The NightLase laser snoring treatment has been receiving increased media attention in recent months - driving patient interest towards the ‘revolutionary’ snoring treatment. The media has described NightLase as a ‘quick and painless’ fix for snoring - so Laser + Holistic Dental has prepared this article to make sure you understand the full picture before deciding if NightLase is the right treatment for you.

Dr Lisa Matriste, Laser + Holistic Dental founder, was the first dentist in Australia to perform the NightLase treatment. With more than 12 years of professional development and international training in dental sleep medicine, Dr Matriste was attracted to the potential of the NightLase technology to offer a more ‘lifestyle acceptable’ treatment than existing solutions like CPAP machines and Mandibular Advancement Splints. “NightLase is a highly effective way to treat snoring for many patients, but I am concerned that the media is creating unrealistic expectations and inconsistent messages about the treatment”.

After working with the NightLase technology for the last few years Dr Lisa Matriste has refined the NightLase technique to deliver consistently good results for patients that reduces the volume of their snoring, and simultaneously reduces the symptoms and severity of sleep apnoea. Dr Matriste says “NightLase is a relatively new technology in Australia. With the surge in interest surrounding NightLase, there are now many professionals who are treating snoring without doing any dental or medical diagnostics and also without following a consistent protocol.”

If you are not based in Melbourne and cannot get your NightLase treatment with Laser + Holistic Dental it is really important to understand these five things before starting your treatment.

1. Snoring Is Highly Correlated With Obstructive Sleep Apnoea
2. Comprehensive Dental & Medical Diagnostics Are Essential
3. If Your Snoring Is Cured - You May Still Be At Risk Of Apnoea Related Medical Events
4. NightLase Is Not A ‘Quick Fix, instant Miracle Cure’
5. NightLase Treatment Protocols Are Not Equal

Snoring Is Highly Correlated With Obstructive Sleep Apnoea

More often than not - snoring masks serious underlying health conditions like sleep apnoea. Snoring is the partial blockage of the airway which creates the sound, whereas sleep apnoea is a full airway blockage for 10 seconds or longer.. When someone has a sleep apnoea event they are not breathing.

At Laser + Holistic Dental we always do sleep studies before starting NightLase treatment - virtually every single patient has had some degree of sleep apnoea, with many patients regularly stopping breathing several times a minute, and some people even being recorded as holding their breath for 60-90 seconds.

These periods of not breathing trigger a stress response in the body, increasing heart rate and blood pressure as the body struggles to adapt to the rapidly dropping oxygen levels.

Medical research has found that patients with sleep apnoea are:

• More likely to die at about 2x the mortality rate¹
• More likely to suffer from cardiovascular (heart) disease²
• More likely to suffer a fatal stroke³
• More likely to have hypertension (high blood pressure)²
• More likely to have a motor vehicle accident²

If you snore, but do not think you have sleep apnoea - we can confidently say that our clinical experience suggests that you may have a false sense of security. It is critical to have the diagnostic sleep studies performed so we can see if NightLase is the right treatment for you and identify the best course of action for your health.

Comprehensive Dental & Medical Diagnostics Are Essential

Laser + Holistic Dental collaborates with medical specialists like Sleep & Respiratory Physicians and Ear, Nose & Throat Surgeons (ENT) to diagnose and treat you in the best way possible.

Dentists with appropriate training are in an ideal position to identify any anatomical risk factors in the oral cavity that may be contributing to your snoring or sleep apnoea issues. Before starting treatment, our dentists will do an oral examination and take photographic records to see if you are an ideal candidate for NightLase. During this oral examination our dentists can identify factors like an enlarged or long palate or large tongue which are commonly major contributors to snoring and sleep apnoea.

As NightLase works by tightening the tissues in the throat, it may not be as effective for people where the primary cause of their symptoms is a large tongue. If a patient with a large tongue starts NightLase treatment without having this diagnosis, they may spend significant amounts of time and money to receive a poor result without having had that risk explained to them in the first place.

Patients with a long palate are in a similar position. Most clinics recommend three NightLase treatments (with some offering as little as one!) - a patient with a long palate is unlikely to see a significant reduction in snoring and sleep apnoea after so few treatments. It takes time for the soft tissue to shrink. At Laser + Holistic Dental we have seen good results for people with abnormally long palates - it just takes more treatments and more time.

From a medical perspective, a quality sleep study is critical to identify underlying issues like sleep apnoea, heart irregularities, low blood oxygen levels and sleep bruxism. At Laser + Holistic Dental we provide patients with a convenient, comfortable home sleep study kit to avoid the need to go into a hospital for an overnight stay. The results are then analysed by a sleep scientist and a medical specialist to identify areas of concern and recommend a course of treatment.

In most cases we recommend NightLase patients get a Cone Beam Volumetric Tomographic Analysis (CBVT). This is 3D scan done in-house that is used to measure the airway volume, and can also be used to identify nasal and dental pathologies. For patients with obvious nasal issues it is recommended that they consult with an ENT Surgeon as these may be playing a significant role in their snoring and sleep apnoea symptoms.

Once treatment starts, we monitor your progress using the SnoreLab smartphone app to record snoring volume along with other devices to measure your night time blood oxygen levels. When the course of NightLase is completed, the patient will have another home sleep study to give a before and after snapshot that we can directly compare to measure the therapeutic benefits. In some cases we may also recommend another CBVT scan to measure the improvements in airway volume.

At Laser + Holistic Dental this scientific approach to patient care allows us to diagnose problems and manage symptoms to steer us towards a great treatment outcome. These diagnostics provide our clinicians with the ability to directly measure your treatment successes without compromising your health.

If Your Snoring Is Cured - You May Still Be At Risk Of Apnoea Related Medical Events

Whilst snoring is the most common symptom of sleep apnoea, many people have sleep apnoea without snoring. A significant risk of proceeding with a treatment like NightLase without performing due diligence diagnostics is that the snoring volume with be eliminated or greatly reduced, without diagnosing and managing conditions like sleep apnoea.

In our experience, nearly everyone who snores has sleep apnoea. If the snoring has been greatly reduced with a successful NightLase treatment - sleep apnoea can still remain. This is known as “silent apnoea”.

There are a number of obvious risk factors that relate to sleep apnoea - body weight, muscle density in the neck, a blocked nose, or large tongues and palates. It is reasonably common for fit and otherwise healthy people to actually be suffering from sleep apnoea because of one (or a combination) of these things.

In our professional opinion, it is unwise to pursue NightLase treatment without assessing the situation carefully. Initial diagnostics combined with post treatment follow up like the process we conduct at Laser + Holistic Dental are extremely comprehensive and allow our clinicians to confidently advise the patient.

If you are having or have had the NightLase treatment without a sleep study and proper medical diagnostic tests, we strongly recommend that you have a sleep study to ensure no sinister conditions like sleep apnoea are continuing to cause you health problems.

NightLase Is Not A ‘Quick Fix, Miracle Cure’

Despite what some may think - NightLase is not a ‘quick fix’ or a ‘miracle cure’. NightLase is a process - usually taking several months. It is unrealistic to expect significant improvements after one or even two sessions.

The reason that NightLase takes time is simply because collagen takes time to regenerate. The collagen in the soft tissue regenerates and tightens up after being exposed to the laser energy - which is what makes the NightLase treatment work. For a short course of NightLase the effect will probably take more than three months and for an average course this would take six to seven months.

Like all parts of the body, collagen degrades over time as cells die off and then regenerate. Over time, the tightened collagen from the NightLase treatment will also break down - which is why an annual ‘top-up’ laser session is recommended to maintain the best outcome possible. At Laser + Holistic Dental, the annual ‘top-up’ NightLase session is included at no charge as part of our treatment packages.

For a patient who does want an instant cure to their snoring, a Mandibular Advancement Splint (MAS) is likely to bring a more immediate result than NightLase. These splints work by holding the jaw forward, widening the airway space and stopping the tongue from falling back into the throat. The splints are less attractive for most patients from a ‘lifestyle’ and convenience perspective but they can have an immediate result with stopping snoring.

In some cases our patients have chosen to pursue multiple treatment options such as the combination of a splint and NightLase. For those who are not coping with CPAP or have severe sleep apnoea and perhaps a large tongue - the combination approach has seen a greater overall reduction in snoring and sleep apnoea symptoms.

If you want to stop snoring tonight, sorry to tell you but NightLase simply cannot achieve that. Perhaps try a splint instead. However, if you would prefer to invest your time into your treatment to avoid having to wear a splint whilst sleeping - NightLase could be the best option for you.

All NightLase Treatment Protocols Are Not Equal

NightLase is a fairly new technology, especially to Australia. Like anything new, there a group of professionals with a broad experience base who are leading the technology. To date, there are very few officially trained NightLase practitioners in Australia who have invested in international training from Fotona. Even between these trained NightLase practitioners - the diagnostic and treatment protocols can vary which may contribute to a inconsistency in patient outcomes.

Based on our extensive experience offering NightLase - consider the following when choosing a practitioner:

• Less than three NightLase treatments will provide no significant benefit.
• Sleep study diagnostics are essential, as is ongoing monitoring.
• An oral examination and X-ray imaging is critical to evaluate any anatomical causes for the snoring or sleep apnoea - without this you may be wasting time and money on NightLase.
• Co-operation between medical specialists is recommended to manage any sleep apnoea symptoms.
• Using suction reduces saliva build up and allows the laser energy to stimulate the tissues properly.

To help you choose an experienced clinician that should guide you towards a positive treatment outcome, ask the clinics these questions:

• How many laser shots are done per NightLase treatment?
• Is the treatment done sitting or lying down?
• Is there oral suction tubing used to suck up saliva during the treatment?
• What sort of diagnostics - before and after treatment does your clinic do?
• Will a trained dentist perform an oral examination on me?
• Has the practitioner undergone official NightLase training from Fotona?

We hope this article has helped you understand how to find the best treatment option. If you still have any further questions - please contact us now.

References

1. Obstructive Sleep Apnea as a Risk Factor for Stroke and Death
2. Epidemiology of obstructive sleep apnea - A population health perspective
3. Investigating the relationship between stroke and obstructive sleep apnea