Patent Application
20140076335
1. Field of the Invention
This invention relates generally to an apparatus for optimizing the effectiveness of positive airway pressure devices used in the treatment of obstructive sleep apnea in human beings, and more particularly to a structure which reduces air leakage through the mouth, thereby permitting reduction of the required air pressure applied to the user.
2. Prior Art
Sleep apnea occurs when a person momentarily stops breathing or has diminished breathing during sleep. The severity of sleep apnea can vary depending on the frequency that breathing actually stops or slows. In general, the pause in breathing may last from seconds to minutes and can occur up to 30 times or more an hour.
One common type of sleep apnea, called obstructive sleep apnea (OSA), is the result of blocked airflow during sleep. Such blockages can result from narrowing in the pharyngeal airway arising from natural muscle relaxation during sleep. Anatomical factors such as obesity can also contribute to OSA due to the low muscle tone around the airway. This reduces oxygen in the blood and causes loud snoring and arousal from sleep. In some cases, severe sleep apnea can present serious risk of injury arising from interrupted oxygen supply to the body.
Conventional treatments of sleep apnea involve lifestyle changes such as avoiding alcohol or muscle relaxants, losing weight, and quitting smoking. It is also known that maintaining the lower jaw forward and allowing the tongue to maintain a forward position will further reduce the obstruction of the pharyngeal airway. However, for those unable to pursue the conventional methods of treatment, medical therapies have been developed to protect patients suffering from sleep apnea from the interrupted breathing process.
One such therapy is positive airway pressure (PAP), or continuous positive airway pressure (CPAP) therapy. PAP therapy uses a device to deliver a stream of compressed air to the nose of a patient afflicted with OSA to reduce any collapse of the pharyngeal airway when the patient inhales. In effect, this pressurized air provides a pneumatic splint to the airway, thereby keeping it open for unobstructed breathing.
A common PAP device features a mask which covers the nose and is referred to as a nasal CPAP or NCPAP. NCPAP is an effective non-surgical treatment for OSA and has found broad application. For some patients, improvement in the quality of sleep and quality of life resulting from NCPAP therapy can be noticed after a single night.
However, one of the problems encountered in the use of existing NCPAP devices is the escape of air through the oral cavity of the patient, reducing the pressure in the user's airways and, consequently allowing the muscles and soft tissue to relax and again obstruct the airway and greatly reducing the effectiveness of the device. Maintaining an effective pressure throughout the night while the patient is asleep is the key to relief of OSA, and the lose of air pressure through the mouth is a predominant problem. The need to seal the oral cavity and reduce blockage of the airway is more then evident.
Prior art has shown many attempts in the art of oral devices. U.S. Pat. No. 5,752,822 to Robson teaches a dental orthotic for positioning the tongue in a forward position. The device rests in the users mouth and provides a means for elevating the tongue from its natural resting position to allow the tongue to move forward and therefor reduce blockage of pharyngeal airway. The device to Robson however, does not provide a means for sealing the oral cavity of the user as may be desired with the employment of NCPAP machines.
U.S. Pat. No. 5,467,783 to Meade teaches a dental orthotic device for preventing backward movement of the lower jaw. However the device does not provide a means for maintaining the tongue in a substantially forward position nor provide a substantial seal of the oral cavity.
These and similar devices fall short in providing adequate reduction in airway obstruction by sealing the oral cavity, maintaining the lower jaw in a substantially forward position, and allowing the tongue to passively maintain a forward position.
As such, there is a continuing and unmet need for a dental orthotic device that can maintain the lower jaw and tongue at a substantially forward position while concurrently sealing the oral cavity. Such a device should additionally accommodate the lateral width of the tongue without constricting the tongue or restricting the natural resting position the tongue when the device is in the as used position.
The forgoing examples of related art and limitation related therewith are intended to be illustrative and not exclusive, and they do not imply any limitations on the invention described and claimed herein. Various limitations of the related art will become apparent to those skilled in the art upon a reading and understanding of the specification below and the accompanying drawings.
The device herein disclosed and described provides a solution to the shortcomings in prior art and achieves the above noted goals through the provision of an intra-oral appliance as a means for preventing or significantly reducing the escape of air through the user's mouth provided during NCPAP therapy.
Use of the device by the user is passive so that it continues to function effectively even while the user is asleep. By reducing air leakage via the mouth, the amount of positive pressure required to maintain an effective pneumatic splint may also be reduced.
As a secondary benefit resulting the provided reduction in applied air pressure, employment of the device herein also reduces the amount of air leaking around the seal of the mask, further enhancing the effectiveness and stability of the PAP therapy process. Further utility is found in that the PAP machine can function effectively at a lower applied air pressure, thereby being quieter and using less energy.
In a particularly preferred mode, the device includes an oral appliance which is fitted to the teeth of a patient in such a manner as to urge the jaw into a slightly forward or protruding position. The oral device is provided with an integral, central tongue receiving portion which receives the tongue of the patient in a substantially forward position. The oral appliance is closely fitted to the anatomy of the teeth, gums, and tongue of the user to provide a means for sealing the oral cavity when it is in place.
The positioning of the tongue in the tongue receiving portion in the forward position provides a means for achieving an unimpeded airflow through the pharyngeal airway with no active participation required of the patient. Once the seal is obtained, the patient can simply relax and fall asleep while the PAP process continues throughout the period of sleep.
The mouth seal device generally includes an upper U-shaped cavity portion for engaging the maxillary teeth, and a lower U-shaped cavity portion for engaging the mandibular teeth. The upper and lower portions are preferably disposed at a predetermined angle as a means for holding the user's mouth slightly open and to provide a tongue passage between the maxillary and mandibular incisors. In a first preferred mode the tongue passage includes a cavity portion having a first open end extending from a location inside the users mouth adjacent the incisors to a closed terminating end wall located substantially exterior the users mouth. The provision of the passage provides great advantage over prior art in that the tongue can be passively maintained at a substantially forward position insomuch as being outside the mouth of the user. Maintaining the tongue in this position is additionally enhanced when a positive air pressure is applied such as during NCPAP therapy.
In another preferred mode however the tongue receiving portion includes a substantially central planar member providing a means for cradling the tongue. In this mode the planar member provides a means for maintaining the tongue at a forward position while concurrently sealing the oral cavity. However this mode may or may not provide a means for maintaining the tongue in a position substantially exterior the users mouth.
The device may be constructed from a variety of materials commonly used in dentistry. In a particularly preferred method of construction of the invention, the device is customized for an individual user by a qualified dental professional by molding impressions of the teeth and recording the bite position in a conventional manner. A dental laboratory then fabricates the device based on the data provided by the dental professional using a soft acrylic or silicone material which provides a comfortable feel to the patient and which may be readily cleaned or sterilized between usages.
In yet another particularly preferred method, pre-fabricated impression trays can be provided in a variety of sizes and shapes. A qualified dental professional selects the one which best fits the user's mouth anatomy. This is also a conventional impression procedure where the dental professional prepares a customized version of the mouth seal using this tray to mold the impressions of the teeth and actual tongue shape of the patient. The height of the side walls of the tray is selected to ensure the mouth seal produced using the form has sufficient coverage of the teeth and gums to prevent air flow around its periphery.
A thermally responsive material is placed in the tray and the entire tray with liner is submerged in hot water so the liner softens. When placed in the mouth of the patient and the patient bites down, the liner then directly forms to and around the patient's teeth and gums. This process is commonly referred to as the ‘boil-and-bite’ process. When cooled, the liner material is set, retaining an impression of the patient's teeth and mouth and allows for subsequent routine placement into the mouth
In an additionally preferred method employing the boil-and-bite process, the tongue receiving cavity of the device additionally includes this aforementioned thermally responsive material. In this manner the user may additionally form the tongue receiving cavity to a specified depth and geometry. Added utility and advantage over prior art is found in that the boil-and-bite process is conventionally employed only with the teeth receiving portions of such dental orthotics and not so with tongue related portions. A user is essentially provided with unlimited ability to customize the fit and feel of the device within their mouth.
In another method for forming the invention, the mouth seal is fabricated directly in the mouth of the patient using a two part putty that hardens in a short period of time upon mixing of the two parts. A quantity of the putty is prepared and the hardening process is initiated by mixing the two parts together. That mixture is then placed into the impression tray, again in a conventional procedure. The entire form with putty is placed into the mouth of the patient, the teeth and tongue positioned appropriately, with the tongue forward to form the cradle, and the assembly allowed to harden. Once the putty has become firm, the entire assembly is removed from the patient's mount and excess material making up the form is removed by processes such as cutting, grinding, or sanding.
In application with a user undergoing PAP therapy, an oral formed according to one of the methods described above is engaged into the mouth of the user, typically directly by the user and the PAP process is started. The pressurized air provided by the PAP equipment will provide a means for enhancing the seal of the device in the users mouth and will additionally aid in maintain the tongue in the forward position in the tongue receiving portion of the device.
With respect to the above description, before explaining at least one preferred embodiment of the herein disclosed invention in detail, it is to be understood that the invention is not limited in its application to the details of construction and to the arrangement of the components in the following description or illustrated in the drawings. The invention herein described is capable of other embodiments and of being practiced and carried out in various ways which will be obvious to those skilled in the art. Also, it is to be understood that the phraseology and terminology employed herein are for the purpose of description and should not be regarded as limiting.
As such, those skilled in the art will appreciate that the conception upon which this disclosure is based may readily be utilized as a basis for designing of other structures, methods and systems for carrying out the several purposes of the present disclosed device. It is important, therefore, that the claims be regarded as including such equivalent construction and methodology insofar as they do not depart from the spirit and scope of the present invention.
As used in the claims to describe the various inventive aspects and embodiments, “comprising” means including, but not limited to, whatever follows the word “comprising”. Thus, use of the term “comprising” indicates that the listed elements are required or mandatory, but that other elements are optional and may or may not be present. By “consisting of” is meant including, and limited to, whatever follows the phrase “consisting of”. Thus, the phrase “consisting of” indicates that the listed elements are required or mandatory, and that no other elements may be present. By “consisting essentially of” is meant including any elements listed after the phrase, and limited to other elements that do not interfere with or contribute to the activity or action specified in the disclosure for the listed elements. Thus, the phrase “consisting essentially of” indicates that the listed elements are required or mandatory, but that other elements are optional and may or may not be present depending upon whether or not they affect the activity or action of the listed elements.
It is an object of the invention to provide a mouth seal device for concurrent employment in combination with a PAP therapy device as a means for sealing the oral cavity of a user while concurrently providing a means for maintaining the tongue and lower jaw at a substantially forward position.
It is another object of the invention to provide a mouth seal device sealing the oral cavity of a user while concurrently providing a means for maintaining the lower jaw at a substantially forward position and passively maintaining the tongue at a forward position substantially exterior the users mouth.
It is yet another object of the invention to provide a mouth seal device that is custom formed to the users teeth and tongue via the conventional boil-and-bite process described above.
These and other objects, features, and advantages of the invention will be brought out in the following part of the specification, wherein detailed description is for the purpose of fully disclosing the invention without placing limitations thereon.
The accompanying drawings, which are incorporated herein and form a part of the specification, illustrate some, but not the only or exclusive, examples of embodiments and/or features. It is intended that the embodiments and figures disclosed herein are to be considered illustrative rather than limiting. In the drawings:
Now referring to drawings in
It is one of the objects of the present invention to provide a means for sealing the oral cavity of a user undergoing PAP therapy. Shown in
The oral appliance device 10 in accordance with a particularly preferred mode of this invention may be constructed from a variety of materials commonly used in dentistry. In one particularly preferred method of construction of the invention, the device 10 is customized for an individual user by a qualified dental practitioner by molding impressions of the teeth and tongue and recording the bite position and tongue geometry as is conventionally known in the art. The device 10 is the fabricated based on the data provided by the practitioner using a soft acrylic or silicone material which provides a comfortable feel to the patient and which may be readily cleaned or sterilized between usages.
A more detailed description this and other preferred methods of construction of the device 10 will be set forth later in this disclosure. Briefly, other preferred methods of construction include the conventional boil-and-bite technique wherein a thermally responsive material such as ethylene-vinyl acetate, or other material known in the art, such as the commercially available ThermAcryl®, is employed to allow the user to mold impressions themselves.
The device 10 includes and upper cavity 12 and lower cavity 18. The cavities 12, 18 are generally U-shaped and are intended to engage and conform to the maxillary 110 and mandibular 112 teeth of the respective dental arches of a user in the as used position. The upper cavity 12 and lower cavity 18 include forward sidewalls 14, 20 and rearward sidewalls 16, 22 respectively extending therefrom which provide a means for sealing the periphery of the mouth of the user, and is discussed in more detail below.
As a further note the terms ‘forward’ and ‘rearward’, ‘front’, ‘rear’, ‘right’ and ‘left’ refer herein to the anatomical directions. The use of these terms with various components should therefor be easily understood by a person skilled in the art as related to orientation, direction, and disposition.
As can be seen clearly in the side view of
There is included a tongue receiving cavity 24 communicating axially between the upper cavity 12 and lower cavity 18 within the body of the device, as can be seen more clearly in the rear view of
In the as worn position of the device 10 in the current disclosed preferred mode, the endwall 28 will be disposed substantially forward the U-shaped cavities 12, 18 such as to allow the tip of the tongue to be passively positioned up to the endwall 28 and therefor outside of the mouth 108, when the user is asleep and employing NCPAP therapy. The endwall 28 generally conforms to the curvature and contour of the human tongue as to comfortably receive the tongue in a rested position.
However, in other modes of the device 10, it may be preferred that the endwall 28 is substantially inline with the forward walls 14, 20 of the upper 12 and lower 18 cavities respectively, as opposed to substantially forward the cavities 12, 18 as shown. This would allow the tongue to still maintain a substantially forward position from its relaxed position with the tip of the tongue behind the lower dental arch but not outside the mouth 108.
As such it must be noted that the forward position of the endwall 28 may be further or closer to the forward walls 14, 20 depending on a particular users needs and should therefor not be considered limiting by the depictions. However again noting it is particularly preferred that the endwall 28 extends substantially forward of the cavity portions 12, 18 to allow the user to maintain the tongue 118 in a forward position outside of the users mouth 108. Further, as will be set forth later in this disclosure, the endwall 28 of the cavity 24 can be custom fitted to a users tongue geometry for improved fit and comfort.
Shown in the top and bottom views of
In the as used position of the device 10 shown previously in
This, along with the achieved forward position of the tongue 118 in the receiving cavity 24 significantly reduces or at least partially blocks the flow of air around the periphery of the seal provided by the forward walls 14, 20, wherein such a seal is most preferred with concurrent employment of NCPAP therapy.
In use, the current mode of the device 10 allows the user to position their tongue 118 at a substantially forward position such as to allows the tip 119 of the tongue 118 to engage the rear side of the incisors 111. There is shown a substantial gap 17 located between the left and right sides of the rearward wall 16 of the upper cavity 12 that allows the tongue to extend to such a forward position.
The disclosed preferred modes of the present invention have been shown to significantly seal the oral cavity of a user as is desired with employment of an NCPAP device. Those skilled in the art will appreciate various methods for constructing or forming the device 10, however below are provided a few particularly preferred methods of forming such a mouth seal device 10 in accordance with the above noted preferred modes.
As previously stated, in one particularly preferred method of construction of the present invention, the device 10 is customized for an individual user by a dental practitioner by conventional means of molding impressions of the teeth and recording the bite position. The device 10 may then be fabricated based on the data provided using a soft acrylic or silicone material, or other suitable material known in the art which provides a comfortable fit and feel to the patient and which may be readily cleaned or sterilized between usages.
As an alternative to the method described above, an additional preferred method of forming the device includes providing pre-fabricated mouth seal impression trays in a variety of sizes and shapes. In this current method a practitioner selects the one which best fits the user's mouth anatomy. This is also a conventional impression procedure where the dentist prepares a customized version of the mouth seal device 10 using this tray to mold the impressions of the teeth and actual tongue shape of the patient. The height of the side walls of the tray is selected to ensure the mouth seal produced using the form has sufficient coverage of the teeth and gums to prevent air flow around its periphery of the oral cavity.
A liner employing thermally responsive material is placed in the tray and the entire tray with liner is submerged in hot water so the liner softens. Such thermally responsive material can be any thermally responsible material known in the art. When placed in the mouth of the user and the user bites down, the liner then directly forms to and around the user's teeth and gums. This is commonly referred to as the ‘boil-and-bite’ process. When cooled, the liner material is set, retaining an impression of the user's teeth and mouth and allows for subsequent routine placement into the mouth.
In yet another method for forming the preferred modes of the invention, the mouth seal device 10 is fabricated directly in the mouth of the patient using a two part putty that hardens in a short period of time upon mixing of the two parts. A quantity of the putty is prepared and the hardening process is initiated by mixing the two parts together. That mixture is then placed into the impression tray, again in a conventional procedure. The entire form with putty is placed into the mouth of the user, the teeth and tongue positioned appropriately, with the tongue forward to form the cradle, and the assembly allowed to harden. Once the putty has become firm, the entire assembly is removed from the patient's mount and excess material making up the form is removed by processes such as cutting, grinding, or sanding.
In still yet another preferred method, the user selects from a plurality of different shape and sizes of pre-fabricated devices formed either partially or in entirety of thermally responsive material. In this method, the user can proceed with the conventional boil-and-bite technique for retaining an impression of the teeth and mouth. Additionally, for the preferred modes described in
For the current method of construction and for all mode of the device 10, the device 10 in its entirety may be formed of such thermally responsive material as to allow the user to employ the boil-and-bite technique for forming all aspects of the invention including the angle 40. Alternatively, the device 10 may include a predetermined endwall 28 distance yet provide thermally responsive material for the cavities 12, 18 for making teeth impressions but not a tongue impression.
Further, it must be noted that the above outlined methods may be used in conjunction with each other wherein some components of the device 10 are formed employ a technique from one of the above methods while other components of the device 10 are formed employing another. For example, the cavities 12, 18 may be formed via the conventional molding impressions done by a dental practitioner while the endwall 28 and cavity 24 may be formed via the boil-and-bite technique employing thermally responsive material.
While all of the fundamental characteristics and features of the invention have been shown and described herein, with reference to particular embodiments thereof, a latitude of modification, various changes and substitutions are intended in the foregoing disclosure and it will be apparent that in some instances, some features of the invention may be employed without a corresponding use of other features without departing from the scope of the invention as set forth. It should also be understood that various substitutions, modifications, and variations may be made by those skilled in the art without departing from the spirit or scope of the invention. Consequently, all such modifications and variations and substitutions are included within the scope of the invention as defined by the following claims.
This application claims priority to U.S. Provisional Patent Application Ser. No. 61/537,003 filed on Sep. 20, 2011 which is incorporated herein in it's entirety by reference.
