+ Q.1 What are some signs that I may not be sleeping well?
Night after night of improper sleep and breathing takes its toll on our quality of life and may include the following:
• Always being tired, no energy
• Feeling of depression
• Easily irritated
• Falling asleep at inappropriate times
• Difficulty concentrating
• Wake up with headache
• Others are frustrated
• Decreased sex drive
Unfortunately, snoring and obstructive sleep apnea doesn't only affect the person with the problem. Anyone who has slept with a person who snores knows it can disrupt his or her sleep as well. This second hand snoring can cause the bed partner to suffer the same daytime sleepiness problems that their snoring partne experiences which may lead to marital discord and adverse health consequences.
+ Q.2 Is Snoring Dangerous?
Snoring, a sign of Obstructive Sleep Apnea (OSA) can kill you according to a UCLA School of Dentistry study: the struggle for breath can result in soaring blood pressure, which can damage the walls of the carotid arteries and increase your risk of stroke.
+ Q.3 What is Obstructive Sleep Apnea
Obstructive Sleep Apnea is a sleep disorder with serious medical consequences.
Obstructive Sleep Apnea (OSA) occurs when the tongue and soft palate collapse onto the back of the throat, blocking air flow into the lungs. Lacking oxygen, the brain awakens the sleeping person to breathe (up to 300 times / night), depriving the person of essential REM sleep and causing a list of problems associated with the chronic lack of sleep.
Symptoms of Obstructive Sleep Apnea are:
Loss of energy
Anxiety and depression
Untreated, chronic sleep apnea can cause:
High blood pressure
Moreover, sleep apnea may be responsible for impaired job performance and motor vehicle accidents. Fortunately, sleep apnea can be diagnosed and treated.
+ Q.4 How severe is my OSA?
The degree of OSA is based on your AHI (Apnea Hyponea Index). The AHI is determined during your over night sleep study, a polysomnography or PSG. An apnea event is described as lack of breathing for at least 10 seconds. Hyponea is "shallow breathing" that leads to a reduction in oronasal airflow of greater than 50% for at least 10 seconds. The total number of apnea and hyponea events that occurred during your PSG are added together and divided by the total amount of time slept to provide an "index" number.
+ Q.5 Why is it important that sleep apnea be treated?
There are two reasons to treat snoring and apnea. The first is to improve your quality of life. Apnea and snoring can result in altered sleep patterns; and as we know, sleep is very important to the healing process and our ability to perform normally throughout the day. Snoring, of course, can be a nuisance to a bed partner as well.
The second reason is the relationship of apnea to serious medical consequences. Untreated sleep apnea can cause or worsen the following:
• High blood pressure and other cardiovascular disease
• Risk for heart attack
• Risk for stroke
• Pulmonary hypertension
• Weight gain
• Migraine headaches
• Morning headaches
• Hyperactivity in children
• Impotency and sexual dysfunction
• Depression and anxiety
• Mood swings
• Job impairment
• Marital and other personal relations
• The likelihood of motor vehicle accidents
• Accidents at the workplace
• Acid reflux
• Bruxism (teeth grinding)
• Brain and cognitive changes
+ Q.6 What is Oral Appliance Therapy (OAT)?
An oral appliance is a small device, similar to an orthodontic retainer or an athletic mouthguard. It is worn in the mouth during sleep to prevent the soft throat tissues from collapsing and obstructing the airway. Some appliances hold the lower jaw forward during sleep while others have direct effect on tongue position. Oral appliances relieve snoring and may treat OSA by realigning the jaw and/or tongue in relation to the head. Although oral appliances do not work on everybody, a well-made, well-fitted appliance may reduce or eliminate snoring, and may significantly relieve symptoms of OSA.
+ Q.7 What does Oral Appliance Therapy consist of?
Fabricating an oral appliance is comfortable and non-invasive. We will make several measurements of your jaws including making molds of both the upper and lower jaw. Two diagnostic radiographs (x-rays) will be taken to make certain your teeth are healthy to provide support for an oral appliance and to determine jaw structure. Treatment progression and outcome will be monitored with a home sleep testing unit.
+ Q.8 What is the role of my physician in this treatment?
Obstructive sleep apnea is a serious medical disease. It can only be diagnosed by your physician after having an overnight sleep study. We will work with your physician and keep him or her informed regarding our progress.
+ Q.9 How do oral appliances help me to stop snoring?
The oral appliance moves the lower jaw forward. This moves the tongue and other stuctures forward, and keeps the airway open when your muscles in the throat relax while sleeping.
+ Q.10 Do oral appliances really work?
According to the literature, Oral Appliance Therapy (OAT) is 84.0% effective in treatment of non-severe Obstructive Sleep Apnea cases and 69.2% effective for severe cases. (Hoekema A. Oral-Appliance Therapy In Obstructive Sleep Apnea-Hypopnea Syndrome. A clinical study on therapeutic outcomes. 2008. ISBN 90-367-2925-4)
The American Academy of Sleep Medicine published the "Practice Parameters for the Treatment of Snoring and Obstructive Sleep Apnea with Oral Appliances" in 2006. "Oral appliances (OA) are indicated for use in pateints with mild to moderate Obstructive Sleep Apnea (OSA) who prefer them to continuous positive airway pressure (CPAP) therapy, or who do not respond to, are not appropriate candidates for, or who fail treatment attempts with CPAP. Until there is higher quality evidence to suggest efficacy, CPAP is indicated whenever possible for patients with severe OSA before considering OA's."
+ Q.11 How do I know if an oral appliance will work for me?
A.11: After a comprehensive examination and review of your sleep study it will be determined if you are a candidate for an oral appliance. Once it is custom made for your mouth, it will be slowly adjusted to maximize its capabilities. Success may come instantly with results obvious in as little as one night. In some cases it may take several adjustments to reach a healthy outcome. No medical treatment including CPAP, surgery, or oral appliance therapy can guarantee that your apnea will be eliminated. The only way to treat apnea is to try one of the these treatments. True success of any of these treatments can only be measured with a follow up Sleep Study. In the case of oral appliance threrapy the follow up sleep study is done while wearing the appliance. Although patients may feel better and are quiet at night with their oral appliance, it is only possible to measure the success with the sleep study.
+ Q.12 Should I try a non-custom appliance that I’ve seen on TV first?
The mass produced appliances you can receive through the mail are ‘fixed’ appliances. They are not adjustable. These generic, fixed appliances are more likely to be uncomfortable and to create side effects of joint and muscle pain. While it MAY resolve snoring, the critical jaw position and bite relationship cannot be determined without a full examination. Additionally, research has shown a low compliance rate with fixed appliances in comparison to adjustable appliances.
And comfort is not the only concern. The major function of these “boil and bite” appliances is strictly the resolution of snoring. This may give you a false sense of security because the reduction or resolution of snoring does not guarantee that apneic events have stopped. This can create what is termed a “silent apneic,” which still results in inadequate oxygen intake and can be extremely dangerous to your overall health.
+ Q.13 Which appliance should I have?
There are several appliance choices. One of the purposes of the first visit is to decide which is the best for you. We have samples of the appliances so you can see how they work. You may also visit the oral appliances page ((link to oral appliances page)) for more information.
+ Q.14 Are Oral Appliances Covered by Insurance?
A.14: Oral Appliances are often covered in full or in part by MEDICAL insurance. Depending on many factors such as the severity of your apnea and specific policy limitations, coverage may vary. A knowledgeable office will help you to maximize your medical benefits. It is important that all proper documentation ( including our complete oral exam & evaluation and recommendation) is obtained and sent to your insurance company. Simply calling them and asking if you are coverd may lead to an inaccurate answer and prevent you from obtaining treatment. We recommend that you leave it up to the practice to guide you through this process.
+ Q.15 How long will it take to get the appliance?
If at your first visit a decision is made to proceed with oral appliance therapy, impressions may be immediately taken and the appliance insertion visit can be scheduled. Usually that appointment can be scheduled two weeks from the initial visit.
+ Q.16 Is it hard to adjust to sleeping with an appliance in your mouth?
A.16: Most patients find the appliances very comfortable. Because the appliances are custom made using molds of your teeth, they fit precisely and are easy to get used to. A very small percentage of patients need a couple of weeks or more to get used to the appliances. Patients who cannot sleep using CPAP adjust easily to a dental appliance
+ Q.17 How can we be sure the appliance is effective once I have been fitted?
A.17: After two weeks of no snoring habit upon wearing the device, we send you home with the home study equipment, to ensure that your sleep apnea is treated effectively. Sometimes, we do find that adjustments are necessary to fully treat the apnea. These adjustments can be completed by yourself in the comfort of your own home or in our office if you prefer. Most of our patients adjust the oral appliance on their own.
+ Q.18 How long does an oral appliance last?
We are telling our patients 3-5 years, although we expect many will last much longer, even up to 10 years. Patients with heavy bruxing (tooth-grinding) activity may wear them out somewhat faster.
+ Q.19 It is difficult to use my CPAP. Can I use an oral appliance instead?
A.19: CPAP is the gold standard for treating sleep apnea but unfortunately many people find that they can't tolerate wearing it. For persons with severe apnea, though CPAP is the treatment of choice, oral appliance therapy can often allow them to reach healthy levels and eliminate there CPAP use or reduce the air pressure on there CPAP machines. For persons with mild to moderate apnea an appliance will in most cases eliminate the need to use there CPAP machine
+ Q.20 Can oral appliances be made for people without teeth?
A.20: The answer is YES. Depending on the type of appliance and the condition of a patient's mouth an oral appliance can be made for people without teeth.
Custom dental appliances for sleep apnea are covered by most medical insurance companies and Medicare.
What causes snoring? At least 30% of adults snore on a regular basis, but that doesn’t mean snoring is normal. Airway blockage is the root cause of all snoring problems. Learn when and why you should be worried about snoring.
Drowsy during the day? Excessive daytime sleepiness, snoring, gasping during sleep, morning headaches, night sweats are signs of obstructive sleep apnea. Learn more about the symptoms of sleep apnea.
How does a custom mouthpiece stop snoring? Tongue retaining devices and mandibular repositioning devices can prevent collapse of the tongue and soft tissues in the throat during sleep. Learn how these dental devices stop snoring.
Why are anti-snoring mouthpieces risky? Mouthpieces can cause tooth movement, TMJ and bruxism. They can also stop snoring without treating sleep apnea. Learn other reasons to see a qualified dentist for oral appliance therapy.