addressing the anatomical problems at multiple levels.
It must be our mission to treat OSA in a way that works for the patient. Appliances can be a highly effective solution when coupled with a properly working nose. Let's use our power together to change the trajectory of this highly mistreated disease and deliver an undeniable improved quality of life to the people that desperately need it.